Document Type : case report


1 Department of Pediatrics, Faculty of Medicine, Islamic Azad University of Medical, Mashhad, Iran.

2 Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Pediatric Nephrologist, Assistant professor ,Department of Pediatric, Division of Nephrology Mashhad University of Medical Sciences, Dr Sheikh Hospital ,Mashhad Iran.

4 Obstetrician and gynecologist, Department of obstetrics gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

5 Department of Pediatric, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Mashhad, Iran


Hepatoblastoma (HB) is a rare malignant tumor of the liver; but is the most common malignancy of liver in infancy and childhood that usually occurs in the first three years of life. These tumors are usually present by abdominal mass, abdominal pain, anemia, thrombocytosis, and high serum levels of AFP; and may cause decreased appetite and weight loss.
Complications such as ascites, GIB, icterus, splenomegaly and vascular thrombosis may occur, while hepatic vein or inferior vena cava thrombosis is quite rare especially with a spread to right atrium and pulmonary artery branches. Multidisciplinary therapy by a pediatric oncologist, a pathologist, an experienced radiologist, a pediatric cardiologist and a pediatric surgeon is very important to diagnose and manage the condition. We report on the case of an infant with a huge abdominal mass and much extended tumor thrombosis till the pulmonary artery branches that shrunk appropriately after the first course of chemotherapy.


  1. Aronson DC, Czauderna P,Maibach R,Perilongo G,Morland B. The treatment of hepatoblastoma: Its evolution and the current status as per the SIOPEL trials. J Indian Assoc Pediatr Surg 2014 Oct-Dec; 19(4): 201–207.
  2. Pizzo PA, Poplack DG. Principles and Practice of Pediatric Oncology. Philadelphia: Wolters Kluwer & Lippincott Williams & Wilkins; 2015.
  3. Fish JD, Lipton JM, Lanzkowsky P. Lanzkowsky’s Manual of Pediatric Hematology and Oncology. United States: Elsevier; 2022.
  4. Pham TA, Gallo AM, Concepcion W, et al. Effect of Liver Transplant on Long-term Disease-Free Survival in Children With Hepatoblastoma and Hepatocellular Cancer. JAMA Surgery 2015 December; 150(12): 1150-58.
  5. Loh A, Bishop M, Krasin M, Davidoff A, Langham MR. Long-term physiologic and oncologic outcomes of inferior vena cava thrombosis in pediatric malignant abdominal tumors. Journal of Pediatric Surgery 2015 Apr; 50(4): 550–555.
  6. Sarper N, Corapcioglu F, Anik Y, Ural D, Yildiz K, Tugay M. Unresectable multifocal hepatoblastoma with cardiac extension: excellent response with HB-94 chemotherapy protocol. J Pediatr Hematol Oncol 2006 Jun; 28(6): 386-90.
  7. Huang, Yen-Lin MD*; Shih, Shin-Lin MD‡; Liu, Hsi-Che MD†; Yeh, Ting-Chi MD†. Hepatoblastoma with Tumor Extension through the Inferior Vena Cava into the Right Atrium. Journal of Pediatric Gastroenterology and Nutrition 2010 June; 50(6): 577.
  8. Endo K, Yokoi A, Mishima Y, Tamaki A, Takemoto J, Morita K, et al. Resectable hepatoblastoma with tumor thrombus extending into the right atrium after chemotherapy: A case report. J Ped Surg Case Reports 2016 Jan; 7: 20-22.
  9. Hu HM, Zhang WL, Wang YZ, Zhang Y, Yi Y, Li F, et al. Treatment outcomes for hepatoblastoma children with pulmonary metastasis and extrapulmonary involvement: experience of 36 cases at a single institution. Transl Cancer Res 2020 Oct; 9(10): 6402-6411.
  10. Fanelli MC, Guilhen JC, Duarte AA, Souza FK, Cypriano MD, Caran EM, et al. Management of Pediatric Tumors With Vascular Extension. Front Pediatr 2022 Jan 9; 1-5.