Hosting 728 files, 2951 images, and 4 contributors.

Random Case

Joseph Junewick, MD FACR
over 10 years ago
Enter A Workflow
Standard2   Academic2

Please choose a workflow. A standard workflow allows you to browse the repository with full case detail; the academic workflow allows you to browse the repository with limited case detail revealed. Double click on the images to launch image viewer.

ARSt Case Repository


Case Detail

Anatomy: Gastrointestinal
Joseph Junewick, MD FACR
Diagnostic Category: Neoplasia Malignant
Created: over 9 years ago
Updated: over 9 years ago
Tags: PEDS
Modality/Study Types: CT US
Adobe32 PDF Imagej32 ImageJA


2 year old male with hepatomegaly but otherwise healthy.

Case Images




US – Heterogeneous predominantly hyperechoic infiltrative hepatic mass.

CT – Axial and coronal reformated images demonstrate macrolobulated heterogeneous mass nearly replacing the entire liver.


Hepatoblastoma is the most common primary hepatic neoplasm in childhood. Patients usually present with abdominal mass; less commonly with anorexia, weight loss, anemia, hemihypertrophy, or isosexual precosity. There is a higher incidence of hepatoblastoma in patients with Beckwith-Wiedemann syndrome and familial polyposis. The median age of onset is one year with most cases occurring before 5 years. Hepatoblastoma occurs more frequently in Caucasians and males.

The malignant component is comprised of either fetal or embryonal epithelial cells, but can also demonstrate a malignant mesenchymal component. Pure fetal histology is associated with a better prognosis. Lesions are usually large, homogeneous, well-circumscribed and unifocal. Serum alpha-fetoprotein is elevated in about 80% of patients; patients with low or normal alpha-fetoprotein levels are associated with a poor prognosis. Alpha-fetoprotein is used to assess response to treatment and often heralds recurrent or metastatic disease.

Approximately 40% of patients have advanced disease at the time of presentation. Metastatic disease most often affects the lungs. Regional lymph node metastasis to the porta hepatis and invasion of the portal vein also occur. Osseous metastasis is unusual.


Junewick JJ and Shreve P. PET-CT in Pediatric Malignancies in Clinical PET-CT in Radiology, Springer (2011).

Corporate Office: 616.363.7272, 3264 North Evergreen Drive, Grand Rapids, MI 49525

Spectrum Health Helen Devos Childrens Hospital GE HealthCare