Spontaneous Rupture of Hepatoblastoma in a Neonate

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  • 新生児破裂肝芽腫の1例
  • 症例報告 新生児破裂肝芽腫の1例
  • ショウレイ ホウコク シンセイジ ハレツ カン ガ シュ ノ 1レイ

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Abstract

Hepatoblastoma is the most common liver tumor among children. It usually presents with abdominal swelling and abdominal mass. We report an unusual neonate who presented with an acute abdominal crisis due to rupture of the liver tumor. A male neonate after vaginal delivery was admitted to our NICU because of abdominal distention. His gestational age was 37 weeks and 5 days and birth weight was 2,250g. Physical examination at the time of admission confirmed the presence of an abdominal mass extending to the level of the pubic bone. His blood pressure was 59/30 mmHg and his pulse was 150/min, and the hemoglobin level was 9.9g/dl. Ultrasonography of the abdomen detected an abdominal tumor with intra-tumor hemorrhage and a small amount of ascites. The serum alfa-fetoprotein level was markedly elevated to 1,147,000ng/ml. Computed tomography (CT) scan showed a huge tumor arising from the left lobe of liver and expanding extra-hepatically. Early left lateral segmentectomy was planned. However 3 days before the scheduled segmentectomy, hypovolemic shock developed. Emergent laparotomy was applied to left lateral segmentectomy. Four hundred milliliters of blood was aspirated from abdominal cavity. The rupture site of the hepatoblastoma was found to be on the posterior side of the tumor. Histological diagnosis was hepatoblastoma of the embryonal type. The postoperative clinical course was favorable. Multidrug chemotherapy using cis-platin was initiated on the 28^<th> postoperative day. After six cycles of treatment, the patient is now 1 year and 7 months old and is healthy and free from disease.

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