The case history of a boy suffering from acute lymphoblastic leukemia (ALL) and carcinoma of the liver as secondary malignoma is reported. After completion of the combined ALL-therapy, a splenogenous thrombocytopenia emerged which was successfully treated by splenectomy. In the biopsy material liver cirrhosis and HBsAg-positive hepatitis could be detected; these proved to be progressive in the course of the following year. At the end of another year, a hepatocellular carcinoma was diagnosed, causing the patient's death, who was still in complete hematological remission 5 7/12 years after the onset and 2 9/12 years after the end of the ALL-therapy. Only two cases of hepatocellular carcinoma following ALL in childhood have been described in the literature so far.