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Pediatrics Education and Research

Volume  5, Issue 2, May-Aug 2017, Pages 97-100

 

Case Report

Dual Paraneoplastic Syndromes in a Case of Pediatric Hepatoblastoma: A Rare and Challenging Case
Ankit Ranjan*, Smilu Mohanlal**, Alpana Kondekar***, Purvi Kadakia****, Radha Ghildiyal*****, Surabhi Wattal******
*Resident (Third year) **Specialty Medical Officer ***Associate Professor ****Assistant Professor *****Professor ******Resident (Second year), Department of Pediatrics, TN Medical College and BYL Nair Hospital, Mumbai Central, Mumbai 400008, India.
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DOI: https://dx.doi.org/10.21088/per.2321.1644.5217.18

Abstract

Hepatic malignant neoplasms comprise the third most common cause of intraabdominal malignancies. Apart from the constellation of clinical findings associated with malignancies; liver malignancies have also been associated with perilous paraneoplastic syndromes. This report is about a 10 years old boy presenting with abdominal distension since 1 month with firm massive hepatosplenomegaly. Investigations revealed deranged liver enzymes with HBsAg positive status. CT abdomen was suggestive of heterogenous hepatic lesions. Serum alphafetoprotein level came as >90000 ng/ml. Liver biopsy revealed the diagnosis of Hepatoblastoma. Patient subsequently developed paraneoplastic symptoms in the form of hypertensive urgencies and resistant hypoglycaemic episodes manifesting as seizures requiring Nitroprusside drip ultimately and Glucose infusion Rate as high as 12mg /Kg/minute. On PRETEXT staging the tumour was classified as Stage 4 which is the nonresectable variety. The child was started on Cisplatin and Doxorubicin. However, he deteriorated, proceeding to liver failure with deranged liver function tests, raised PT/INR and active bleeding. The parents took a discharge against medical advicedue to financial constraints. As hepatoblastoma is extremely rare in this age group with the disease predominantly presenting as Paraneoplastic syndromes,Doctors should be ready for uncommon and rare possibilities.

Keywords: Abdominal Lump; Hepatoblastoma; Hypertension; Hypoglycemia.


Corresponding Author : Ankit Ranjan, Department of Pediatrics, 1st Floor, College Building, TN Medical College and BYL Nair Charitable Hospital, Dr. AL Nair Road, Mumbai Central, Mumbai400008.