[Hepatic involvement in pediatric neoplasms].

The liver is an organ which appears particularly susceptible to undergo a series of toxic effects related to the presence of a neoplastic process and the modalities adopted for its treatment. However, the phenomena of liver toxicity which are encountered at diagnosis and during treatment of pediatric neoplasias, are numerous and of complex nature, quite often of difficult explanation. The authors have distinguished: - primitive benign and malign tumors of the liver; - toxic effects dependent from the neoplastic infiltration of tumors arising in extrahepatic sites; - toxicity not related to neoplastic infiltration. Several cases of different solid neoplasias are described, which exemplify the several modes by which the liver can be affected by tumors, and the possible etiopathogenetic mechanisms are searched for. In addition, the authors refer on the aspects of liver toxicity observed in a series of 44 children affected by acute lymphoblastic leukemia. They distinguish a toxicity which precedes treatment; - a toxicity which arises during the induction-consolidation phase of therapy; - a toxicity which comes out during maintenance with Methotrexate and 6-mercaptopurine, this latter strictly correlated to the continuous administration of these two drugs. Finally, the complicated correlation between acute hepatitis and leukemia is discussed, and the attention is focused particularly on the possible antileukemic affect of the acute liver infection, which is capable to determine, in few well described cases, a complete, although transient disease remission.