Liver
Other Toxicity
Less commonly reported hepato-biliary complications include:
- Cholelithiasis
- Focal nodular hyperplasia (FNH)
- Nodular regenerative hyperplasia (NRH)
- Microvesicular fatty change
Higher risk of biliary calculi in survivors of childhood cancer compared to the general population.
Cumulative risk of cholelithiasis was 0.42% at 10 years and 1.03% at 18 years after diagnosis.
Treatment factors associated with cholelithiasis include:
- Ileal conduit
- Parenteral nutrition
- Abdominal surgery
- Abdominal radiation therapy (RT)
- HSCT
Focal nodular hyperplasia (FNH):
Often an incidental finding on imaging in childhood cancer survivors, with no specific therapeutic association
The pathogenesis of FNH is poorly understood - possibly arises as a reaction to a localized vascular anomaly or from thrombosis, intimal hyperplasia, high sinusoidal pressures, or increased flow. High doses of alkylating agents, history of VOD/SOS, or hepatic RT may produce vascular injury and subsequent localized circulatory disturbances.
MR scanning is used to identify FNH.
There is no risk of malignant transformation.
Nodular regenerative hyperplasia (NRH)
NRH is a rare condition where there are multiple monoacinar regenerative hepatic nodules and mild fibrosis.
The pathogenesis is not well established, but may represent a nonspecific tissue adaptation to heterogeneous hepatic blood flow.
Biopsy may be necessary to distinguish NRH from a second malignancy.
In a study of patients who recently completed intensified therapy for acute lymphoblastic leukemia, histological evidence of fatty infiltration of the liver was found in 93% of patients.
Fibrosis developed in 11% and was associated with higher serum LDL-cholesterol.
Prospective studies are needed to define whether acute post-therapy fatty liver change contributes to the development of steatohepatitis or the metabolic syndrome in this population.
