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A 10-year-old boy suffered from left hypochondrium pain for 3 days. He had a palpable stiff mass and tenderness in the upper abdomen. Laboratory examinations showed slightly elevated liver enzyme levels (AST/ALT=74/38 U/L; GGT=38 U/L), and markedly elevated serum alpha fetoprotein level (88,000 ng/mL). Abdominal ultrasonography revealed multiple tumors in the overall left and right liver parenchyma (Fig. 1). Abdominal computed tomography revealed that the liver contained PRETEXT Ⅲ multiple tumors that were slightly enhanced in the arterial phase (Fig. 2A, B). He underwent extended left hepatectomy, and histopathology showed hepatoblastoma of the combined fetal and embryonal type. He received adjuvant chemotherapy and achieved complete remission for 10 months after chemotherapy without liver transplantation.
Hepatoblastoma is a rare primary malignant hepatic tumor that occurs during infancy and childhood, occurring predominantly in the first 2 years of life. The occurrence of hepatoblastoma is infrequent in children older than 5 years, and thus, the actual incidence could not be calculated (1). In most cases, hepatoblastoma is present as a solitary mass (2). Hepatoblastoma should always be considered even when the liver displays multiple tumors in school-aged children or adolescents.
Conflict of interest statement: The authors have no conflicts of interest to declare.