From the Archives of the AFIP
Fibrolamellar Carcinoma of the Liver: Radiologic-Pathologic Correlation
John K. McLarney, MAJ, MC, USA1,
Patrick T. Rucker, MD1,
Greg N. Bender, COL, MC, USA1,
Zachary D. Goodman, MD2,
Naoko Kashitani, MD1,3 and
Pablo R. Ros, MD, MPH1,4
1 Departments of Radiologic Pathology (J.K.M., P.T.R., G.N.B., N.K., P.R.R.)
2 Hepatobiliary Pathology (Z.D.G.), Armed Forces Institute of Pathology, 14th and Alaska Sts, NW, Washington DC 20306
3 Department of Radiology, Okayama University, Japan (N.K.)
4 Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass (P.R.R.)
View larger version (165K):
[in a new window]
|
Figure 1a. Histologic appearance of fibrolamellar carcinoma. (a) High-power photomicrograph (original magnification, x160; hematoxylin-eosin stain) demonstrates nests of fibrolamellar malignant tumor cells (arrowhead) separated by fibrotic strands or lamellae (arrow). (b) High-power photomicrograph (original magnification, x160; hematoxylin-eosin stain) shows more confluent fibrosis separating the malignant tumor cells. (c) High-power photomicrograph (original magnification, x280; hematoxylin-eosin stain) shows the granular (mitochondria-laden) appearance of the cytoplasm and large nuclei with prominent nucleoli (arrow). (d) High-power photomicrograph (original magnification, x160; Masson stain) demonstrates intense staining of lamellae, indicative of extensive collagen.
|
|
View larger version (167K):
[in a new window]
|
Figure 1b. Histologic appearance of fibrolamellar carcinoma. (a) High-power photomicrograph (original magnification, x160; hematoxylin-eosin stain) demonstrates nests of fibrolamellar malignant tumor cells (arrowhead) separated by fibrotic strands or lamellae (arrow). (b) High-power photomicrograph (original magnification, x160; hematoxylin-eosin stain) shows more confluent fibrosis separating the malignant tumor cells. (c) High-power photomicrograph (original magnification, x280; hematoxylin-eosin stain) shows the granular (mitochondria-laden) appearance of the cytoplasm and large nuclei with prominent nucleoli (arrow). (d) High-power photomicrograph (original magnification, x160; Masson stain) demonstrates intense staining of lamellae, indicative of extensive collagen.
|
|
View larger version (165K):
[in a new window]
|
Figure 1c. Histologic appearance of fibrolamellar carcinoma. (a) High-power photomicrograph (original magnification, x160; hematoxylin-eosin stain) demonstrates nests of fibrolamellar malignant tumor cells (arrowhead) separated by fibrotic strands or lamellae (arrow). (b) High-power photomicrograph (original magnification, x160; hematoxylin-eosin stain) shows more confluent fibrosis separating the malignant tumor cells. (c) High-power photomicrograph (original magnification, x280; hematoxylin-eosin stain) shows the granular (mitochondria-laden) appearance of the cytoplasm and large nuclei with prominent nucleoli (arrow). (d) High-power photomicrograph (original magnification, x160; Masson stain) demonstrates intense staining of lamellae, indicative of extensive collagen.
|
|
View larger version (154K):
[in a new window]
|
Figure 1d. Histologic appearance of fibrolamellar carcinoma. (a) High-power photomicrograph (original magnification, x160; hematoxylin-eosin stain) demonstrates nests of fibrolamellar malignant tumor cells (arrowhead) separated by fibrotic strands or lamellae (arrow). (b) High-power photomicrograph (original magnification, x160; hematoxylin-eosin stain) shows more confluent fibrosis separating the malignant tumor cells. (c) High-power photomicrograph (original magnification, x280; hematoxylin-eosin stain) shows the granular (mitochondria-laden) appearance of the cytoplasm and large nuclei with prominent nucleoli (arrow). (d) High-power photomicrograph (original magnification, x160; Masson stain) demonstrates intense staining of lamellae, indicative of extensive collagen.
|
|
View larger version (117K):
[in a new window]
|
Figure 2a. Fibrolamellar carcinoma in a 20-year-old man who presented with abdominal pain. (a) Abdominal radiograph demonstrates an irregular, nodular calcification (black arrow) within a hepatic mass as well as a pulmonary metastasis (white arrow). (b) Gallium-67 citrate scan shows increased uptake in the hepatic mass.
