Unravelling an unusual blastoma in an infant with confusing radiological diagnosis

We report an unusual case of an 8-month-old child, who presented to us with a mass per abdomen with confusing imaging characteristics reported as a germ cell tumour / Neuroblastoma. Patient presented with a large mass per abdomen which had both retroperitoneal and intraperitoneal components and was compressing the adjacent structures and was appearing heterogenous with calcifications within. The more favoured diagnosis on imaging was a peritoneal or retroperitoneal germ cell tumor / Neuroblastoma. Repeated imaging revealed that the mass was abutting / compressing the left lobe of the liver and high AFP beta HCG and LDH values were noted. Imaging guided biopsy was performed preoperatively which led to the suspicion of a hepatoblastoma variant. Intraoperatively, it could be concluded that the mass was indeed involving the left lobe of the Liver. On surgical resection after laparotomy, it was found that the superior aspect tumor connected to the inferior surface of the left lobe of the liver. Hence a confirmatory diagnosis was made based on the radiographic, surgical, blood investigations and histopathological reports. The report of the specimen from surgical resection revealed a mixed epithelial and mesenchymal type of hepatoblastoma of typical histology.