The incidence of HCC may be higher for children with vertically transmitted hepatitis B who seroconverted from hepatitis B e-antigen to hepatitis B e-antibody before the age of 3 years.[192] For the majority of adults, HCC is identified in cirrhotic livers; the opposite is true for children, as 60-70% of HCC cases are found in a noncirrhotic liver.[193] HCC is rare and often advanced and inoperable at the time of diagnosis.[194] Screening procedures for HCC are not uniform, but alpha-fetoprotein is typically elevated over 400 ng/dL, often reaching over 1,000 ng/dL.[195, 196] Cure is accomplished only

with complete surgical resection, although chemotherapy may be more effective in children than adults.[193] High recurrence rates in adults fell when LT was restricted to individuals who met the Milan criteria: a single tumor diameter less see more than 5 cm, no more than 3 foci with each one not exceeding 3 cm, and absence of vascular invasion, or extrahepatic involvement.[197] However, Milan criteria may not be applicable in children and recommendations must be individualized.[190, 193, 195, 198] Successful LT outcomes have been achieved even for those children who did not meet the more liberal University of California San Francisco Criteria (single tumor <6.5 cm or maximum of three

tumors with none >4.5 cm and cumulative tumor size <8 cm) or the “up-to-seven” criteria (absence of angioinvasion, number of nodules plus the maximum size of the largest nodule equal or lower than 7).[144] Satisfactory LT outcomes www.selleckchem.com/products/DAPT-GSI-IX.html have been achieved in some children with large, multifocal tumors, with some having microscopic blood vessel invasion or limited local extrahepatic

extension.[186, 190, 193] 44. Prompt referral to a liver transplant center should occur for children with or suspected to have hepatocellular carcinoma. (2-B) 45. As the Milan criteria may not be applicable to children, transplantation for hepatocellular carcinoma must be individualized and should be considered in the absence of radiological evidence of extrahepatic disease or gross vascular invasion, irrespective of size of the 上海皓元医药股份有限公司 lesion or number of lesions. (2-B) 46. Absolute contraindications to transplant include radiological evidence of extrahepatic disease (1-B); relative contraindications to transplant include major venous invasion, or rapid disease progression despite chemotherapy. (2-B) 47. Hepatocellular carcinoma (HCC) is uncommon among children and there are no current data to support general screening for HCC in children; children with bile salt excretory pump disease and tyrosinemia are at higher risk for developing HCC and should undergo periodic screening. (2-B) Infantile hemangioma (IH), the most common pediatric tumor, has three categories: 1) focal lesions, 2) multifocal lesions, and 3) diffuse lesions.[199] All focal and most multifocal lesions are asymptomatic and involute spontaneously.