PMC6304646_01
Abdominal magnetic resonance images: (a) T1W, (b) arterial phase, and (c) portal phase. Focal hepatic lesion with lobulated borders and a 13 cms of diameter which has signal heterogeneity in T1 and T2 sequences, with restrictive regions in the diffusion sequence; the lesions are highlighted in the arterial phase; they are practically isointense in the portal and late phase. Irregular hypointense linear area which corresponds to a scar zone.
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fig1
Abdominal magnetic resonance imaging was then carried out (Figure 1) which showed results compatible with fibrolamellar hepatocarcinoma, with no signs of cirrhosis or portal hypertension.
Histopathological findings of the tumor. Tumor made up of polygonal cells with a broad eosinophilic cytoplasm and a vesicular nucleus with a prominent central nucleolus. The tumor cells are separated by fibrocollagenous lamellae which are highlighted with Masson's trichrome staining.
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fig2
Given the lack of an etiology of the hyperammonemic encephalopathy and findings suggestive of fibrolamellar hepatocellular carcinoma, a liver biopsy was performed which confirmed the diagnosis through immunohistochemistry (Figure 2) which reports diffuse and intense expression for cytokeratin 7Y CD68, with marked sinusoidal capillarization with CD34 and expression for CD68 there is weak but diffuse expression for glutamine synthetase, and glypican 3 and amyloid A are negative.