Abstract
Hepatoblastoma is a rare pediatric cancer. Hepatoblastoma typically presents asymptomatically with an enlarging abdominal mass but can be associated with paraneoplastic secretion of beta-gonadotropin leading it to present like peripheral precocious puberty. This case highlights a rare initial presentation of hepatoblastoma as precocious puberty in a two-year-old patient who presented with persistent abdominal and genital pain. The patient was treated with right hepatic lobectomy and subsequently two cycles of cisplatin and was considered to be in remission without concern for recurrent disease. Considering that there have been more reports of this pathology in recent years, it is crucial to discuss the presentation, diagnosis, and treatment of this pathology. This case emphasizes the importance of maintaining hepatoblastoma as a differential diagnosis when evaluating precocious puberty and abdominal pain to avoid delays in diagnosis and treatment. This article also highlights our team's approach to the workup and treatment of this pathology, which can serve as a roadmap for other clinicians.