CASE REPORT article
Front. Pediatr.
Sec. Pediatric Gastroenterology, Hepatology and Nutrition
This article is part of the Research TopicPrecision and Minimally Invasive Surgery in Children with Gastrointestinal MalformationsView all 3 articles
Hepatoblastoma with spindle cell sarcomatous metastasis in a 14-year-old girl: A case report
Provisionally accepted
- 1Department of Pediatric Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences,, Jinan, China
- 2Department of Pathology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
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Hepatoblastoma is the most common pediatric liver malignancy and occurs predominantly in children younger than 5 years old. We reported the case of a 14-year-old girl who was diagnosed as mixed epithelial-mesenchymal hepatoblastoma without any metastases. Initial evaluation revealed markedly elevated serum alpha-fetoprotein (7800 ng/mL) and a large hepatic mass (17.3*18.4*8.5 cm) in the left liver lobes on contrast-enhanced CT. The patient underwent surgical resection, with pathology confirming mixed epithelial-mesenchymal HB. Postoperative chemotherapy (cisplatin, doxorubicin, and 5-FU) normalized alpha-fetoprotein levels, but skull metastasis developed during treatment. Histopathology of the metastatic lesion showed spindle cell sarcoma with decreased GPC-3/HEP expression and elevated CD34/Ki-67. Multiple chemotherapy regimens (ICE, AVCP) showed limited efficacy. Subsequent treatment with alternating TGIE/CIV chemotherapy combined with anlotinib and cranial radiotherapy achieved disease stabilization without subsequent progression during follow-up. This case highlights the aggressive nature and chemotherapy resistance of mesenchymal HB components, emphasizing the need for novel therapeutic approaches incorporating targeted agents.
Keywords: Alpha-Fetoprotein, chemotherapy, Hepatoblastoma, metastasis, Spindle cell sarcoma
Received: 23 Dec 2025; Accepted: 31 Jan 2026.
Copyright: © 2026 Zhang, Yu, Ge, Wang, Bai, Kang and Wang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Suyi Kang
Jingfu Wang
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