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Fibrolamellar Hepatocellular Carcinoma: Pre- and Posttherapy Evaluation with CT and MR Imaging¹

¹ From the Departments of Radiology (T.I., M.P.F., L.G.) and Surgery (W.M.), University of Pittsburgh Medical Center, 200 Lothrop St, Pittsburgh, PA 15213-2582; and the Department of Radiology, Yamanashi Medical University, Japan (T.I.). Received October 26, 1999; revision requested December 7; revision received January 4, 2000; accepted January 27. Address correspondence to M.P.F. (e-mail: federlemp@radserv.arad.upmc.edu).

View larger version (113K): [in a new window]   Figure 1a. Fibrolamellar HCC in a 27-year-old woman. Pretherapy, contrast-enhanced, transverse, helical CT sections. (a) Large central tumor (black arrows) compresses the IVC and the hepatic veins. Note the gas bubbles (white arrows) within the tumor, which indicates infarction. (b) Both the anterior and the posterior branches of the right portal vein (straight arrows) are occluded. Peripheral wedge-shaped infarcts (I) are noted along with satellite tumor nodules (curved arrows).

View larger version (112K): [in a new window]   Figure 1b. Fibrolamellar HCC in a 27-year-old woman. Pretherapy, contrast-enhanced, transverse, helical CT sections. (a) Large central tumor (black arrows) compresses the IVC and the hepatic veins. Note the gas bubbles (white arrows) within the tumor, which indicates infarction. (b) Both the anterior and the posterior branches of the right portal vein (straight arrows) are occluded. Peripheral wedge-shaped infarcts (I) are noted along with satellite tumor nodules (curved arrows).

View larger version (153K): [in a new window]   Figure 2a. Fibrolamellar HCC in a 28-year-old man. Pretherapy nonenhanced T1-weighted spin-echo MR imaging sections (700/20). (a) Transverse MR image shows a large tumor (straight arrows) that fills the right hepatic lobe. Note the flow void in the patent hepatic veins (HV) and the tumor thrombus (curved arrow) within the IVC. (b) Coronal MR section shows the tumor (arrow) extending into the IVC.

View larger version (155K): [in a new window]   Figure 2b. Fibrolamellar HCC in a 28-year-old man. Pretherapy nonenhanced T1-weighted spin-echo MR imaging sections (700/20). (a) Transverse MR image shows a large tumor (straight arrows) that fills the right hepatic lobe. Note the flow void in the patent hepatic veins (HV) and the tumor thrombus (curved arrow) within the IVC. (b) Coronal MR section shows the tumor (arrow) extending into the IVC.

View larger version (145K): [in a new window]   Figure 3a. Fibrolamellar HCC in a 19-year-old man. (a) Pretherapy transverse contrast-enhanced helical CT section obtained in the hepatic arterial phase. A large tumor (solid arrows) fills the left hepatic lobe. Central calcifications (open arrow) (also evident on nonenhanced scans [not shown]), hypervascularity, and heterogeneous enhancement are characteristic features, along with upper abdominal lymphadenopathy (N). (b) Pretherapy transverse contrast-enhanced helical CT section obtained in the hepatic arterial phase shows upper abdominal lymphadenopathy (N). The tumor and nodes were resected. (c) Surveillance contrast-enhanced transverse helical CT scan obtained 1 year later. Surgical clips (arrow) mark the edge of the liver along the line of resection. A huge recurrent tumor mass (M) occupies the mesentery and omentum. (d) Surveillance contrast-enhanced transverse helical CT scan obtained 1 year later. A huge recurrent tumor mass (M) occupies the mesentery and omentum, with malignant ascites and peritoneal tumor implants (arrow) also noted.

View larger version (131K): [in a new window]   Figure 3b. Fibrolamellar HCC in a 19-year-old man. (a) Pretherapy transverse contrast-enhanced helical CT section obtained in the hepatic arterial phase. A large tumor (solid arrows) fills the left hepatic lobe. Central calcifications (open arrow) (also evident on nonenhanced scans [not shown]), hypervascularity, and heterogeneous enhancement are characteristic features, along with upper abdominal lymphadenopathy (N). (b) Pretherapy transverse contrast-enhanced helical CT section obtained in the hepatic arterial phase shows upper abdominal lymphadenopathy (N). The tumor and nodes were resected. (c) Surveillance contrast-enhanced transverse helical CT scan obtained 1 year later. Surgical clips (arrow) mark the edge of the liver along the line of resection. A huge recurrent tumor mass (M) occupies the mesentery and omentum. (d) Surveillance contrast-enhanced transverse helical CT scan obtained 1 year later. A huge recurrent tumor mass (M) occupies the mesentery and omentum, with malignant ascites and peritoneal tumor implants (arrow) also noted.

View larger version (134K): [in a new window]   Figure 3c. Fibrolamellar HCC in a 19-year-old man. (a) Pretherapy transverse contrast-enhanced helical CT section obtained in the hepatic arterial phase. A large tumor (solid arrows) fills the left hepatic lobe. Central calcifications (open arrow) (also evident on nonenhanced scans [not shown]), hypervascularity, and heterogeneous enhancement are characteristic features, along with upper abdominal lymphadenopathy (N). (b) Pretherapy transverse contrast-enhanced helical CT section obtained in the hepatic arterial phase shows upper abdominal lymphadenopathy (N). The tumor and nodes were resected. (c) Surveillance contrast-enhanced transverse helical CT scan obtained 1 year later. Surgical clips (arrow) mark the edge of the liver along the line of resection. A huge recurrent tumor mass (M) occupies the mesentery and omentum. (d) Surveillance contrast-enhanced transverse helical CT scan obtained 1 year later. A huge recurrent tumor mass (M) occupies the mesentery and omentum, with malignant ascites and peritoneal tumor implants (arrow) also noted.

View larger version (123K): [in a new window]   Figure 3d. Fibrolamellar HCC in a 19-year-old man. (a) Pretherapy transverse contrast-enhanced helical CT section obtained in the hepatic arterial phase. A large tumor (solid arrows) fills the left hepatic lobe. Central calcifications (open arrow) (also evident on nonenhanced scans [not shown]), hypervascularity, and heterogeneous enhancement are characteristic features, along with upper abdominal lymphadenopathy (N). (b) Pretherapy transverse contrast-enhanced helical CT section obtained in the hepatic arterial phase shows upper abdominal lymphadenopathy (N). The tumor and nodes were resected. (c) Surveillance contrast-enhanced transverse helical CT scan obtained 1 year later. Surgical clips (arrow) mark the edge of the liver along the line of resection. A huge recurrent tumor mass (M) occupies the mesentery and omentum. (d) Surveillance contrast-enhanced transverse helical CT scan obtained 1 year later. A huge recurrent tumor mass (M) occupies the mesentery and omentum, with malignant ascites and peritoneal tumor implants (arrow) also noted.

View larger version (166K): [in a new window]   Figure 4. Recurrent fibrolamellar HCC in a 50-year-old woman 11 months after primary resection. Transverse contrast-enhanced helical CT section obtained in the portal venous phase. A surgical clip (open arrow) marks the line of resection. The recurrent fibrolamellar HCC (straight solid arrows) resembles an untreated fibrolamellar HCC: huge, hypervascular, and heterogeneous. Also note the portocaval adenopathy (curved solid arrow).