University of Texas Rio Grande Valley at Doctors Hospital at Renaissance Edinburg, TX, United States
Mariana Gonzalez Del Hierro, MD1, Grigoriy Rapoport, MD2, Mohammed Shakhatreh, MD1, Asif Zamir, MD, FACG1, Martha Solis, MD3 1University of Texas Rio Grande Valley at Doctors Hospital at Renaissance, Edinburg, TX; 2University of Texas Rio Grande Valley at Doctor's Hospital at Renaissance, Edinburg, TX; 3University of Texas at Rio Grande Valley - Doctors Hospital at Renaissance, Edinburg, TX
Introduction: Fibrolamellar Hepatocellular Carcinoma (FL-HCC) is a very rare cancer that represents < 1% of all hepatic malignancies that occurs in the younger population. Typical patients do not have a history of cirrhosis or chronic liver disease and there is an equal gender distribution. At the time of diagnosis, the average mass size tends to be around 10 cm and 50% of those affected, present with metastasis to the proximal lymph nodes. Diagnosis is usually made with cross-sectional imaging. CT typically demonstrates a single tumor with clear margins, decreased attenuation and central scarring. The tumor is highly vascular and typically has increased contrast avidity in the arterial phase. On MRI, there is usually decreased signal in T1 and T2 due to the fibrotic tissue of the scar and there is very similar enhancement as seen on CT. While imaging plays a major role in establishing a diagnosis, the gold standard is with biopsy. Histopathology typically reveals big cells with large nuclei, eosinophilic cytoplasm and a central lamellated surrounding scar. In this case we present a patient diagnosed with FL-HCC.
Case Description/Methods: A 44-year-old man with history of hypertension and diabetes presented to the hospital with a 3 week history of abdominal pain. MRI was significant for a 16 x15 cm heterogeneous mass with multi-foci fat and central scarring. Imagining was unable to completely categorize the mass and a right lobe liver excision was performed. Pathology results were consistent with FL-HCC with clear surgical margins and the surrounding liver with micro vesicular steatosis. After surgery the patient underwent surveillance with triple phase CT imaging every 6 months for two years and has continued to remain in remission.
Discussion: FL-HCC is an aggressive tumor that commonly returns after first surgical attempt at resection, typically requiring a second intervention and/or liver transplant. Since this tumor is rare, there are no established management guidelines. Combination therapy with surgery, chemotherapy, and radiation provide the best outcomes.
Figure: CT demonstrating a low-attenuation mass with central scarring
Disclosures: Mariana Gonzalez Del Hierro indicated no relevant financial relationships. Grigoriy Rapoport indicated no relevant financial relationships. Mohammed Shakhatreh indicated no relevant financial relationships. Asif Zamir indicated no relevant financial relationships. Martha Solis indicated no relevant financial relationships.
Mariana Gonzalez Del Hierro, MD1, Grigoriy Rapoport, MD2, Mohammed Shakhatreh, MD1, Asif Zamir, MD, FACG1, Martha Solis, MD3. P0791 - An Unusual Case of Fibrolamellar HCC, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.