Fibrolamellar hepatocellular carcinoma: Advances, challenges and opportunities in a rare malignancy

Table 1 Main characteristic of fibrolamellar hepatocellular carcinoma in imaging modalities

Modality	Characteristic findings	Diagnostic utility
Computed tomography	Large, lobulated mass with central scar, calcifications	Good for detecting mass, vascular involvement
Magnetic resonance image	T2 hyperintense mass, T1 hypointense, scar hypointense	Better for soft tissue contrast, evaluates central scar
Ultrasound	Hypoechoic, heterogeneous lesion	First-line, limited specificity
PET/CT	May be useful in recurrence or unclear imaging	Not standard, adjunct in certain scenarios

PET: Positron emission tomography; CT: Computed tomography.

Table 2 Summary of differences between fibrolamellar and convention hepatocellular carcinoma

Feature	FLHCC	Conventional HCC
Typical age group	Adolescents/young adults	Older adults with liver disease
Underlying liver disease	Absent	Often present
AFP elevation	Rare	Common
Histology	Large eosinophilic cells, fibrous lamellae	Variable, often trabecular
Genetic alterations	DNAJB1-PRKACA fusion	TP53, TERT, CTNNB1 mutations
Common metastasis sites	Lymph nodes, lungs, peritoneum	Lungs, bones

AFP: Alpha-fetoprotein; FLHCC: Fibrolamellar hepatocellular carcinoma; HCC: Hepatocellular carcinoma.