What percentage of pediatric liver tumors are malignant?

1.   ?    10 percent
2.   ?    25 percent
3.   ?    50 percent
4.   ?    70 percent

More than 90% of BENGIN pediatric liver tumors occur before what age?

1.   ?    1st 6 months of life
2.   ?    1st year of life
3.   ?    1st 2 years of life
4.   ?    1st 5 years of life

What is most common benign liver tumor in children?

1.   ?    Mesenchymal hamartoma
2.   ?    Hemangioma
3.   ?    Hemangioendothelioma
4.   ?    Hepatic adenoma

An isolated cavernous liver hemangioma is (rarely or commonly) associated with hemangiomas in other parts of the body?

1.   ?    Rarely
2.   ?    Commonly

What is the treatment of solitary, asymptomatic liver hemangioma in a child (usually it is seen in older children)?

1.   ?    Observaton
2.   ?    Embolism
3.   ?    Resection
4.   ?    Steroids

Which is NOT part of the triad of infantile hemangioendothelioma (also known as hemangiomatosis)?

1.   ?    Hepatomegaly
2.   ?    Cutaneous hemangiomas
3.   ?    Splenomegaly
4.   ?    Heart failure from arteriovenous shunts

What does the dynamic CT scan NOT show in infantile hemangioendothelioma?

1.   ?    Prompt filling
2.   ?    Multiple heterogenous areas of increased vascularity
3.   ?    Stippled calcification
4.   ?    Rapid venous phase secondary to the shunt

What is the treatment of asymptomatic infantile hemangioendothelioma?

1.   ?    Observaton
2.   ?    Embolism
3.   ?    Resection
4.   ?    Steroids

What is mortality of extensive liver hemangiomatosis?

1.   ?    Under 10 percent
2.   ?    20 - 30 percent
3.   ?    50 - 60 percent
4.   ?    75 - 80 percent

Mesenchymal hamartomas almost always involve the RIGHT lobe of the liver; and almost all present during the first ____ of life?

1.   ?    6 months
2.   ?    1 year
3.   ?    2 years
4.   ?    5 years

Which statement regarding the workup of mesenchymal hamartomas is NOT true?

1.   ?    US shows mixed cystic and solid lesion
2.   ?    Lesion is usually in the right lobe
3.   ?    Technetium 99 scan shows reduced uptake in mass
4.   ?    AFP is elevated

Wht is the treatment of isolated mesenchymal hamartoma?

1.   ?    Observaton
2.   ?    Embolism
3.   ?    Resection
4.   ?    Steroids

Hepatic adenoma is rare prior to adolescence, but is increased in incidence in all groups EXCEPT?

1.   ?    Von Giercke's disease = type 1 glycogen storage disease
2.   ?    BCPill users
3.   ?    Von Recklinghausen's disease

What happens to alpha-fetoprotein in hepatic adenoma?

1.   ?    Normal
2.   ?    Decreased
3.   ?    Elevated

T or F: It is fairly easy to distinguish hepatic adenoma from hepatocellular carcinoma?

1.   ?    True
2.   ?    False

What is the treatment of hepatic adenoma?

1.   ?    Enucleation
2.   ?    Resection of lobe
3.   ?    Steroids
4.   ?    Observation

85 percent of focal nodular hyperplasia occurs in patient of what age?

1.   ?    Less than 2 years
2.   ?    Less than 5 years
3.   ?    More than 10 years
4.   ?    More than 15 years

Which is NOT seen in patients with focal nodular hyperplasia?

1.   ?    Tumor uptake with Liver scans
2.   ?    Hypervascular lesions on angiography
3.   ?    Venous pooling on the emptying phase

What is the surgical management of focal nodular hyperplasia?

1.   ?    Enucleation
2.   ?    Resection of lobe
3.   ?    Steroids
4.   ?    Observation

T or F: Teratomas of the liver are usually benign?

1.   ?    True
2.   ?    False

More than what percentage of patients with polycystic liver disease have polycystic kidney disease as well?

1.   ?    10 percent
2.   ?    30 percent
3.   ?    50 percent
4.   ?    75 percent

T or F: Even small asymptomatic benign liver cysts should be excised?

1.   ?    True
2.   ?    False

What fraction of hepatoblastomas occurs before the age of 24 months?

1.   ?    10 percent
2.   ?    33 percent
3.   ?    66 percent
4.   ?    90 percent

What factors are associated with an increased incidence of hepatoblastoma?

1.   ?    Beckwith-Weidemann and hemihpertrophy
2.   ?    Fanconi's anemia
3.   ?    Cirrhosis
4.   ?    Type 1 glycogen storage disease
5.   ?    All

What factors are associated with an increased incidence of hepatoblastoma?

