This is a twenty two years old male patient with weight loss, abdominal pain, hepatomegaly and elevated liver function tests. The serological markers for viral B, C hepatitis and tumoral markers were normal. The CT scan demonstrated a hipodense, nodular lesion in the liver and the histological examination was reported as a typical fibrolamellar hepatocarcinoma.
Twenty two years old male patient with history of smoking (7 pack/year) and alcohol consumption of 317 g per month since three years. He had a diagnosis of epilepsy treatment with carbamazepine and episode of pneumonia was diagnosed three years ago.
He was refered to the hospital for severe abdominal pain in the upper right quadrant three weeks before to the hospitalization with nocturnal sweating and weight loss of 10 kg in the last year. The last week he had nausea and gastrobiliary vomiting. At the physical examination he had a thin complexion and hepatomegaly 4-4-5-cm was found. The liver function tests were abnormal with AST 121 UI, ALT 111 UI, ALP 134 UI, albumin 2.9 mg/dL. The other biochemestry values were normal and the virological markers for hepatitis A, B and C and HIV were negative. The carcinoembrionary antigen and alpha pheto protein tumoral markers were in normal values. A CT scan was made (Figure 1) and a liver biopsy was reported as typical fibrolamellar hepatocarcinoma (Figure 2).
The fibrolamellar carcinoma represent 1%-2% of cases of hepatocelular carcinoma. Forty percent are young patients and the mean age of presentation is between 25 to 35 years. It is possible to observe a well defined nodule with a prominent center. Most cases are asymptomatic or abdominal pain, weight loss and jaundice could be present. The CT scan show a hipodense, heterogeneous nodular lesion with calcifications and with the administration of IV contrast media, the lesion could be observed larger. The nodular focal hyperplasia is the main differential diagnosis.
The liver biopsy stablish the definitive diagnosis and it is possible to observe a trabecular cords, dense cells with a mix stroma of lamellar collagena. Eosnophilic inclusions of α-1 antitrypsin or cytoplasic pseudoinclusions are observed by the histological examination. The fibrolamellar carcinoma has a better prognosis than hepatocarcinoma with a survival of 34% at 4 years of follow up and a survival of 63% if the tumor is complete resected. The recurrence rate of this tumor has been reported at 40 months in post liver transplant patients.
