Sakai Kenji, Ohashi Tomofumi, Hara Shuichiro, Osawa Hideki, Ide Yoshihito, Noro Hiroshi, Hirao Takafumi, Iwasaki Teruo, Hatanaka Nobutaka, Yamasaki Yoshio
Dept. of Surgery, Japan Community Health care Organization(JCHO)Osaka Hospital.
Gan To Kagaku Ryoho. 2020 Dec;47(13):2326-2328.
We report a rare case of hepatic fibrolamellar hepatocellular carcinoma(FLC). A 25-year-old Vietnamese male experienced loss of appetite and abdominal pain. He was referred for further examination of a 20 cm tumor in the left lobe of the liver detected in mass screening ultrasonography. He tested negative for HBs-antigen and HCV-antibody. The serum PIVKA- Ⅱ level was elevated. Liver function test findings were normal. The arterial phase of contrast enhanced abdominal CT revealed a 20×30 cm tumor that was well-enhanced, except for a central scar in the left lobe of liver. Enhanced MRI showed a high intensity tumor. T2-weighted MRI showed an iso-intensity tumor with a low-intensity central fibrous scar. Upon diagnosing the patient with FLC, we performed left hepatic trisegmentectomy. Pathological findings of the surgical specimen showed eosinophilic large neoplastic cells surrounded by fibrous stroma arranged in a lamellar fashion. This confirmed the diagnosis. FLC, which occurs in noncirrhotic livers of young patients, is a distinct clinicopathological variant of hepatocellular carcinoma. Hepatectomy for FLC should be accompanied with regional lymphadenectomy because of its association with lymph node metastasis. We also reviewed cases reported in Japan.
我们报告一例罕见的肝纤维板层状肝细胞癌（FLC）。一名25岁的越南男性出现食欲不振和腹痛。他因在大规模筛查超声检查中发现肝脏左叶有一个20厘米的肿瘤而被转诊进行进一步检查。他的乙肝表面抗原和丙肝抗体检测均为阴性。血清异常凝血酶原Ⅱ水平升高。肝功能检查结果正常。腹部增强CT动脉期显示肝脏左叶有一个20×30厘米的肿瘤，除中央瘢痕外强化良好。增强MRI显示肿瘤呈高信号。T2加权MRI显示肿瘤呈等信号，中央有低信号纤维瘢痕。在诊断该患者为FLC后，我们进行了左肝三段切除术。手术标本的病理检查结果显示嗜酸性大肿瘤细胞被呈板层状排列的纤维间质所包围。这证实了诊断。FLC发生于年轻患者的非肝硬化肝脏，是肝细胞癌一种独特的临床病理亚型。由于FLC与淋巴结转移有关，因此对其进行肝切除时应同时进行区域淋巴结清扫。我们还回顾了日本报道的病例。
