2021 Volume 60 Issue 6 Pages 353-358
Background : Fibrolamellar carcinoma (FLC) is a rare variant of hepatocellular carcinoma that predominantly affects relatively young persons with no underlying liver disease.
Case : Herein, we present the case of a 37-year-old woman, who was diagnosed as having a rapidly evolving FLC. On admission, she was diagnosed as having multiple liver tumors, with multiple lymph node metastases. Tests for both hepatitis B antigens and hepatitis C antibodies were negative, and the serum α-fetoprotein level was within normal limits. A tentative diagnosis of FLC was made based on the findings of fine-needle aspiration cytology (FNAC) of material obtained from an enlarged cervical lymph node. The tumor cells were large, discohesive, and polygonal in shape, with abundant granular cytoplasm. We also noted some neoplastic cells containing “pale bodies.” On immunocytochemical analysis, the neoplastic cells showed strongly positive staining for arginase-1 and cytokeratin 7, and less pronounced staining for CD68. The patient died 20 days after admission, and an autopsy examination confirmed the diagnosis of FLC with general metastases and pulmonary lymphangitis carcinomatosa.
Conclusion : Although the diagnosis of FLC can pose challenges, recognition of the specific morphological and immunohistochemical features of FLC, even by FNAC of material obtained from a metastatic site, can facilitate diagnosis.
