A rare case of non-treated fetal–type hepatoblastoma for five years stayed without metastases in a young boy

Abstract

Hepatoblastoma is the most common malignant neoplasm of the liver in infancy. In this paper, we present a rare case of non-treated hepatoblastoma in an 18-month-old baby male who presented with an asymptomatic abdominal mass associated with elevated Alpha-fetoprotein. Contrast-enhanced CT revealed a solid mass located in the left lobe of the liver, measuring about 6 × 6 cm, and not enhancing the contrast. US-guided Tru-cut biopsy was performed which showed pure epithelial fetal-type hepatoblastoma. The parents refused neoadjuvant chemotherapy and the connection was disconnected with them because of the ongoing crisis in Syria. After five years, the patient returned with the same clinical picture. CT scan was repeated which revealed the same tumor without metastases. The decision was made to do a left hepatectomy after another confirmation with a surgical biopsy. Histopathological examination showed a multifocal pure epithelial-fetal well-differentiated type of hepatoblastoma with a favorable grade. Moreover, surgical margins and liver capsule appeared free, and the tumor was considered in Stage 1 accordingly. To this date, the boy was followed up with serial US and Alpha-fetoprotein (AFP)levels without signs of recurrence. Hepatoblastoma with pure fetal-type histology can be treated with complete surgical excision without neoadjuvant or adjuvant chemotherapy if the tumor was resected completely because this type of neoplasm is slow growing and has a good prognosis.