|
|
View larger version (111K):
[in a new window]
|
Figure 2b. Fibrolamellar carcinoma in a 20-year-old man who presented with abdominal pain. (a) Abdominal radiograph demonstrates an irregular, nodular calcification (black arrow) within a hepatic mass as well as a pulmonary metastasis (white arrow). (b) Gallium-67 citrate scan shows increased uptake in the hepatic mass.
|
|
View larger version (114K):
[in a new window]
|
Figure 3a. Fibrolamellar carcinoma in a 34-year-old patient with elevated levels of transaminase. (a) US scan demonstrates a 15-cm echogenic intrahepatic mass with irregular margins and a hypoechoic rim. (b) On a contrast material–enhanced CT scan, the mass demonstrates linear, enhancing vessels that create "compartments" within the tumor. (c) Hepatic angiogram (arterial phase) demonstrates the large intrahepatic mass with tortuous, irregular vessels that compartmentalize the tumor. (d) Technetium-99m–labeled sulfur colloid scan displays a cold defect, which corresponds to the mass. (e) Photograph of the gross specimen shows the lobulated mass with a central scar that was not visualized on images.
|
|
View larger version (129K):
[in a new window]
|
Figure 3b. Fibrolamellar carcinoma in a 34-year-old patient with elevated levels of transaminase. (a) US scan demonstrates a 15-cm echogenic intrahepatic mass with irregular margins and a hypoechoic rim. (b) On a contrast material–enhanced CT scan, the mass demonstrates linear, enhancing vessels that create "compartments" within the tumor. (c) Hepatic angiogram (arterial phase) demonstrates the large intrahepatic mass with tortuous, irregular vessels that compartmentalize the tumor. (d) Technetium-99m–labeled sulfur colloid scan displays a cold defect, which corresponds to the mass. (e) Photograph of the gross specimen shows the lobulated mass with a central scar that was not visualized on images.
|
|
View larger version (98K):
[in a new window]
|
Figure 3c. Fibrolamellar carcinoma in a 34-year-old patient with elevated levels of transaminase. (a) US scan demonstrates a 15-cm echogenic intrahepatic mass with irregular margins and a hypoechoic rim. (b) On a contrast material–enhanced CT scan, the mass demonstrates linear, enhancing vessels that create "compartments" within the tumor. (c) Hepatic angiogram (arterial phase) demonstrates the large intrahepatic mass with tortuous, irregular vessels that compartmentalize the tumor. (d) Technetium-99m–labeled sulfur colloid scan displays a cold defect, which corresponds to the mass. (e) Photograph of the gross specimen shows the lobulated mass with a central scar that was not visualized on images.
|
|
View larger version (65K):
[in a new window]
|
Figure 3d. Fibrolamellar carcinoma in a 34-year-old patient with elevated levels of transaminase. (a) US scan demonstrates a 15-cm echogenic intrahepatic mass with irregular margins and a hypoechoic rim. (b) On a contrast material–enhanced CT scan, the mass demonstrates linear, enhancing vessels that create "compartments" within the tumor. (c) Hepatic angiogram (arterial phase) demonstrates the large intrahepatic mass with tortuous, irregular vessels that compartmentalize the tumor. (d) Technetium-99m–labeled sulfur colloid scan displays a cold defect, which corresponds to the mass. (e) Photograph of the gross specimen shows the lobulated mass with a central scar that was not visualized on images.
|
|
View larger version (131K):
[in a new window]
|
Figure 3e. Fibrolamellar carcinoma in a 34-year-old patient with elevated levels of transaminase. (a) US scan demonstrates a 15-cm echogenic intrahepatic mass with irregular margins and a hypoechoic rim. (b) On a contrast material–enhanced CT scan, the mass demonstrates linear, enhancing vessels that create "compartments" within the tumor. (c) Hepatic angiogram (arterial phase) demonstrates the large intrahepatic mass with tortuous, irregular vessels that compartmentalize the tumor. (d) Technetium-99m–labeled sulfur colloid scan displays a cold defect, which corresponds to the mass. (e) Photograph of the gross specimen shows the lobulated mass with a central scar that was not visualized on images.
