A 86 year old female patient with osteoarthritis under non-steroidal anti-inflammatory drugs treatment presented with a 10 x 7 cm palpable mass in the upper abdomen. She died of peptic ulcer bleeding.
On the autopsy, her 1,259 g weighted liver showed micronodular cirrhosis and a white, firm, irregular shaped tumor that measured 9 cm in diameter affecting 80% of the left lobe (Figure 1). Histopathological study found a hepatocellular carcinoma of trabecular and scirrous type as well as cholangiocellular carcinoma (Figures 2to5).
Detail from Figure 4, Syrian red stain. Of note, the scirrous type resembles fibrolamellar carcinoma.
Histologically, scirrous type hepatocellular carcinoma could be easily mistaken by a fibrollamelar carcinoma, since the latter usually show polygonal cells with abundant, eosinophilic cytoplasm and thick collagen bands.