HCAs are quite rare in children in whom they account for 2% to 4% of all hepatic tumors. Sex hormone imbalance, for instance usage of anabolic/androgenic steroids in the treatment of chronic anemia or hypogonadism is the most common association of HCA in children [3
]. Associated metabolic disorders include glycogen storage disease (most commonly type Ia) familial diabetes mellitus and Hurlerís disease [3
An association between Fanconiís anemia and hepatocellular neoplasm was first reported in 1965 as an incidental autopsy finding in a patient with advanced postnecrotic cirrhosis who had received testosterone therapy. In 1971, Bernstein et al.  described hepato- cellular carcinoma complicating oxymetholone therapy of Fanconi\'s anemia in a non-cirrhotic patient. Both estrogens and androgens are capable of tumor progression as promoters of hepatic neoplasm, and in Fanconiís anemia, chromosome instability may serve as the substrate for enhanced oncogenesis .
The distinction between adenoma and carcinoma in patients with Fanconiís anemia is difficult to draw, since tumor that have cytological features associated with HCC may regress following androgen withdrawal. Androgen- related hepatocellular tumors which are typically multiple, demonstrate marked cellular pleomorphism, prominent nucleoli and extensive pseudoglandular formation, resembling HCC .
Occurrence of significant dysplasia in tumor cells of children with Fanconiís anemia, causes a nosologic dilemma to call the tumor hepatocellular adenoma or carcinoma. Proliferating cell nuclear antigen labelling index in lesions with Fanconiís anemia is found significantly greater than adenomas of other children . There is only one FA case treated with anabolic steroids in the literature defined by Bernstein et al.  that developed metastatic HCC. But pulmonary metastases had not been confirmed by tissue diagnosis.
What would be the role of C hepatitis infection in this patient? Has it played a role in the development of tumor? Would it cause malignant transformation? Hepatitis B virus infection is known to be associated with the development of hepatocellular carcinoma endemic or sporadic. In adult hepatocellular carcinoma, the sequence of nucleic acids of the hepatitis C virus was detected by polymerase chain reaction method in tumor tissues, but no association between hepatitis C infection and childhood HCC has been demonstrated .
The importance of steroid metabolism in tumorigenesis has been investigated. In an experimental study by Eagon et al.  it has been shown that preneoplastic stages such as hyperplasia of liver there is an elevation of both receptor activities and that the progression from hyperplasia to cancer results in suppression of oestrogen receptor expression but maintenance of androgen receptor.
Acute leukemia, hepatocellular carcinoma and squa- mous cell carcinoma have been reported in-patients with Fanconiís anemia . LeBrun et al.  described a 9- year-old boy with Fanconiís anemia. He had been treated with oxymetholone, a synthetic androgen for 3 years. He had died of intracerebral hemorrhage and at autopsy the liver had contained several adenomas and a large fibrolamellar hepatocellular carcinoma.
They also question the malignancy of liver tumors in Fanconiís anemia patients. These tumors perhaps should be simply labelled ďHepatocellular neoplasmsĒ. This will reflect their uncertain malignant potential [3,9]. There are two Fanconiís anemia patients known to have liver tumors that produced pulmonary metastasis. This case may include malignant potential with microscopic atypia, cellular pleomorphism occurrence of C hepatitis infection. But androgen therapy as etiological factors in Fanconiís anemia, low proliferation activity, the well-documented reports about regression of these tumors with androgen withdrawal encouraged us to follow this patient after surgery without any chemotherapy.
In conclusion, patients taking androgenic-anabolic steroids should be carefully monitored with US and CT and tumor markers should be measured. The worrisome pathology that may occur in hepatic tumor in children particularly with androgen therapy does not necessarily predict malignant behaviour.