Hepatocellular carcinoma (HCC) is a very rare pediatric tumor. The incidence is 0.5-1.0 cases per million children. The most common clinical sign is abdominal mass. HCC often develops in the presence of underlying liver disease and cirrhosis, especially viral hepatitis. The authors hereby report a 9-year-old girl with hepatocellular carcinoma associated with positive hepatitis B surface antigen at Queen Sirikit National Institute of Child Health. She was admitted because of massive upper gastrointestinal bleeding (UGIB) due to esophageal varices. Multiple sessions of esophagogastroscopy with sclerotherapy banding ligation and glue injection of esophageal varices were performed but she still had massive UGIB. Sengstaken-Blakemore tube was used, after which she developed a ruptured esophagus. Finally she passed away. Liver necropsy was performed and diagnosed as HCC.