<![CDATA[Introduction: Hepatoblastoma (HB) is a rare primary malignant tumor of the liver in children. Treatment procedures for HB usually involve surgery and even liver transplantation, in addition to neoadjuvant or palliative systemic chemotherapy. However, the recent development of transarterial chemoembolization (TACE) procedures has provided an additional option that is considered quite effective in treating HB. This treatment procedure is believed to have many advantages as a treatment option prior to surgery and/or liver transplantation. This case is interesting to discuss because this procedure is still rarely performed in Indonesia. Whereas in many countries it has shown success and is quite desirable option both as a bridge therapy before surgery and palliative therapy. Case Presentation: We present a case of an 8-month-old baby boy diagnosed with HB. The patient had a history of preterm birth. Hemoglobin (Hb) level was 7 g/dL, and platelet count was elevated. Alpha-fetoprotein (AFP) levels were elevated to 122,010 ng/dL. Ultrasonography showed a large solid mass in the right liver lobe, raising suspicion of malignancy. Contrast enhanced 3-phase computed tomography (CT) scan imaging showed a solid mass in the right lobe of the liver that was contrast-enhanced, hypovascularized, contained intra-tumor necrotic components, had ill-defined borders, and was not encapsulated. It measured approximately 9.02 x 9.94 x 9.93 cm, and appeared to cover almost the entire right lobe of the liver. This finding was diagnosed as PRETEXT III hepatoblastoma. An experienced interventional radiologist performed TACE with cisplatin agent. Subsequent evaluation 20 days after the first TACE, the size of the tumor mass had reduced by 20% from the previous size. This finding warrants consideration of the next optimal therapeutic approach, i.e., whether to proceed with surgical intervention or perform subsequent TACE prior to surgery. In our case, we proceeded with a repeat of TACE followed by surgery.Conclusions: Transarterial chemoembolization appears to be one of the effective treatment options for large and invasive HB, as experience has shown that TACE can shrink tumor size, provide clearer borders, and reduce alpha-fetoprotein (AFP) levels after the first TACE. TACE can thus facilitate more optimal surgical and transplantation procedures. Thus, we believe that TACE has the potential to become a recognized HB treatment option in the future.]]>