|
|
View larger version (112K):
[in a new window]
|
Figure 4a. Fibrolamellar carcinoma in a patient who presented with jaundice. (a) US scan shows a heterogeneous mass with a hyperechoic scar and shadowing from the calcification. (b) T2-weighted spin-echo MR image (repetition time msec/echo time msec = 2,216/80) demonstrates the hyperintense mass with a hypointense scar (arrow). Intrahepatic biliary dilatation adenopathy in the porta hepatis (not shown) was an incidental finding.
|
|
View larger version (127K):
[in a new window]
|
Figure 4b. Fibrolamellar carcinoma in a patient who presented with jaundice. (a) US scan shows a heterogeneous mass with a hyperechoic scar and shadowing from the calcification. (b) T2-weighted spin-echo MR image (repetition time msec/echo time msec = 2,216/80) demonstrates the hyperintense mass with a hypointense scar (arrow). Intrahepatic biliary dilatation adenopathy in the porta hepatis (not shown) was an incidental finding.
|
|
View larger version (135K):
[in a new window]
|
Figure 5a. Progressive homogeneity of fibrolamellar carcinoma at dynamic CT. (a) Nonenhanced CT scan shows a large low-attenuation mass. (b) Contrast-enhanced arterial-phase CT scan demonstrates irregular heterogeneous enhancement of the lesion and fails to show a scar. (c) Contrast-enhanced CT scan shows a 3.0-cm enlarged heterogeneous lymph node with central necrosis in the porta hepatis. (d) Contrast-enhanced equilibrium-phase CT scan shows that the tumor has become more homogeneous and has evidence of a central scar. (e) Photograph of the bivalved gross specimen demonstrates the lobulated tumor with a small, central, yellowish fibrous scar.
|
|
View larger version (120K):
[in a new window]
|
Figure 5b. Progressive homogeneity of fibrolamellar carcinoma at dynamic CT. (a) Nonenhanced CT scan shows a large low-attenuation mass. (b) Contrast-enhanced arterial-phase CT scan demonstrates irregular heterogeneous enhancement of the lesion and fails to show a scar. (c) Contrast-enhanced CT scan shows a 3.0-cm enlarged heterogeneous lymph node with central necrosis in the porta hepatis. (d) Contrast-enhanced equilibrium-phase CT scan shows that the tumor has become more homogeneous and has evidence of a central scar. (e) Photograph of the bivalved gross specimen demonstrates the lobulated tumor with a small, central, yellowish fibrous scar.
|
|
View larger version (109K):
[in a new window]
|
Figure 5c. Progressive homogeneity of fibrolamellar carcinoma at dynamic CT. (a) Nonenhanced CT scan shows a large low-attenuation mass. (b) Contrast-enhanced arterial-phase CT scan demonstrates irregular heterogeneous enhancement of the lesion and fails to show a scar. (c) Contrast-enhanced CT scan shows a 3.0-cm enlarged heterogeneous lymph node with central necrosis in the porta hepatis. (d) Contrast-enhanced equilibrium-phase CT scan shows that the tumor has become more homogeneous and has evidence of a central scar. (e) Photograph of the bivalved gross specimen demonstrates the lobulated tumor with a small, central, yellowish fibrous scar.
|
|
View larger version (109K):
[in a new window]
|
Figure 5d. Progressive homogeneity of fibrolamellar carcinoma at dynamic CT. (a) Nonenhanced CT scan shows a large low-attenuation mass. (b) Contrast-enhanced arterial-phase CT scan demonstrates irregular heterogeneous enhancement of the lesion and fails to show a scar. (c) Contrast-enhanced CT scan shows a 3.0-cm enlarged heterogeneous lymph node with central necrosis in the porta hepatis. (d) Contrast-enhanced equilibrium-phase CT scan shows that the tumor has become more homogeneous and has evidence of a central scar. (e) Photograph of the bivalved gross specimen demonstrates the lobulated tumor with a small, central, yellowish fibrous scar.
