Liver tumors in children of all ages most commonly present as
an asymptomatic mass, although occasionally they are identified incidentally
in patients with other symptoms, such as abdominal pain, nausea and
vomiting, fever, and weight loss. Symptoms may sometimes indicate
tumor rupture. The vast majority of children will have no evidence
of underlying liver disease as jaundice, ascites, and abnormal liver function
tests are usually not observed at presentation. Hepatoblastoma should
be considered in patients with predisposing conditions such as a
history of prematurity, hemihypertrophy, Beckwith-Weidemann syndrome,
or a history of familial colon cancer. Hepatocellular carcinoma
most commonly presents in an asymptomatic patient but sometimes
arises in patients with a history of hepatitis B or C infection, cirrhosis,
or other underlying disorders, such as tyrisonemia, galactosemia,
glycogen storage disease, and –1 antitrypsin deficiency.
Less common malignancies like undifferentiated sarcoma of the liver, rhabdoid tumor
of the liver, and angiosarcoma do not have a pathognomonic presentation.
Malignant involvement of the liver is more common as a metastatic
site of neuroblastoma, Wilms tumor, sarcomas, lymphoma, and leukemia.
Benign tumors may be asymptomatic when diagnosed incidentally
as a palpable mass or may present with nonspecific abdominal complaints.
Hemangiomas and hemangioendotheliomas typically present in infancy
and may present with congestive heart failure or consumptive coagulopathy
as part of the Kassabach-Merritt syndrome. Adenomas may occur in
teenage girls with a history of oral contraceptive use. Mesenchymal
hamartomas and focal nodular hyperplasia are other benign entities
observed in childhood.