1.   ?    11p and 5q abnormalities
2.   ?    Beckwith-Weidemann and hemihpertrophy
3.   ?    Fetal alcohol syndrome
4.   ?    Tyrosinemia
5.   ?    TPN cholestasis
6.   ?    All

What viral infection is hepatocellular carcinoma associated with?

1.   ?    Epstein-Barr virus
2.   ?    Hepatitis A
3.   ?    Hepatitis B
4.   ?    Cytomegalovirus

T or F: Both hepatoblastoma and hepatocellular carcinoma are what type of malignancies?

1.   ?    Epithelial
2.   ?    Mesenchymal
3.   ?    Kuppfer cell
4.   ?    APUD cell

Which variant of hepatocellular carcinoma has a better prognosis?

1.   ?    Fibrolamellar
2.   ?    Embryonal
3.   ?    Fetal

Which subclass of hepatocellular carcinoma has the best prognosis?

1.   ?    Fetal
2.   ?    Embryonal
3.   ?    Mixed epithelial and mesenchymal (spindle cells)
4.   ?    Anaplastic (sheets of cells)

The most common symptom of a malignant liver tumor is what?

1.   ?    Mass which moves with respiration
2.   ?    FUO
3.   ?    Anorexia and weight loss
4.   ?    Jaundice

A few cases of hepatoblastoma present with precocious puberty in boys (virilization); this is due to what?

1.   ?    Tumor limiting estrogen production
2.   ?    Tumor producing HcG
3.   ?    Tumor production of 5 alpha reductase

True or false: serum bilirubin is usually normal in hepatoblastoma; the SGOT, alkaline phosphatase are slightly increased, and the alpha-fetoprotein is increased in 90 percent.

1.   ?    True
2.   ?    False

T or F: The serum ferritin is increased in 97% of patients with cirrhosis?

1.   ?    True
2.   ?    False

Both alpha-fetoprotein and ferritin can be used as tumor markers-true or false?

1.   ?    True
2.   ?    False

True or false: hepatocellular carcinoma rarely has calcifications on plain x-rays or CT scans, and the tumor is usually multicentric?

1.   ?    True
2.   ?    False

What metastatic studies are NOT part of the evaluation for hepatocellular carcinoma or hepatoblastoma?

1.   ?    Bone scan
2.   ?    Bone Marrow
3.   ?    Gallium scintigraphy

What is a Stage 2 hepatoblastoma?

1.   ?    Microscopic residual disease
2.   ?    Gross residual disease
3.   ?    Ipsilateral nodal involvement
4.   ?    Complete resection, tumor less than 5 cm

What percent of hepatoblastoma is initially amenable to complete resection?

1.   ?    25 percent
2.   ?    40 percent
3.   ?    60 percent
4.   ?    80 percent

True or false: with no distant spread, an acceptable surgical option for liver cancer in children is lobectomy and excision of between 1 and 3 isolated multicentric nodules from the opposite lobe?

1.   ?    True
2.   ?    False

In patients with a left lateral hepatic segmentectomy, which hepatic vein(s) is/are divided?

1.   ?    Left and middle vein
2.   ?    Right and middle vein
3.   ?    Left vein only
4.   ?    Right vein only

Which is NOT one of the most common metabolic problems are encountered after major liver resection?

1.   ?    Hypoalbuminemia
2.   ?    Coagulopathy
3.   ?    Hyperglycemia
4.   ?    Hypoprothrombinemia

Hepatic regeneration occurs quickly and may be complete by what time?

1.   ?    4th postoperative day
2.   ?    3rd postoperative week
3.   ?    2nd postoperative month

Which is not a bad prognostic indicator for hepatoblastoma?

1.   ?    Embryonal histology
2.   ?    Multifocal disease
3.   ?    Diploidy
4.   ?    AFP more than 1 million

What percentage of hepatoblastoma patients have completely resectable tumors?

1.   ?    10 Percent
2.   ?    25 Percent
3.   ?    50 Percent
4.   ?    75 Percent

T or F: Overall survival for hepatoblastoma versus hepatocellular carcinoma is 50 ­ 70% vs. 15% ?

1.   ?    True
2.   ?    False

What DNA type of hepatoblastoma has a worse prognosis?

1.   ?    Diploid
2.   ?    Aneuploid
3.   ?    Pleuiody has no effect on outcome

What is the overall survival after liver transplantation for hepatoblastoma?

1.   ?    10 percent
2.   ?    25 percent
3.   ?    50 percent
4.   ?    75 percent