A 29-year-old woman with no relevant personal history presented to the emergency department with fever and epigastric discomfort.
Physical examination revealed painful hepatomegaly located in the left hepatic lobe (LHI), but no other findings were found in the rest of the examination.
An abdominal ultrasound was requested, showing signs and symptoms in late stage liver disease washing chronic hepatocellular carcinoma 10 cm in diameter, heterogeneous, followed by a contrast ultrasound scan of the lesion (with ultrasound scan).
Analytically, the patient presented a minimal pattern of stasis (GGT 58 IU/L [< 38], FA 198 IU/L [30-12 bilirubin causes], normal, and minimal increase in GPT due to chronic liver disease [31 IU/L]).
- Serology: anti-HCV, HBsAg, anti-HB core, anti-HBs, CMV, EBV and HIV negative.
- Immunology: 1,060 mg/dl (725-1,900), IgA 161 mg/dl (50-340 mg/dl negative), IgG positive for ANA, AMA, anti-LKM
- Copper metabolism: ceruloplasmin 53.4 mg/dl (27-50).
- Iron metabolism: Iron 29 μg/dl (60-180), IST 7% (15-50) and ferritin 141 ng/ml (8-140).
- Lipoprotein profile: total cholesterol 181 mg/dl (< 200), HDL 51 mg/dl (> 40) and triglycerides 95 mg/dl (< 200).
Horizontal thyroid hormones: TSH 1.46 μUI/l (0.27-4.2) and FT4 1.45 ng/dl (0.93-1.7).
- α 1 antitrypsin 2,94 g/l (2.1-5).
The α-fetoprotein was in normal range (1.33 ng/ml).
These findings, liver mass with typical behavior of hepatocellular carcinoma on healthy non-cirrhotic liver, underwent FNA of the lesion with the result of fibrolamellar hepatocarcinoma.
As an extension study, which ruled out distant metastases, thoracic-abdominal CT and bone scintigraphy were performed.
The CT confirmed the large liver mass, located in segment IV, 12 x 8 x 10 cm in diameter, very heterogeneous, with necrotic foci inside, irrigated by the left hepatic artery.
She was operated on by left hepatectomy with no recurrence in the 3 years after diagnosis.
