Hepatocellular Carcinoma with Both Fibrolamellar and Classical Components: An Unusual Morphological Pattern

Abstract

Fibrolamellar carcinoma (FLC) is an uncommon form of primary liver malignancy with unique clinical, histological, and biological characteristics. It is usually seen in young adults without underlying liver disease. Histologically, it shows large cells with abundant eosinophilic cytoplasm, large vesicular nuclei, prominent nucleoli, and lamellar type fibrosis. In contrast, classical hepatocellular carcinoma (HCC) is typically present in elderly male patients with cirrhosis. It is the most common histological subtype, and it is characterized by its resemblance to the normal liver, both in its growth pattern and its cytology. The unusual case of a liver carcinoma that presented with histological features of both FLC and classical HCC is herein reported. This was the case of a 37-year-old female complaining of diffuse abdominal discomfort and epigastric pain for two months. She was referred to us for further management after she was diagnosed with HCC in a noncirrhotic liver. She underwent a left-sided hepatectomy. A yellow nodular mass with well-defined borders and a necrotic center was present in the resection specimen. The morphological features and immunohistochemical studies were consistent with a diagnosis of FLC mixed with classical HCC. The patient was followed up for five months, and no signs of recurrence were evident.

Synchronous Fibrolamellar Hepatocellular Carcinoma and Auricular Myxoma

“…There at least two cases of metastasis mimicking atrial myxoma in hepatocellular carcinoma [ 1 , 10 ]. Fibrolamellar hepatocellular carcinoma (FLHCC) usually appears in younger patients (median age of 25 years) [ 11 ], although recent studies show two distinct peaks of incidence, the first at 10 to 30 years of age and the second at 70 to 79 years of age [ 2 , 4 ]. At the moment of diagnosis, our patient was 53 years old, which is inconsistent with the data reported in the literature.…”

“…FHLCC prefers the left lobe of the liver, and, grossly, it is usually yellow to pale tan and firm, with an average size of 6–19 cm at its longest diameter. About 75% of tumors present a central scar; some tumors present foci of necrosis, hemorrhage, and calcification [ 3 , 11 ].…”

“…Histopathologically, the tumor is composed of large polygonal cells with large vesicular nuclei containing marginalized chromatin and prominent nucleoli with eosinophilic (oncocytic) cytoplasm surrounded by distinctly lamellar stroma. Calcifications and pale bodies are seen in more than 50% of cases [ 11 , 13 ]. Stainable copper is found in 75% of all FLHCC cases [ 12 ].…”

“…Stainable copper is found in 75% of all FLHCC cases [ 12 ]. Immunohistochemical markers for FHLCC are CK7, EMA, mCEA, CA19-9, EpCAM, and CD68 [ 11 , 13 ]. Whenever possible, complete surgical resection is the preferred treatment for FLHCC [ 4 ].…”

Neoplasias hepáticas malignas: 1.a parte. Hepatocarcinoma: papel de la biopsia hepática, estudios de inmunohistoquímica y otros aspectos importantes

“…Recientemente hemos descrito una variante inusual de HCC mixto con componente clásico y fibrolamelar (26).…”