Fibrolamellar hepatocellular carcinoma

Case contributed by Mauricio Macagnan
Diagnosis almost certain


Incidental finding on ultrasound.

Patient Data

Age: 30 years
Gender: Female

Note: This case has been tagged as "legacy" as it no longer meets image preparation and/or other case publication guidelines.

Total Abdominal Ultrasonography

The liver contour is regular, with slightly heterogeneous parenchyma. In segment VIII, there is a slightly hypoechoic nodule, ill-defined margins, measuring about 8.2 x 8.1 x 5.3 cm, of undetermined etiology.

The dimensions and contour of the liver are preserved. There is a nodular lesion in segment VIII of the right hepatic lobe, with heterogeneous contrast enhancement in the arterial phase and tending to homogenize in the late phase, bordered by halo hypoattenuation.

A solid 6.6cm nodule in segment VIII, with high signal on T2-weighted sequence and DWI and intermediate signal intensity on the T1-weighted sequence. It has a markedly hypointense central scar on T2.

It displays slightly heterogeneous enhancement in the arterial phase, becoming homogeneous in the following stages, with the exception of its central scar.

One way to differentiate between Fibrolamellar Hepatocellular Carcinoma (FHC) and Focal Nodular Hyperplasia is through the central scar analyzed in sequence T2, where the FHC has low T2 signal and FNH has high T2 signal.

Case Discussion

Hepatic nodules are frequent findings in imaging and appropriate differentiation through imaging and clinical history helps to monitor and manage these patients.

This patient had an incidental liver nodule during abdominal ultrasound. It was worked up through computed tomography and MRI.

In this case, the difference between FHC and FNH is important and can be diagnosed with conventional MRI and contrast. Some cases may require specific contrasts, such as Primovist, to aid in differentiation when examination with conventional gadolinium is not sufficiently clear.

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