Abstract
Fibrolamellar hepatocellular carcinoma is a primary hepatic tumor that usually appears in young adults. Radical surgery is considered curative for this kind of tumor, so early diagnosis becomes essential for the prognosis of the patients. The main characteristic of this entity is the central scar, which is the center of differential diagnosis. We report the case of a 30-year-old man who was diagnosed with fibrolamellar hepatocellular carcinoma by ultrasonography. Contrast-enhanced CT confirmed this diagnosis, and the patient underwent a [18F] fluorocholine PET/CT. Hypermetabolism and the morphology in the nuclear medicine exploration suggest neoplastic nature of the lesion. Radical surgery was performed, and histopathologic analysis was performed, which resulted in focal nodular hyperplasia. Hepatic masses with central scar could have a difficult differential diagnosis, and focal nodular hyperplasia could mimic fibrolamellar hepatocellular carcinoma imaging patterns. These morphofunctional characteristics have not been described in [18F] Fluorocholine PET/CT, so there is a need to find out the potential role PET/CT in the differential diagnosis of hepatic mass with central scar.
Highlights
Fibrolamellar hepatocellular carcinoma (FLHCC) is a rare primary hepatic tumor that is more frequent in non-cirrhotic young adult populations (5 to 35 years old) [1]
As FLHCC has a mortality rate similar to conventional hepatocellular carcinoma, performing surgery with complete resection is the treatment of choice [2], and it is considered one of the only curative options, so its early diagnosis may affect the prognosis of these patients [3]
In reference to differential diagnosis of these injuries in computerized tomography (CT) studies, FLHCC is usually described as hypoattenuating lesions in precontrast study, heterogeneous hypervascular enhancement in arterial phase, and irregular hyperattenuating or isoattenuating in the portal venous and late phases, while the central scar could show hypoenhancement and calcifications in all phases [16]
Summary
Fibrolamellar hepatocellular carcinoma (FLHCC) is a rare primary hepatic tumor that is more frequent in non-cirrhotic young adult populations (5 to 35 years old) [1]. Cytoplasm usually contains pale bodies and hyaline globules, surrounded by lamellar stroma, composed of collagen deposited in parallel bands. This tumor diagnosis usually needs a confirmatory test, as conventional hepatocellular carcinomas have overlapping features with FLHCC [4]. Ultrasonography (US) is usually the first imaging study that helps in the diagnosis of FLHCC. It is usually described as a solitary, lobulated mass with variable echographic texture. It is characterized by a central scar that could appear as a central area of hyperechogenicity. Radioisotope-labelled choline PET/CT demonstrated more sensitivity than [18F]FDG PET/CT in differentiated HCC [9,10,11]
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