Successful Surgical Removal of a Hepatoma.

EDITORIAL SYNOPSIS A case of hepatoma in a girl of 15 without pre-existing liver disease is reported. The growth was removed by partial hepatectomy, and, histologically, it had a low degree of malignancy. In patients with such tumours there may be a sudden and unheralded decline in general health, emphasizing the need for early diagnosis and expeditious surgical treatment. Primary tumours of the liver are sufficiently rare in the white-skinned races to excite interest, and Cruickshank (1961) estimates their necropsy incidence at 01450% in Great Britain, which corresponds well with that found for Europe as a whole by Berman (1951). Hepatomas, defined as tumours arising from liver parenchyma, are three times commoner in the male, are rarely encountered before the third decade, and predominate in the sixth decade of life. Among the malignant tumours of infancy the disease is relatively common, taking third place after neuro-blastomata and renal embryomata (Clatworthy, Boles, and Newton, 1960). It is generally recognized that in Great Britain the majority of hepatomas arise in livers already rendered abnormal, especially by cirrhosis (Parker, 1957) or haemochromatosis (Stewart, 1931). These tumours are almost invariably malignant and curative treatment is seldom possible. They have a low sensitivity to irradiation with x rays or radioisotopes taken up by the liver, such as 32p in the form of chromic phosphate or radioactive gold; their frequent multiplicity throughout the liver often precludes surgical removal. However, surgical extirpation of a hepatoma has been reported by Rosenberg and Ochsner (1948) and subsequently by Although these tumours were either pedunculated or confined to the left lobe of the liver, in the case described by Otaki and his colleagues a right hemi-hepatectomy was successfully performed. The case described in this report is of interest in that a hepatoma occurred in a girl without pre-existing liver disease; it was of low malignancy and was successfully removed. A girl, aged 15 (hospital no. 178864), was admitted to Ronkswood Hospital, Worcester, on 2 May 1962. She had been the subject of jocular comment for the past three months because of the increasing girth of the upper abdomen. Seen in the OutPatient Department on 16 April she admitted no ill-health and presented as a cheerful, healthy, plump girl. The skin was free from blemishes but the upper abdomen was protruding. A firm, grossly nodular tumour, moving with respiration, filled the epigastrium. On 17 April a blood count showed haemoglobin 12 …