Copyright © Dr. Yogesh Kumar Sarin Yogesh Kumar Sarin* and Parveen Kumar Department of Paediatric Surgery, Maulana Azad Medical College, India *Corresponding author: Dr. Yogesh Kumar Sarin, Director Professor & Head, Department of Paediatric Surgery, Maulana Azad Medical College, New Delhi-110002, INDIA Submission: December 21, 2017; Published: April 12, 2018 Mixed Epithelial and Mesenchymal Hepatoblastoma with Teratoid Features-A Diagnostic Dilemma Introduction Mixed epithelial and mesenchymal (MEM) hepatoblastoma (HBL) with teratoid features, or teratoid hepatoblastomas (THBL) may mimic other pediatric tumors, especially teratomas, and their recognition can be challenging on imaging studies and in small biopsy samples [1]. This case emphasizes the importance of recognizing this rare and unusual variant of HBL. Case Report One and half-year-old boy was brought to us with a progressively increasing right-sided abdominal lump noticed since last 7 months. There was no other associated constitutional complaint. On examination, patient had stable vitals but gross pallor. Abdominal examination revealed a 15x15cm firm, immobile, non-tender mass with lobulated surface with ill-defined margins in the right lumbar, right hypochondriac, epigastric, umbilical and right iliac fossa regions. Liver margin could not be palpated separately. Rest of the systemic examination was normal. Investigations revealed severe anaemia with (Hb 3.4gm/dl). His renal and liver function tests were essentially normal with slight rise in AST level of 183 U/l. X-ray abdomen showed coarse calcifications in the area of the mass (Figure 1). Ultrasonography (USG) revealed a large solid lesion in right lumbar region with coarse calcification and vascularity; organ of origin could not be estimated accurately. Liver showed two target lesions in segment VII and VIII. Contrast enhanced computerised tomography (CECT) showed 11.5x9 cm predominantly exophytic, mildly enhancing mass lesion of having solid and cystic components having large calcifications; there were ill-defined planes between the mass and inferior margin of right lobe of liver (Figure 2 & 3). The mass was attenuation inferior vena cava posteriorly and displacing the portal vein superiorly, however both the vessels showed normal contrast opacification. The liver measured 12cm with a well-defined mildly enhancing lesion in superior segment of right lobe. Rest of the abdominal structures including spleen, bilateral kidneys, pancreas and thorax were normal. No abdominal lymphadenopathy or free fluid was noted. Figure 1: X-ray abdomen showing coarse calcifcations in the area of the mass. Case Report Research in Pediatrics & Neonatology C CRIMSON PUBLISHERS Wings to the Research 1/5 Copyright © All rights are reserved by Sabah M Ali Volume 2 - Issue - 2 ISSN: 2576-9200 Abstract We report 1½ -year-old boy harboring mixed epithelial and mesenchymalhepatoblastoma with teratoid features. The diagnostic dilemma in the present case is presented and review of literature of the entity is done. Keywords: Hepatoblastoma; Mesenchymal; Epithelial; Teratoid Features; Abdominal examination; Epigastric; Umbilical; Anaemia Abbreviations: MEM: Mixed Epithelial and Mesenchymal; HBL: Hepatoblastoma; THBL: Teratoid Hepatoblastomas; USG: Ultrasonography; CECT: Contrast Enhanced Computerised Tomography; VMA: Vanillylmandelic Acid