Hepatic masses in children: a 15-year experience at a single tertiary care center in India

Background: Hepatic masses are rare and challenging to diagnose and manage in pediatric populations; therefore, data on clinical presentation, management strategies, and long-term outcomes are limited. Hence, the aim of the study was to review the incidence, clinical spectrum, management, and outcome of hepatic masses in pediatrics. Methods: This retrospective, cross-sectional study reviewed the medical records of pediatric patients (age <18 years) presenting to a pediatric hepatologist and diagnosed with hepatic masses between 2010 and 2024 at a tertiary care center. Results: Thirty-nine patients were identified with hepatic masses, 21 (53.8%) had benign tumors and 18 (46.2%) had malignant tumors. The median age of patients was 39 months (range: 2–208 months) at presentation, and 19 (48.7%) of them were females. The most common presentation is abdominal distension (n=14, 35.8%), while the less frequent presentations were abdominal pain (n=6, 15.38%), pallor (n=6, 15.38 %) and anorexia (n=4, 10.20%). Hepatic masses were an incidental finding in 5 patients (12.80%). Patients underwent different radiologic investigations including ultrasound imaging (n=15, 38.4%), computed tomography (CT; n=26, 66.6%), magnetic resonance imaging (MRI; n=8, 20.5%), and positron emission tomography (PET; n=11, 28.2%). Histopathology was done preoperatively in 9 (23.07%) patients and post operatively in 17 (43.5%) patients. Most patients underwent surgical resection (n=16, 41%), 5 (12.8%) patients received chemotherapy for malignant tumors, and 5 (12.8%) patients underwent liver transplantation. Surgical complications occurred in 2 (5.1%) patients but were successfully managed. One patient was lost to follow up and no mortality was reported in the remaining patients with long-term follow up. Conclusion: The immediate and long-term clinical outcomes of surgical resection and liver transplantation, with or without chemotherapy, are good without considerable morbidity or mortality. This study contributes valuable real-world data to inform clinical practice and future research in this area.