OVERVIEW
Hepatic fibrous interlaminar carcinoma (FIC) is a rare primary hepatic malignancy that is most commonly seen in young patients without cirrhosis. Its degree of malignancy is lower than that of primary hepatocellular carcinoma, and the tumor is often more limited. The prognosis is better if it is detected at an early stage and surgically resected at an early stage.
Etiology
The etiology of FLC is not clear. Racial or environmental factors may be involved.FLC does not exist in patients with a history of hepatitis B virus infection and hepatic cirrhosis. Some reports suggest that FLC is transformed by focal nodular hyperplasia; others suggest that FLC originates from the proliferation of epithelial cells, followed by fiber growth leading to fibrous platysma-forming cell carcinoma.
Symptoms
FLC often occurs in children and adolescents between the ages of 5 and 35, and occasionally in middle-aged and elderly people. The incidence is approximately the same in both sexes. Abdominal discomfort, abdominal pain, abdominal distension, fatigue, anorexia, weight loss, palpable abdominal mass in most patients, and jaundice are less common.
Examination
1. ALT, AKP and serum bilirubin may be mildly to moderately elevated; a few FLC patients have elevated serum AFP and positive HBsAg.
2. Serum unsaturated vitamin B12 binding capacity, vitamin B12 concentration and plasma neurotensin and CEA are often elevated.
3. Pathologic diagnosis of FLC
(1) H-E staining shows abundant strong eosinophilic granules in the plasma of tumor cells.
(2) Collagen fibers and fibroblasts are in parallel rows in the form of laminae, encircling clusters of tumor cells with nest-like or sheet-like distribution.
4. Plain radiographs show foci of calcification within the tumor.
5. Ultrasonography can show homogeneous and fibrotic features in the tumor, and homogeneous strongly echogenic mass and strongly echogenic posterior shadow caused by calcification are its typical features.
6. Enhanced CT scan shows significant density enhancement of fibrous layer cancer.
7. Angiography shows a multivessel mass with significant coloration, and intervals are often seen in the capillary phase.
8. Nuclide imaging shows radioactive defects.
Diagnosis
Young patients, especially female patients with the above symptoms and signs, should be targeted to do relevant examinations, and the diagnosis is mainly based on clinical manifestations and laboratory and other auxiliary examinations. Histologic examination can clarify the diagnosis.
Differential diagnosis
FLC should be differentiated from ordinary hepatocellular carcinoma, focal nodular hyperplasia of the liver, hepatic adenoma and metastatic hepatocellular carcinoma.
1. Focal nodular hyperplasia can be detected by ultrasound and CT as liver-occupying lesions, and nuclide imaging suggests excessive uptake or normal uptake, whereas FLC is a radioactivity defect.
2. Hepatic adenoma is mainly seen in women of childbearing age with a history of oral contraceptives. 99mTc-PMT delayed imaging suggests that hepatic adenoma is strongly positive, and pathologic examination can make a definite diagnosis.
3. Secondary hepatocellular carcinoma has history or evidence of primary cancer. Ultrasonography mainly shows multiple round-like foci, hypoechoic when the mass is small, and hyperechoic when the mass is large; CT shows multiple round-like or irregular hypodense foci.
Treatment
1. Surgery
Since most FLC patients are located in the left liver and the tumor boundary is clear, and the patients are young and have no history of hepatic cirrhosis, the first choice of treatment is hemihepatectomy. For palliative resection, radiotherapy or chemotherapy can be supplemented.
2. For patients with unresectable liver tumor without extrahepatic metastasis
Hepatic artery ligation and intubation chemotherapy can be adopted first, and then resection can be performed after the tumor shrinks.
3. Liver transplantation can also be performed
FLC is the only liver transplantation with better effect in the treatment of primary liver cancer.
4. Transcatheter hepatic artery embolization
To shrink the tumor and relieve the symptoms.
Since FLC patients have late recurrence and slow growth after tumor resection, recurrent tumors can be resected again to remove the recurrent foci or extrahepatic metastases. Because FLC cells can secrete vitamin B12 binding protein and neurotensin, these two indicators can be used to monitor the tumor growth after surgery.
Prognosis
The median survival of clinical stage hepatocellular carcinoma is 6 months, while FLC can reach 32-68 months. The overall 5-year survival rate is 36%. The prognosis of FLC is much better than that of hepatocellular hepatocellular carcinoma.FLC has slow tumor growth, low malignancy, high surgical resection rate, and even if the tumor cannot be resected and has distant metastasis, the survival time of the patients reaches 24 months on average.