The patient has biopsy proven HCC, but the serum alpha-feta-protein (AFP) was normal. Does this surprise you?
No. Fibrolamellar HCC is not associated with underlying cirrhosis and the AFP is usually normal.
Is it unusual for a fibrolamellar HCC to present as a large solitary liver mass?
No, in fact this is the commonest manner of presentation. They are typically large ( > 6cm) at the time of diagnosis.
Large well defined heterogenous mass in the left lobe of liver, with internal appearance like striations. No diffusion restriction and variably, largely only rim enhancement with washout and persistent delayed enhancement of the capsule with large non enhancing central necrosis.
No synchronous lesion.
No background hepatic cirrhosis.