Differential Diagnosis for an 8-year-old Child with Liver Tumor, High Liver Values, Low Leukocytes, and High Thrombocytes

• Single most likely diagnosis:
  • Hepatoblastoma: This is the most common primary liver cancer in children, often presenting with a liver mass and elevated liver enzymes. The age of the child and the presence of a liver tumor on CT scan make hepatoblastoma a strong consideration.
• Other Likely diagnoses:
  • Hepatic adenoma: Although less common in children, hepatic adenomas can present with elevated liver enzymes and a liver mass. The high thrombocyte count could be related to the tumor's effect on the liver's ability to regulate blood cell production.
  • Focal nodular hyperplasia (FNH): FNH is a benign tumor of the liver that can cause elevated liver enzymes and present as a mass on imaging. It is more common in females and can have a variable presentation.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
  • Metastatic neuroblastoma: Neuroblastoma is a common extracranial solid tumor in children, and it can metastasize to the liver. Although less likely than hepatoblastoma, missing this diagnosis could have severe consequences due to the aggressive nature of neuroblastoma.
  • Hepatic lymphoma: Primary hepatic lymphoma is rare but can present with a liver mass and abnormal liver function tests. It requires prompt diagnosis and treatment due to its potential for rapid progression.
• Rare diagnoses:
  • Mesenchymal hamartoma: A rare, benign liver tumor that can present in childhood with a liver mass and elevated liver enzymes.
  • Inflammatory myofibroblastic tumor (IMT): A rare tumor that can occur in the liver and present with a mass and systemic symptoms, including abnormal liver function tests.
  • Biliary rhabdomyosarcoma: A rare, malignant tumor of the biliary tract that can present with a liver mass and jaundice, although it is more commonly associated with the biliary tree rather than the liver parenchyma itself.