Hepatoblastoma with Dr. Greg Tiao
With Dr. Dr. Greg Tiao · Grand Rounds
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Podcast
Hepatoblastoma with Dr. Greg Tiao
10 min · Published Feb 2022
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Hepatoblastoma
54 min · Published Nov 2017
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Hepatoblastoma: Update Course 2014
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Quality of Life Outcomes for Patients Who Underwent Conventional Resection and Liver Transplantation for Locally Advanced Hepatoblastoma
1 min · Published Jan 2026
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Clinical & Research Update: Pediatric Liver Tumors - A Case-Based Discussion with Drs. Katherine Somers & Alex Bondoc
69 min · Published Apr 2026
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What the experts said
Hepatoblastoma is the most common malignant liver tumor in the pediatric population
Treatment strategies for hepatoblastoma have changed dramatically over the past 25 years
There are around 250 new cases of hepatoblastoma per year
Hepatoblastoma is nowhere near the most common liver tumor or the most common abdominal tumor in children
Neuroblastoma is the most common solid malignancy in the pediatric population
Hemangioma is the most common liver lesion in children
Hepatoblastoma can present as an asymptomatic abdominal mass, tumor rupture, or respiratory distress due to tumor size
Hepatoblastoma can present as a paraneoplastic syndrome like precocious puberty
An elevated alpha fetoprotein (AFP) is a key component in the workup and is critical for the diagnostic algorithm and treatment response
Most experts rely on MRI to delineate anatomy and evaluate the extent of liver involvement in hepatoblastoma
Eovist is an MRI contrast agent taken up by hepatocytes and then excreted, providing the best definition when looking at the liver on imaging
To establish a diagnosis of hepatoblastoma, four things are needed: history, abdominal imaging, AFP check, and liver biopsy
The most important intervention for survival is to achieve complete resection
Aggressive resections include trisectionectomy, mesohepatectomy, resection with additional procedure in remnant liver, and liver transplantation
Couinaud labeled liver segments in a counterclockwise fashion by injecting portal vessels, similar to how districts of Paris are labeled
The right hepatic vein differentiates anterior and posterior sections of the right liver
The right portal vein separates superior and inferior segments of the right liver
The pre-text staging system classifies tumors based on the number of contiguous liver sections free of disease (minus four equals pre-text stage)
Pre-text 1 has three contiguous sections free of disease, pre-text 2 has two, pre-text 3 has one, and pre-text 4 has no free sections or diffuse tumor
Pre-text 1 and 2 tumors with greater than 1 cm margin from middle hepatic vein and portal bifurcation should be considered for resection at diagnosis
Pre-text 3 and 4 tumors represent a big game changer in practice that improved survival from less than 30% in the 1970s-80s to 80-90% today
Pre-text 3 tumors should generally be biopsied at diagnosis, started on neoadjuvant chemotherapy, then referred to transplant center or center with expertise in advanced liver resections
Indications for transplant in pre-text 3 or 4 disease include unresectable disease, unsafe resection, or inadequate liver remnant
It is important to consult a transplant center early for pre-text 3 and 4 tumors
The PHITT (Pediatric Hepatic International Tumor Trial) is an ongoing multinational trial to identify high and low risk features for each pre-text stage
The PHITT study has been ongoing for three years