eMedicine Specialties > Radiology > Gastrointestinal

Hepatocellular Carcinoma, Fibrolamellar: Follow-up

Author: W Ross Stevens, MD, Clinical Professor, Department of Radiology, Southern Illinois University School of Medicine; Head, Radiology Residency Director, Division of Gastrointestinal Radiology, St John's Hospital
Contributor Information and Disclosures

Updated: Aug 22, 2007

Intervention

A percutaneous biopsy of a fibrolamellar carcinoma may be obtained for a definitive preoperative diagnosis. A percutaneous biopsy specimen is usually obtained by using either CT scanning or ultrasonographic guidance. Routine image-guided biopsy techniques are used. Fibrolamellar carcinomas are often pathologically heterogeneous, and they may contain areas of HCC or neuroendocrine differentiation. Nodular hyperplastic changes in the liver, adjacent to the tumor, may mimic FNH. Therefore, in patients with suggested fibrolamellar carcinoma, the acquisition of multiple core-needle biopsy samples is recommended to avoid misdiagnosis from sampling error. Potential complications of image-guided biopsy of fibrolamellar carcinoma are uncommon and include hemorrhage and infection.

Aggressive surgical treatment is used in patients with fibrolamellar carcinoma. The initial treatment usually involves resection of the primary tumor or liver transplantation, with en bloc resection of metastatic lymphadenopathy. Despite aggressive initial therapy, tumor recurrence within 2-12 months of resection with intent to cure is typical. Tumor recurrence almost always involves the liver, and it may be unifocal or multifocal. Intrahepatic recurrence is not necessarily located at the surgical margins. In addition, recurrent regional lymphadenopathy is often present. Distant metastases to lung or other remote sites may occur late in the course of the disease.

Surgical resection of recurrent and metastatic tumors has been shown to improve survival and is recommended. Patients with unresectable lesions can be treated with chemotherapy. Radiation therapy has not been reported to be useful.

 


More on Hepatocellular Carcinoma, Fibrolamellar

Overview: Hepatocellular Carcinoma, Fibrolamellar
Imaging: Hepatocellular Carcinoma, Fibrolamellar
Follow-up: Hepatocellular Carcinoma, Fibrolamellar
Multimedia: Hepatocellular Carcinoma, Fibrolamellar
References
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References

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Further Reading

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Keywords

HCC, fibrolamellar carcinoma, fibrolamellar hepatoma, oncocytic hepatocellular carcinoma

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Contributor Information and Disclosures

Author

W Ross Stevens, MD, Clinical Professor, Department of Radiology, Southern Illinois University School of Medicine; Head, Radiology Residency Director, Division of Gastrointestinal Radiology, St John's Hospital
W Ross Stevens, MD is a member of the following medical societies: American College of Radiology, American Medical Association, American Roentgen Ray Society, Illinois State Medical Society, and Radiological Society of North America
Disclosure: Nothing to disclose.

Medical Editor

John L Haddad, MD, Clinical Associate Professor, Department of Radiology, Weill Medical College of Cornell University; Director of Body MRI, Department of Radiology, Methodist Hospital in Houston
John L Haddad, MD is a member of the following medical societies: American College of Radiology, American Medical Association, and Radiological Society of North America
Disclosure: Nothing to disclose.

Pharmacy Editor

Bernard D Coombs, MB, ChB, PhD, Consulting Staff, Department of Specialist Rehabilitation Services, Hutt Valley District Health Board, New Zealand
Disclosure: Nothing to disclose.

Managing Editor

Udo P Schmiedl, MD, PhD, Clinical Professor, Department of Radiology, University of Washington; Consulting Staff, Swedish Medical Center, University of Washington Medical Center, Seattle Radiologists
Udo P Schmiedl, MD, PhD is a member of the following medical societies: American College of Radiology and Radiological Society of North America
Disclosure: Nothing to disclose.

CME Editor

Robert M Krasny, MD, Consulting Staff, Department of Radiology, The Angeles Clinic and Research Institute
Robert M Krasny, MD is a member of the following medical societies: American Roentgen Ray Society and Radiological Society of North America
Disclosure: Nothing to disclose.

Chief Editor

John Karani, MBBS, FRCR, Consulting Staff, Department of Radiology, King's College Hospital, London
Disclosure: Nothing to disclose.

 
 
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