Abstract
A 45-year-old man who was pointed out having liver dysfunction in a medical checkup had an 8-cm liver tumor on an abdominal ultrasonography. The patient was referred to our hospital for further examination. Hepatitis B virus antigen and hepatitis C virus antibody were negative. Alpha-fetoprotein (AFP) and PIVKA-II remarkably elevated. Using CT (computed tomography) and MRI (magnetic resonance images) results, fibrolamellar hepatocellular carcinoma (FLHCC) was suspected. Bisegmentectomy 5 and 6 was performed. Histologic examination showed cancer cells proliferating in cords surrounded by lamellated collagen fibers which is characteristic of FLHCC. After the operation, AFP and PIVKA-II significantly increased and a nodule of the upper left lobe of the lung was discovered on CT. Lung partial resection was performed 22 months after the liver resection, and the pathological diagnosis was metastasis of FLHCC. As of 50 months after the initial operation, the patient is doing well without having elevation in tumor markers and signs of tumor recurrence. FLHCC is clinically and pathologically different from usual hepatocellular carcinoma. We report a case of FLHCC with lung metastasis in which operation was effective.
