Lest it be overlooked, not all focal liver lesions detected in childhood are tumors. Infective/inflammatory lesions and cysts have to be considered too. Most pediatric malignancies are of the hematolymphoid type and do not usually form mass lesions. Primary malignant tumors of the liver are uncommon and represent about 1.3% of all malignancies in childhood. Hepatoblastoma (HB) and hepatocellular carcinoma (HCC) are the most common primary malignant tumors of the liver and represent about two-thirds of all hepatic neoplasms. Metastases from malignancies elsewhere, for example the group of small round blue cell tumors (SRBCT), are common differential diagnoses. Tumors of the liver are infrequently aspirated in the young. In most practices, the tumors are resected rather than subjected to preoperative fine needle aspiration biopsy (FNAB) or core biopsy.