Congenital Hepatoblastoma in a Female Neonate: A Case Report.

Introduction: Congenital hepatoblastoma (CHB) is a rare liver malignancy in infants that is diagnosed either in utero or during the first month of life. This tumor typically demonstrates rapid progression in its early stages. Early detection and prompt intervention are critical for optimal outcomes. Case Presentation: We describe a 10-day-old Arab female neonate who presented with a firm, well-defined abdominal mass in the right upper quadrant, extending slightly across the midline to the left iliac fossa. Laboratory evaluation revealed a markedly elevated alpha-fetoprotein (AFP) level of 663,600 ng/mL, along with leukocytosis, thrombocytosis, and mild anemia. Imaging studies demonstrated a 7 × 7 cm liver tumor involving segments VI and VII, with arterial enhancement, necrotic areas, and intrahepatic biliary duct dilatation, but without evidence of metastasis. Fine needle aspiration confirmed fetal/embryonal-type hepatoblastoma. PRETEXT staging classified the lesion as PRETEXT I, indicating very low risk. The infant received nine cycles of neoadjuvant cisplatin-based chemotherapy, which resulted in significant tumor reduction and facilitated complete surgical resection. Postoperative recovery was uncomplicated. Conclusion: This case illustrates the importance of prompt diagnosis and multidisciplinary management of CHB using combined chemotherapy and surgery. Notably, even in the absence of classic risk factors or syndromic associations in neonates, an abdominal mass warrants thorough investigation. At 18 months of follow-up, the patient demonstrates normal growth and development with no evidence of tumor recurrence and AFP levels within normal range, indicating sustained remission.