An approach to handling pediatric liver tumors.

Tumors and pseudotumors of the liver account for fewer than 2% of the tumors in children and vary considerably in incidence throughout the pediatric age range, with hepatoblastoma, infantile hemangioendothelioma, and mesenchymal hamartoma seen most frequently in the first 2 years of life and hepatocellular carcinoma, focal nodular hyperplasia, and undifferentiated "embryonal" sarcoma noted in older children. Despite the variety of malignant tumors seen in children and the number of patterns in individual tumors (eg, hepatoblastoma), the most important criterion for long-term prognosis is the stage of the tumor at the time of first resection. Accurate staging by the surgeon and pathologist is therefore the primary objective in examination of malignant hepatic tumors.