Prenatal Diagnosis of Congenital Hepatoblastoma: Imaging Features, Perinatal Management, and a Review of Literature

Although uncommon, hepatoblastoma remains the most frequent primary malignant liver tumor in neonates. Prenatal identification of fetal hepatic tumors enables early counseling, delivery planning, and coordinated multidisciplinary care. We report a case of congenital hepatoblastoma diagnosed antenatally at 34 weeks of gestation. Ultrasound demonstrated a large hyperechoic hepatic mass with internal vascularity, arising from the right upper abdomen and crossing the midline. Serial imaging showed progressive enlargement of the lesion, and fetal magnetic resonance imaging confirmed its hepatic origin. Delivery was performed by elective cesarean section at 37 weeks. Postnatally, the neonate presented with abdominal distension and a palpable right hypochondrial mass. Imaging initially suggested hepatic teratoma; however, markedly elevated alpha-fetoprotein levels and histopathological examination confirmed epithelial hepatoblastoma. The infant received neoadjuvant chemotherapy followed by right extended hepatectomy with resection and reconstruction of the inferior vena cava and portal vein. The child is currently under follow-up and has normal development. This case highlights the role of prenatal imaging in facilitating multidisciplinary planning and timely postnatal management of rare congenital hepatic tumors.