Elsevier

Human Pathology

Volume 33, Issue 7, July 2002, Pages 765-769
Human Pathology

Case Studies
Adult-type hepatocellular carcinoma in the center of a fibrolamellar hepatocellular carcinoma*

https://doi.org/10.1053/hupa.2002.125380Get rights and content

Abstract

A large hepatic tumor was detected in the noncirrhotic liver of a 27-year-old female patient. The tumor was radiologically characterized by a peripheral mass encircling a central ovoid tumor, and was resected by an extended right hemihepatectomy. Histologic examination revealed that the peripheral and major component of the tumor represented a fibrolamellar hepatocellular carcinoma, whereas the central, well-demarcated tumor was a less well-differentiated adult-type hepatocellular carcinoma completely encircled by the former. Cells of the peripheral tumor mass abundantly expressed cytokeratin-7, typically present in the fibrolamellar variant, whereas no cytokeratin-7 immunoreactivity was found in the central tumor. To our knowledge, this is the first reported case of a not admixed but clearly separated evolution of these 2 histologic patterns within the same tumor, and suggests that the 2 types of hepatocellular carcinoma may share a common pathogenic pathway. HUM PATHOL 33:765-769. Copyright 2002, Elsevier Science (USA). All rights reserved.

Section snippets

Clinical data

This 27-year-old female patient was known to suffer from bronchial asthma for many years. Three months before the present admission to hospital, she started to complain of colic-like pain attacks in the epigastrium. These attacks, which then recurred almost every 2 weeks, lasted for about 5 minutes and were followed by vomiting, subfebrile temperatures, yellow feces, and intermittent diarrhea. Vasoactive intestinal peptide (VIP) or other gastrointestinal hormones were not measured. After these

Discussion

In this young female patient without hepatic cirrhosis, adult-type HCC developed in the center of a large FL-HCC as a circumscribed and not admixed lesion. In previous reports on FL-HCC components in liver carcinomas with an otherwise different histology, such components have been described as either admixed tumor parts with an unclear separation between HCC and FL-HCC morphologies,7, 8 or as FL-HCC representing a distinct differentiation pathway within an HCC,9 thus leaving unanswered the

Acknowledgements

The authors gratefully acknowledge secretarial help of Erna Kramel and the excellent work of the technicians.

References (14)

  • D Read et al.

    Characterization of neurotensin (6-13) from an hepatic fibrolamellar carcinoma

    Peptides

    (1991)
  • A Okano et al.

    Fibrolamellar carcinoma of the liver with a mixture of ordinary hepatocellular carcinoma: A case report

    Am J Gastroenterol

    (1998)
  • HA Edmondson

    Differential diagnosis of tumors and tumor-like lesions of liver in infancy and childhood

    Arch Dis Child

    (1956)
  • S Saab et al.

    Fibrolamellar hepatocellular carcinoma. Case reports and a review of the literature

    Dig Dis Sci

    (1996)
  • JR Craig et al.

    Fibrolamellar carcinoma of the liver: A tumor of adolescents and young adults with distinctive clinicopathologic features

    Cancer

    (1980)
  • P Van Eyken et al.

    Abundant expression of cytokeratin 7 in fibrolamellar carcinoma of the liver

    Histopathology

    (1990)
  • VR Agarwal et al.

    Molecular basis of severe gynecomastia associated with aromatase expression in a fibrolamellar hepatocellular carcinoma

    J Clin Endocrinol Metab

    (1998)
There are more references available in the full text version of this article.

Cited by (0)

*

Address and reprint correspondence requests to: Arthur Zimmermann, MD Professor of Pathology, Institute of Pathology, University of Berne, Murtenstrasse 31, CH-3010 Berne, Switzerland.

View full text