Calcification in hepatocellular carcinoma: not always an indication of fibrolamellar histology.

Abstract

A distinct pathologic and clinical type of hepatocellular carcinoma (HCC), called fibrolamellar HCC, has been recognized during this decade [1 -3]. This tumor differs from conventional HCC in several respects: it typically occurs in adolescents or young adults; it is not associated with known predisposing risk factors, such as cirrhosis or hepatitis; and it does not cause elevation of serum alpha-fetoprotein. Fibrolamellar HCC is more likely to be resectable than is the usual form of HCC associated with cirrhosis, and it has a considerably better prognosis. There are practical reasons, therefore, to differentiate flbrolamellar HCC from conventional HCC. In a recent report [2] based on a radiologic-pathologic correlation of 1 7 cases of fibrolamellar HCC, the presence of calcification within the tumor was considered to be the most important distinguishing radiologicfeature, that is, calcification was common among the patients with fibrolamellar HCC but was not present in a group of patients with conventional HCC who were reviewed for comparison. In fact, the authors stated that a “review of cases of HCC in the Armed Forces Institute of Pathology Department of Radiologic Pathology showed no radiographically calcified HCCs that were not fibrolamellar.” After reviewing the literature, the authors further concluded that “the previously reported calCified primary hepatic malignancies in adults were either cholangiocarcinomas, mixed cholangiohepatoCellular carcinomas, or hepatocellular carcinomas in young, noncirrtiotic adults. The latter probably were fibrolamellar HCCs.” The imphcation of these observations is that if calcification is found in an untreated HCC occurring in an adult, the tumor will most certainly be of the fibrolamellar variety. We report two cases of calcified hepatocellular carcinoma that were not fibrolamellar.