Table 4 Clinicopathologic and imaging characteristic of fibrolamillar hepatocellular carcinoma in comparison to focal nodular hyperplasia and hepatocellular adenoma [21, 35–45, 70–72]
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 |