Fibrolamellar Carcinoma Clinical Presentation

Updated: Jan 08, 2020
  • Author: Michael A Choti, MD, MBA, FACS; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
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Presentation

History

Patients with fibrolamellar carcinoma (FLC) typically present with nonspecific symptoms or no symptoms at all. When symptoms develop, they are most commonly the following: [12, 13, 26, 27, 28]

  • Abdominal pain
  • Weight loss
  • Malaise

Uncommonly, presenting signs and symptoms may include the following:

  • Migratory thrombophlebitis (Trousseau syndrome) or venous thrombosis as a result of direct invasion of the hepatic veins and inferior vena cava (IVC) or mass effect on the IVC [29]
  • Pain and fever simulating a hepatic abscess [30]
  • Obstructive jaundice due to biliary compression [31, 32]
  • Gynecomastia, due to aromatase production by FLC cells and resultant conversion of circulating androgens to estrogens [26, 33, 34]

Other unusual presentations of fibrolamellar carcinoma have been summarized by Torbenson. [17]

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Physical Examination

The most common physical finding is an abdominal mass or fullness due to hepatomegaly. [26]

Unlike patients with typical hepatocellular carcinoma, the stigmata of chronic liver disease and portal hypertension are usually absent in patients with fibrolamellar carcinoma.

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