Primary tumours of the liver in infants and children.

Primary liver tumours occur in infants and children with sufficient frequency to justify careful evaluation of current techniques in diagnosis and management and to review the pathological classification of this group of neoplasms. In the past nine years (1950-1958) 15 such cases have been diagnosed at the Columbus Children's Hospital, all presenting as clinical problems; an analysis of these cases forms the substance of this report. During the same period of time 46 cases of neuroblastoma and 17 cases of embryoma of the kidney (Wilms' tumour) have been treated at this institution. Although the treatment of liver tumours, as judged from a resume of individual case reports in recent years, has been encouraging, the overall results achieved in significant series have been disappointing and have perhaps fostered a generally hopeless outlook for young patients with such lesions (Donovan and Santulli, 1946; Wangensteen, 1951; Lortat-Jacob and Robert, 1952; Quattlebaum, 1953; Brunschwig, 1953; Pack and Baker, 1953; Lorimer, 1955; Clatworthy and Boles, 1956). In the series from Babies' Hospital in New York City analysed by Andersen (1951) there was only one long-term survivor in 12 cases occurring over a 15-year period. This patient remained well over a six-year follow-up period after excision of the left lobe of the liver had been performed for a mesenchymoma. Gross, in a review at the Boston Children's Hospital, reports two apparent cures out of 18 such cases. One of these received radiotherapy for multiple haemangiomas and has been in excellent health for seven years thereafter; the second has been well over a 10-year period after having a wedge resection of a small haemartoma. Safe techniques for the resection of the left lobe of the liver have been available for many years, and