Vishnu Nagalapuram, Kulkarni Aditya V, Vidhyalakshmi Sreenivasan, Sambandam Swaminathan, Garg Prerna, LeelaKrishnan Venkatakrishnan, Janarthan Krishnaveni, Singh Gursharan, Kaur Maninder, Chitra T V, John Biku Joseph
Department of HPB and Liver Transplantation, PSG Institute of Medical Sciences and Research, Avinashi Road, Coimbatore, India.
Department of Gastroenterology, PSG Institute of Medical Sciences and Research, Avinashi Road, Coimbatore, India.
Ann Hepatobiliary Pancreat Surg. 2017 Feb;21(1):48-51. doi: 10.14701/ahbps.2017.21.1.48. Epub 2017 Feb 28.
The Fibrolamellar variant of Hepatocellular Carcinoma (FLHCC) is a rare form of liver cancer that presents in the 3 decade of life, is rarely associated with cirrhosis or chronic Hepatitis B/C virus infection, and usually presents with normal serum alpha-fetoprotein (AFP) levels. FLHCC presenting during pregnancy is extremely rare, with only 4 cases reported. We present a case of FLHCC in pregnancy and discuss the dilemmas in management. A 26 year-old primigravida, 26 weeks of gestation presented with a month's history of obstructive jaundice secondary. Investigations revealed a mass in the left lateral segment of the liver with extension down the left hepatic duct into the common bile duct. Following an emergency caesarean section at 31 weeks, she underwent a left hepatectomy with extrahepatic bile duct excision. The postoperative course was uneventful. Histopathology showed FLHCC. In conclusion, liver tumors presenting during pregnancy should be managed in a multidisciplinary setup with facilities for neonatal intensive care. Management depends on the presumed pathology, period of gestation and family preferences.
纤维板层样肝细胞癌（FLHCC）是一种罕见的肝癌形式，发病于30岁左右，很少与肝硬化或慢性乙型/丙型肝炎病毒感染相关，且通常血清甲胎蛋白（AFP）水平正常。孕期出现FLHCC极为罕见，仅有4例报道。我们报告一例孕期FLHCC病例并讨论管理中的困境。一名26岁初产妇，孕26周，有一个月的继发性梗阻性黄疸病史。检查发现肝脏左外叶有一肿块，延伸至左肝管并进入胆总管。在孕31周行急诊剖宫产术后，她接受了左肝切除术及肝外胆管切除术。术后过程顺利。组织病理学显示为FLHCC。总之，孕期出现的肝脏肿瘤应在具备新生儿重症监护设施的多学科环境中进行管理。管理取决于推测的病理情况、孕周及家庭意愿。
