A case report of a child with a malignant rhabdoid kidney tumor complicated with radiation-induced liver injury and literature review

The author reported a 12-month-old female child with stage Ⅱ malignant rhabdoid tumor of the right kidney. The tumor bed received radiotherapy after radical resection of the right kidney tumor. The cumulative dose of irradiation was 19.5 Gy/13 Tx. Anorexia, diarrhea and liver function injury occurred 2 months after treatment. The child's liver function was impaired with A Child-Pugh score of 5, grade A, and abdominal CT showed abnormal density, uneven, and clear boundaries in the left lobe of the liver. After surgical resection of the left lobe of the liver, histopathological examination revealed hepatic venous sinus damage and balloon degeneration of hepatocytes, and no tumor cells were found, which was diagnosed as classic radiation-induced liver disease (RILD). The trearment team used drugs to protect RILD and continued to complete chemotherapy, and both liver function and abdominal CT improved after 2 months. Up to 36 months of follow-up, there was no disease survival. Through the case analysis and literature review, the classic clinical features of RILD in children were shared. The scope of liver lesions on imaging was consistent with irradiation range, showing changes like a knife cut, and the histopathological findings were mainly hepatic venous occlusion. RILD in children can be recovered clinically after liver protection treatment.