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Case Report
A Case of Congenital Hepatoblastoma Presented with Hepatic Osteodystrophy Complicated by Multiple Bone Fractures
Clin Pediatr Hematol Oncol 2019;26:110-4.
Published online October 31, 2019
© 2019 Korean Society of Pediatric Hematology-Oncology

Yoon Heui So1,2, Dae Sung Kim1, Bo Ae Yoon1, Yoo-Duk Choi3, Hee Jo Baek1,2 and Hoon Kook1,2

1Department of Pediatrics, Chonnam National University Hwasun Hospital, Hwasun,
Departments of 2Pediatrics and 3Pathology, Chonnam National University Medical School, Gwangju, Korea
Correspondence to: Hee Jo Baek
Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hwasun Hospital, 160 Ilsim-ri, Hwasun 519-809, Korea
Tel: +82-61-379-7695
Fax: +82-61-379-7697
Received September 17, 2019; Revised October 8, 2019; Accepted October 14, 2019.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Hepatic osteodystrophy is frequent complication in patients with chronic liver disease, particularly with chronic cholestasis. We report a male infant with congenital hepatoblastoma, who had osteodystrophy complicated by multiple bone fractures despite adequate supplementation of fat-soluble vitamins including vitamin D. He was born by Caesarean section because of a 7 cm–sized abdominal mass detected by prenatal ultrasonography. The pathologic diagnosis was hepatoblastoma, PRETEXT staging III or IV. Whole body bone scan at the time of diagnosis showed no abnormal uptake. Oral vitamin D3 of 2,000 IU/day was administered with other fat-soluble vitamins. Serum direct bilirubin level gradually increased up to 28.9 mg/dL at postnatal 6 days and was above 5 mg/dL until 110 days of age. Bony changes consistent with rickets became apparent in left proximal humerus since 48 days of age, and multiple bone fractures developed thereafter. With resolving cholestasis by chemotherapy, his bony lesions improved gradually after add-on treatment of bisphosphonate and parenteral administration of vitamin D with calcium. High level of suspicion and prevention of osteodystrophy is needed in patients with hepatoblastoma, especially when cholestasis persists.
Keywords: Congenital hepatoblastoma, Fracture, Hepatic osteodystrophy
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October 2019, 26 (2)
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  • Hee Jo Baek