it has distinct pathologic features and occurs typically without underlying hepatitis or cirrhotic liver and has prognosis slightly better than other forms of hepatocellular carcinoma ( hcc ) . this report describes the clinical findings , radiologic evaluation , and histological features of such a case . the study was performed according to the standards set by the helsinki declaration of 1975 , regarding the human research and was approved by an institutional ethics committee . informed consent was obtained from the patient described in this article . a twenty eight - year - old male presented with a two week history of dyspnea , cough , hemoptysis , chest pain , and fever 38 - 39c . he also complained of loss of appetite , general weakness and left leg pain for two months preceding admission . chest x - ray showed almost total atelectasis of the right lung with compensatory overinflation of the contralateral lung ( figure 1a ) . chest x - ray : almost total atelectasis of the right lung with compensatory overinflation of the contralateral lung ( a ) . ct : a lesion of diameter of 19.3  14.1  19.1 cm in the right lung , pleuritis , th3 osteolysis , and compensatory overinflation of the left lung ( b - d ) . using computed tomography ( ct ) , a lesion of diameter of 19.3  14.1  19.1 cm in the right lung , pleuritis , th3 osteolysis , and compensatory overinflation of the left lung was seen ( figure 1b - d ) . bronchoscopy revealed a total obstruction of the right main bronchus due to submucosal infiltration and compression of the right main bronchus with negative histology of bronchial biopsy specimens . usg of the abdomen revealed liver with numerous heterogeneous , solid areas hypo- and hyperechogenic , some of them with features of liquid or the disintegration up to diameter of 74 mm ( figure 2 ) . liver with numerous heterogeneous ( a ) , solid areas hypo- and hyperechogenic ( b ) , some of them with features of liquid or the disintegration ( a ) . transthoracic fine needle aspiration ( tfna ) revealed celullae suspectae probabiliter neoplasmaticae suggesting tumor fusocellularis ( figure 3a ) . subsequent tfna revealed groups of carcinoma adenoides - like cells with some features of liver origin ( figure 3b ) . fine needle aspiration ( fna ) of the liver revealed cancerous cells ( figure 3c ) . subsequent fna of the liver revealed epithelial cells with nuclear atypia with characteristic pattern of nests and cords of malignant cells , which were separated by lamellar bands of dense , hypocellular collagen connective tissue , with round cytoplasmatic inserts characteristic for fibrolamellar hepatocarcinoma ( figure 3d ) . tfna : celullae suspectae probabiliter neoplasmaticae ( a ) , groups of carcinoma adenoides like cells with some features of liver origin ( b ) . fna of the liver : cancerous cells ( c ) , epithelial cells with nuclear atypia with characteristic pattern of nests and cords of malignant cells , which were separated by lamellar bands of dense , hypocellular collagen connective tissue , with round cytoplasmatic inserts ( d ) . hepatocellular carcinoma is a highly malignant tumor , and the prognosis of hcc patients with extrahepatic metastases is poor , despite multimodality treatment applied . this rare variant of hcc accounts for less than 10% of all cases of hcc , which number falls between 2 - 3% of all malignant cases in the united states . fl - hcc presents as a large , up to 20 cm diameter solitary intrahepatic mass with well - defined margins and a lobulated contour . in most cases regional lymph nodes gross findings differentiate the fl - hcc from hcc as a well - demarcated , lobular , bile - stained , white or tan mass with a central stellate scar or fibrotic bands . the defining feature of fibrolamellar carcinoma is its triad of histological characteristics , i.e. , tumor cells with deeply eosinophilic cytoplasm , presence of macronucleoli and abundant fibrous stroma , arranged in thin parallel lamellae around the tumor cells . fl - hcc cases are advanced in up to 80% of patients at the time of diagnosis , with regional adenopathy predominantly found in up to 70% of patients . lungs are most common sites of metastasizing hcc , which is consistent with our case . in majority of hcc patients at the time of diagnosis distant metastases present as small solitary nodules . uka et al   reported that mediastinal metastases occurred in 6.5% of 151 patients with extrahepatic metastases from hcc , and all of these were lymph node metastases . ishii et al   reported pleural dissemination in 2 of 201 patients with extrahepatic metastases from hcc . however , many authors suggest more favorable prognosis of fl - hcc than that for conventional hcc . kakar et al , following the world health organization blue book statements on fibrolamellar carcinoma , suggest refraining from any comment about its outcome compared to conventional hepatocellular carcinoma . according to their study fibrolamellar tumor resectability is the basis of curative therapy for patients with hcc , but only approximately 30% of newly diagnosed patients undergo surgery and the 5-year survival rate is less than 80% . moreover , most of the inoperable hcc cases remain unresponsive to chemotherapy , with very poor prognosis , and survival . pinna et al   reported that in pediatric patients who undergo liver resection frequencies of metastases to the liver , abdominal lymph nodes , lungs , and mediastinal lymph nodes were 44% , 33% , 29% , and 10% , respectively . prognostic factors such as multiple tumors , lymph node metastasis , and vascular invasion influence the survival time of fl - hcc cases . , there has been no report of a case presenting with huge lung mass as a consequence of lung metastases of fibrolamellar hepatocarcinoma . in conclusion , fl - hcc is a rare histological variant of hcc and should be suspected in young patients with hcc without underlying liver disease . despite relatively slow growth and late recurrence of hcc , fl - hcc should be suspected in case of rapid growth , advanced or multiple metastases of lungs , or peritoneum at the time of diagnosis .
a twenty eight - year - old male presented with a two week history of dyspnea , cough , hemoptysis , chest pain , and fever 38 - 39c . 
 he also complained of loss of appetite , general weakness and left leg pain for two months preceding admission . 
 he was referred with suspicion of lung tumor to our institution . 
 chest x - ray showed almost total atelectasis of the right lung with compensatory overinflation of the contralateral lung . using computed tomography ( ct ) , a lesion of diameter of 19.3  14.1  19.1 cm in the right lung , pleuritis , th3 osteolysis , and compensatory overinflation of the left lung was seen . 
 bronchoscopy revealed a total obstruction of the right main bronchus due to submucosal infiltration and compression of the right main bronchus with negative histology of bronchial biopsy specimens . 
 transthoracic fine needle aspiration revealed celullae suspectae probabiliter neoplasmaticae suggesting tumor fusocellularis . 
 usg of the abdomen revealed liver with numerous heterogeneous , solid areas hypo- and hyperechogenic , some of them with features of liquid or the disintegration up to diameter of 74 mm . 
 subsequent fine needle aspirations of the thorax and liver revealed fibrolamellar hepatocarcinoma and carcinoma adenoides of the lung . 
 patient underwent chemotherapy with 5-fu / ddp / vcr with no response . 
 this report presents a case of a rare lung metastasis from fl - hcc .