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+A 4 and a half years old male child presented to our hospital for abdominal swelling.
+The child occasionally felt stomach ache that was relieved for no reason.
+The child showed no obvious tenderness and rebound.
+He was born as a premature baby in the 32nd week of his mother's pregnancy.
+His medical history included inguinal hernia on 2 sides, but he had only received an operation for the left inguinal hernia.
+No family or genetic history was found.
+Physical examination of this child showed that the abdomen was obviously bulging.
+The mass could be touched below umbilicus about 3 fingers.
+There were no other positive signs.
+The results of laboratory tests were almost normal, including alpha-fetoprotein (AFP) level.
+The Child–Pugh score was less than 5.
+Abdominal ultrasonography showed an uneven lesion in the liver and a diagnosis of HB was considered.
+Enhancement computed tomography (CT) scanning showed a large mass in the left upper abdomen and left lobe of the liver with an irregular edge.
+The size of the mass was 12.3 × 10.2 × 7.2 cm (Fig.1).
+There was an uneven nodular shadow and the edge was obvious when the mass was enhanced.
+Calcification and an expanded bile duct were not observed.
+The left branch of the portal was pressed and the distant part was shown to be unclear.
+Abnormal was not observed in the right branch.
+According to the medical history, the diagnosis of HB was considered.
+We did not recommend a biopsy to the patient because it might cause bleeding and tumor diffusion.
+An operation was necessary.
+The patient underwent DVSS surgery with sufficient preparation.
+Exploration showed an extrahepatic 12 × 10 cm mass in the left lobe of the liver (Fig.2).
+After the operation, the sample was split.
+The edge of the tumor was clear but no envelope.
+Tremelloid mesenchyme was seen on the section (Fig.2C).
+The pathological examination showed that the sample was grey red and 14 × 13 × 7 cm in size.
+The color of the section was grey red and grey white.
+MHL was diagnosed (Fig.3).
+Immunohistochemistry results (Fig.4) were the following: mesenchymal CD34 (+), D2–40 (+), S-100 (-), SMA (+), CD7 (-), epithelium CK19 (+), AFP (-), HCG (-).
+After 9 days of recovery, the patient returned home without complications.
+A follow-up examination, which included blood routine, liver renal function, coagulation routine, and ultrasound scan at 30 days, did not show any abnormality.
+No adverse or unanticipated event was presented.