Transformation of Fibrolamellar Carcinoma to Common Hepatocellular Carcinoma (A Case Report)


avatar M Rahbar 1 , * , avatar A Keshavarz 1 , avatar Sh Jahanbin 1


how to cite: Rahbar M, Keshavarz A, Jahanbin S. Transformation of Fibrolamellar Carcinoma to Common Hepatocellular Carcinoma (A Case Report). J Kermanshah Univ Med Sci. 2007;11(1):e81879. doi:


Introduction: Fibrolamellar Carcinoma (FLC), a subtype of hepatocellular carcinoma (HCC), is a rare primary hepatic malignancy. Several aspects of the clinical features and epidemiology of FLC remain unclear since most literature on FLC consists of case reports and small cases series with limited information on factors that affect survival. Majority of the tumors occurred in patients less than 40 years old. This is a case report from Kermanshah University of Medical sciences. Post-operative diagnosis was confirmed of FLC and HCC in the liver.
Case Report: A 25 years old man presented abdominal mass and RUQ pain with liver mass in ultrasound and CT scanning. Right lobectomy of the liver performed based on fibrolamellar carcinoma (FLC) diagnoses. 9 months after the first operation, lymph nodes metastases were removed. Nine months after the first operation and chemotherapy, a recurrence occurred in the residual liver. Based on histopathological essays , the primary tumor was diagnosed as pure FLC, but the recurrent tumors in the residual liver showed characteristics of common HCC. Thus, during repeated recurrences, histopathological features of tumor have changed from pure FLC to common HCC.
Discussion: Fibrolamellar hepatocellular carcinoma is a variant of hepatocellular carcinoma with distinct clinicopathologic features. It occurs at a young age and is less common risk factors for hepatocellular carcinoma like viral hepatitis and cirrhosis. Elevated alpha-fetoprotein (AFP) level is  infrequent. Physical signs like pain and mass are minimal and laboratory values such as liver enzymes and serum alpha-fetoprotein, are noncontributory. Actualy diagnosis is suggested by clinical history, supported by radiographic studies, and confirmed by histologic examination. Individuals with fibrolamellar carcinoma generally have a greater survival than those with hepatocellular carcinoma. This study confirmed the distinctive clinicopathologic features of fibrolamellar carcinoma as reported in literature. The tumors in fibrolamellar carcinoma case was significantly larger than conventional HCC,  similar findings have been reported in literature.


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