Radiology Teaching Files > Case 642452

Contributed by: Children's Hospital Omaha, Radiologist, Omaha Childrens, Creighton University and UNMC, Nebraska, USA.
Patient: 17 year old
History: 17-year-old female with jaunice and right sided abdominal pain

Fig. 1: Although usually see a solitary well circumscribed mass with variable enhancement, this patient also has nodules in right lobe of liver. The central scar is low attenuation without calcification . Calcification is usually seen in 40 to 45%

Fibrolamellar hepatocellular carcinoma

- Occurs in adolescents and young adults.
- No underlying cirrhosis or known risk factors.
- The alpha-fetoprotein is negative
- Mean age 23 to 28 years with a range of 5 - 35 (mean 23) years; M:F = 1:1

Pathology: well-circumscribed strikingly desmoplastic tumor with calcifications and fibrous central scar

Histology: hepatocyte-like cells with granular eosinophilic cytoplasm growing in sheets/cords/trabeculae separated by broad bands of fibrous stroma arranged in parallel lamellae

- mass of low attenuation and varying degrees of enhancement
- Most commonly see a solitary well circumscribed mass with variable enhancement
- The central scar is low attenuation and calcification is usually seen in 40 to 45%.

Prognosis: 48% resectability rate; 32 months average survival time; 63% 5-year survival time. prognosis better than usual type of hepatocellular carcinoma

Differential Diagnosis: focal nodular hyperplasia (hyperintense central scar on T2WI)


Siegel Marilyn, Pediatric Body CT, Lippincott ,Williams and Wilkins,1999.
Dahnert, Wolfgang. Radiology Review Manual 4th Edition. Williams and Wilkins, 1999

Submitted by: Paras Khandhar, Medical Student, Creighton University Medical Center
Phillip J. Silberberg, M.D, Radiology, Children's Hospital, Omaha, NE

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Additional Details:

Case Number: 642452Last Updated: 11-07-2004
Anatomy: Gastrointestinal (GI)   Pathology: Neoplasm
Modality: CTExam Date: Access Level: Readable by all users
Keywords: fibrolamellar hepatocellular carcinoma

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