Histopathology and Clinicoradiology of Hepatoblastoma-Survival Analysis of an Intriguing Not So Rare Tumor

Background: The incidence of hepatoblastoma is increasing in recent years. Knowledge about various factors associated with improved survival of such patients may aid in early diagnosis and appropriate management of these cases. Aims and Objectives: 1) To analyse the clinicoradiological and histopathological features of hepatoblastoma diagnosed in a tertiary care centre 2) To estimate the survival with relation to various prognostic factors recently identified in the latest WHO classification in Indian context. Materials and Methods: A total of 41 cases of hepatoblastoma diagnosed over a five year period from 2018-2022 were examined by two pathologists independently. Kaplan meier analyses was done to determine survival. Results: The age range was 5 months-12 years. The male: female ratio was 1.6:1. The AFP levels were >65000 ng /ml in 92 % cases. The masses ranged from 5-14 cm in size with 10 cases having multifocal lesions and 5 cases having lung metastases at presentation. The overall survival was 75.26 %. In common with other studies, survival was better in children <2 years, AFP>100 ng/ml, female sex and those without lung metastases. In contrast to studies done worldwide, the survival with PRETEXT stage I was only 5 months (CI 2.861-8.319) despite the most common fetal subtype in this group (p<0.05). Conclusion: There is no relationship between survival and the histological subtype. Despite having fetal pattern, patients in PRETEXT stage I had a worse survival rate, which shows that the biopsy may not be representative of the entire tumor. Keywords: Hepatoblastoma, Clinicoradiology, Histopathology, Survival