Supplementary Material for: Primary Surgical Resection of Localized Hepatoblastoma in an Adolescent

Abstract
introduction:
Hepatoblastoma (HB) is the most common pediatric primary liver malignancy, but is exceptionally rare in adolescents. Older patients often face delayed diagnosis and poorer prognoses compared to infants.
Case Presentation:
A 14-year-old Arab male presented with progressive abdominal distension and mild right upper quadrant pain. Examination revealed a large, firm abdominal mass. Serum alpha-fetoprotein (AFP) was markedly elevated (33,500 ng/mL), while liver function tests were normal. Contrast-enhanced CT showed a 15 × 12 × 10 cm heterogeneous mass involving right hepatic segments (5–8) and medial left segments (4a/b), without vascular invasion or metastasis. Based on characteristic imaging and elevated AFP, an extended right hepatectomy (resecting segments 4a, 4b, 5–8) was performed without preoperative biopsy or chemotherapy.
Histopathology confirmed hepatoblastoma. Recovery was uneventful; AFP normalized postoperatively. At 12-month follow-up, the patient remains disease-free with normal activity.
Conclusion:
Primary surgical resection is a viable strategy for localized hepatoblastoma in adolescents, even with large tumors, when vascular invasion and metastasis are absent. Prompt diagnosis using AFP and imaging, coupled with curative-intent surgery, can achieve excellent outcomes in this rare population.