{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T17:41:27Z","timestamp":1773337287427,"version":"3.50.1"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T00:00:00Z","timestamp":1773273600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:p>Hepatoblastoma (HB) is the most common pediatric liver malignancy and occurs predominantly in children younger than 5\u2005years of age. We report the case of a 14-year-old girl who was diagnosed with mixed epithelial\u2013mesenchymal hepatoblastoma without any metastases. Initial evaluation revealed a markedly elevated serum alpha-fetoprotein level (7,800\u2005ng\/mL) and a large hepatic mass (17.3\u2005cm\u2009\u00d7\u200918.4\u2005cm\u2009\u00d7\u20098.5\u2005cm) in the left liver lobe on contrast-enhanced CT. The patient underwent surgical resection, and pathological examination confirmed mixed epithelial\u2013mesenchymal HB. Postoperative chemotherapy (consisting of cisplatin, doxorubicin, and 5-FU) normalized serum alpha-fetoprotein levels; however, skull metastasis developed during treatment. Histopathological analysis of the metastatic lesion revealed spindle cell sarcoma with decreased GPC-3\/Hepa expression and elevated CD34\/Ki-67 expression. Multiple chemotherapy regimens (ifosfamide, carboplatin, and etoposide; and doxorubicin, vincristine, cyclophosphamide, and cisplatin) demonstrated limited efficacy. Subsequent treatment with alternating albumin-paclitaxel, gemcitabine, ifosfamide, and etoposide\/cyclophosphamide, irinotecan, and vincristine chemotherapy combined with anlotinib and cranial radiotherapy achieved disease stabilization, with no subsequent progression observed during follow-up. This case highlights the aggressive nature and chemoresistance of the mesenchymal components of HB, emphasizing the need for novel therapeutic approaches that incorporate targeted agents.<\/jats:p>","DOI":"10.3389\/fped.2026.1773950","type":"journal-article","created":{"date-parts":[[2026,3,12]],"date-time":"2026-03-12T06:50:11Z","timestamp":1773298211000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Hepatoblastoma with spindle cell sarcomatous metastasis in a 14-year-old girl"],"prefix":"10.3389","volume":"14","author":[{"given":"Yanting","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Pediatric Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuedi","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Junjie","family":"Ge","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingjing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pathology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chuanfeng","family":"Bai","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Suyi","family":"Kang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, Shandong, China"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jingfu","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Oncology, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences","place":["Jinan, Shandong, 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