Diagnosis 3 HCC USguided percutaneous needle biopsy Hepatocellular

Diagnosis: 3. HCC • US-guided percutaneous needle biopsy: – Hepatocellular carcinoma • Pediatric HCC – 2 nd most common malignant hepatic tumor (20~33%) after hepatoblastoma (67~80%) – Two distinct subsets of HCC • In the setting of cirrhosis or underlying metabolic, infectious or vascular liver disease • Sporadic HCC without preceding liver disease – Two major risk factors: Tyrosinemia and perinatally acquired HBV infection – Cirrhosis is absent in 26% - 62% of childhood HCC.

Diagnosis: 3. HCC • Iso or high signal intensity HCC seen on Gadoxetic acid-enhanced hepatobiliary phase MR • OATP 8 (OATP 1 B 1/3)- uptake of hepatobiliary contrast agents by hepatocytes • Nodules with preserved or elevated OATP 8 expression – iso or high SI • Usually, HCCs are hypointense form the lack of gadoxetic acid uptake due to down regulation of OATP 8 expression. • The overexpression of OATP 8 in some HCCs may be due to genomic alteration during hepatocarcinogenesis (5~12%) • Most patients have well- or moderately differentiated tumors and a favorable clinical outcome. • Patients with iso- to hyperintense HCCs on hepatobiliary phase tend to have lower levels of a-fetoprotein (AFP) or protein induced by vitamin K absence or antagonist-II (PIVKA-II). • References • World Journal of Gastroenterology 2018; 24(35): 3980 -3999 • Korean J Radiology 2015; 16(3): 449 -464