Fibrolamellar hepatocellular carcinoma: not a rare tumor in India and a possible new marker

Singhal, D.; Vasdev, N.; Gupta, S.; Soin, A.S.; Nayak, N.C. and Nundy, S. (2002) Fibrolamellar hepatocellular carcinoma: not a rare tumor in India and a possible new marker. Journal of Gastroenterology and Hepatology, 17 (Suppl).

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Abstract

Background: Fibrolamellar Hepatocellular carcinoma (FL-HCC) is a rare tumour occurring mainly in young patients (mean age 25 years) in Western countries. There are no large series from Asia. It is difficult to make the clinically important distinction between FL-HCC and focal nodular hyperplasia by imaging or FNAC. We report our experience with FL-HCC over a 17-month period and the use of the immunohistochemical stain CD99 that may increase diagnostic accuracy and help in treatment planning. Patients and Methods: 24 patients underwent major hepatectomies for liver tumours between 1st August 2000 anr1 31st December 2001. Of these, six had FL-HCC. To further characterize the tumours and to differentiate from benign hyperplastic lesions, we stained them with CD99 (an immunohistochemical marker used for other malignant tumours) and AFP. Results: There were 4 males and 2 females whose ages ranged from 33 to 56 years (median 41 years). Two patients had severe steatohepatitis and severe postoperative complications. One patient died, another was lost to follow up and four are alive at 3-15 months. All six tumours stained positive for CD99, as did nine hepatocellular carcinomas resected during the same period. Six normal liver specimens and three primaries (pancreas and colon) which did not stain for this marker served as negative controls. All the FL-HCC specimens stained negative for AFP. Discussion and Conclusions: FL-HCC is not a rare tumour in India and occurs in an older population than in western countries. The histochemical marker CD99 may provide additional information to diagnose the lesion preoperatively by fine needle aspiration.

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