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Table 4 Clinicopathologic and imaging characteristic of fibrolamillar hepatocellular carcinoma in comparison to focal nodular hyperplasia and hepatocellular adenoma [21, 3545, 7072]

From: Contemporary management of fibrolamellar hepatocellular carcinoma: diagnosis, treatment, outcome, prognostic factors, and recent developments

Lesion Characteristics FL-HCC FNH HCA
Entity Malignant Benign, mainly proliferating normal hepatocytes Benign with the potential to malignant transformation
Location Anywhere in the liver Frequently in the periphery Anywhere in the liver
Size and number Single, large, and lobulated Single or multiple, small in size Single or multiple, small in size
Sex predilection No Otherwise healthy young women Otherwise healthy young women
Causal relationship to oral contraception (OC) Not known Not known Yes
Main findings on imaging CT: large tumor, heterogeneous hypervascular enhancement
MRI: Large tumor, hypointense on T1-weighted and hyperintense on T2-weighted images, T2 hypointense central scare, no fat component, hyperattenuating on the arterial phase, hypo-, iso-, or even hyperattenuating in venous phases
CT: arterial enhancement, presence of central scare
MRI: arterial enhancement, central scare predominantly T2 hyperintense, homogeneous signal intensity, accumulation of liver-specific contrast agent within the central area on delayed T1 images
CT: arterial enhancement, precontrast hyperdense areas showing hemorrhage, low-density areas showing necrosis or fat
MRI: arterial enhancement, hyperintense areas on T1, T2 images showing hemorrhage, hypointense areas on T1 that correlate to hyperintense areas on T2 images showing necrosis, no accumulation of liver-specific contrast agent within the lesion
Treatment Surgical Normally requires no treatment Discontinuation of OC, surgical
  1. FL-HCC fibrolamellar hepatocellular carcinoma, FNH focal nodular hyperplasia, HCA hepatocellular adenoma, CT computed tomography, MRI magnetic resonance imaging