Ann Hepatobiliary Pancreat Surg.  2017 Feb;21(1):48-51. 10.14701/ahbps.2017.21.1.48.

Fibrolamellar variant of hepatocellular carcinoma presenting during pregnancy: management dilemmas

• Vishnu N
• Kulkarni A
• Vidhyalakshmi S
• Sambandam
• Garg P
• LeelaKrishnan V
• Janarthan
• Singh G
• Kaur M
• Chitra T
• John BJ

• KMID: 2371567
• DOI: http://doi.org/10.14701/ahbps.2017.21.1.48

Abstract

The Fibrolamellar variant of Hepatocellular Carcinoma (FLHCC) is a rare form of liver cancer that presents in the 3(rd) decade of life, is rarely associated with cirrhosis or chronic Hepatitis B/C virus infection, and usually presents with normal serum alpha-fetoprotein (AFP) levels. FLHCC presenting during pregnancy is extremely rare, with only 4 cases reported. We present a case of FLHCC in pregnancy and discuss the dilemmas in management. A 26 year-old primigravida, 26 weeks of gestation presented with a month's history of obstructive jaundice secondary. Investigations revealed a mass in the left lateral segment of the liver with extension down the left hepatic duct into the common bile duct. Following an emergency caesarean section at 31 weeks, she underwent a left hepatectomy with extrahepatic bile duct excision. The postoperative course was uneventful. Histopathology showed FLHCC. In conclusion, liver tumors presenting during pregnancy should be managed in a multidisciplinary setup with facilities for neonatal intensive care. Management depends on the presumed pathology, period of gestation and family preferences.

Keyword

Liver; Tumor; Pregnancy; Fibrolamellar; Hepatocellular cancer

MeSH Terms

alpha-Fetoproteins
Bile Ducts, Extrahepatic
Carcinoma, Hepatocellular*
Cesarean Section
Common Bile Duct
Emergencies
Female
Fibrosis
Hepatectomy
Hepatic Duct, Common
Hepatitis, Chronic
Humans
Infant, Newborn
Intensive Care, Neonatal
Jaundice, Obstructive
Liver
Liver Neoplasms
Pathology
Pregnancy*
alpha-Fetoproteins

Figure

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  Fig. 1 Magnetic resonance imaging showing tumor in segments II and III with central hypointense scar (arrow).

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  Fig. 2 Computed tomography scan shows tumor in segments II and III (black arrow) and extension into the CBD (white arrow).

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  Fig. 3 Operative photograph showing a lesion at the segments II and III.

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  Fig. 4 Microphotograph showing neoplastic cells arranged in a lamellar pattern surrounded by dense fibrosis.

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  Fig. 5 Microphotograph showing neoplastic cells positive for Cytokeratin 7.

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  Fig. 6 Management algorithm for liver malignancy diagnosed during pregnancy. DTT, definitive tumor therapy; MTP, medical termination of pregnancy.

Reference

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