|
|
View larger version (97K):
[in a new window]
|
Figure 5e. Progressive homogeneity of fibrolamellar carcinoma at dynamic CT. (a) Nonenhanced CT scan shows a large low-attenuation mass. (b) Contrast-enhanced arterial-phase CT scan demonstrates irregular heterogeneous enhancement of the lesion and fails to show a scar. (c) Contrast-enhanced CT scan shows a 3.0-cm enlarged heterogeneous lymph node with central necrosis in the porta hepatis. (d) Contrast-enhanced equilibrium-phase CT scan shows that the tumor has become more homogeneous and has evidence of a central scar. (e) Photograph of the bivalved gross specimen demonstrates the lobulated tumor with a small, central, yellowish fibrous scar.
|
|
View larger version (135K):
[in a new window]
|
Figure 6a. Increasing homogeneity of fibrolamellar carcinoma and better scar visualization at delayed CT. (a) Nonenhanced CT scan demonstrates a low-attenuation mass with punctate calcifications within a central scar. (b) Contrast-enhanced arterial-phase CT scan shows initial heterogeneous enhancement of the mass. (c) Contrast-enhanced equilibrium-phase CT scan shows increasing homogeneity of the tumor with superior visualization of the scar (arrow).
|
|
View larger version (115K):
[in a new window]
|
Figure 6b. Increasing homogeneity of fibrolamellar carcinoma and better scar visualization at delayed CT. (a) Nonenhanced CT scan demonstrates a low-attenuation mass with punctate calcifications within a central scar. (b) Contrast-enhanced arterial-phase CT scan shows initial heterogeneous enhancement of the mass. (c) Contrast-enhanced equilibrium-phase CT scan shows increasing homogeneity of the tumor with superior visualization of the scar (arrow).
|
|
View larger version (116K):
[in a new window]
|
Figure 6c. Increasing homogeneity of fibrolamellar carcinoma and better scar visualization at delayed CT. (a) Nonenhanced CT scan demonstrates a low-attenuation mass with punctate calcifications within a central scar. (b) Contrast-enhanced arterial-phase CT scan shows initial heterogeneous enhancement of the mass. (c) Contrast-enhanced equilibrium-phase CT scan shows increasing homogeneity of the tumor with superior visualization of the scar (arrow).
|
|
View larger version (103K):
[in a new window]
|
Figure 7a. Delayed enhancement of the central scar in fibrolamellar carcinoma at delayed CT. (a) Contrast-enhanced CT scan demonstrates a heterogeneously enhancing mass with a low-attenuation central scar. (b) Delayed contrast-enhanced CT scan demonstrates delayed enhancement of the central scar (black arrow) and peripheral enhancement of the pseudocapsule (white arrow).
|
|
View larger version (99K):
[in a new window]
|
Figure 7b. Delayed enhancement of the central scar in fibrolamellar carcinoma at delayed CT. (a) Contrast-enhanced CT scan demonstrates a heterogeneously enhancing mass with a low-attenuation central scar. (b) Delayed contrast-enhanced CT scan demonstrates delayed enhancement of the central scar (black arrow) and peripheral enhancement of the pseudocapsule (white arrow).
|
|
View larger version (145K):
[in a new window]
|
Figure 8. Fibrolamellar carcinoma with capsular retraction. Nonenhanced CT scan demonstrates a large mass with capsular retraction (arrow), which is an uncommon finding in malignant neoplasms.
|
|
View larger version (119K):
[in a new window]
|
Figure 9a. Fibrolamellar carcinoma in a 23-year-old woman who presented with bilateral iliofemoral vein thrombosis. (a, b) Contrast-enhanced CT scans (a obtained at a higher level than b) show a 6.5-cm heterogeneous mass in the right hepatic lobe and an enlarged lymph node adjacent and posterior to the pancreas. The lymph node contains a central scar (arrow in b) and is compressing the inferior vena cava. (c) Hepatic angiogram (obtained with a superior mesentery artery injection) shows the intrahepatic vascular mass replacing the right hepatic artery and the posterior pancreatic lymph node with an enlarged supplying artery and neovascularity (arrowhead). The narrowing of the proximal replaced right hepatic artery (arrow) was caused by mass effect of the adjacent tumor and not direct arterial invasion. (d) Photograph of the resected lymph node shows the tumor, which has replaced the normal tissue and contains a central scar of fibrosis.
|
|
View larger version (130K):
[in a new window]
|
Figure 9b. Fibrolamellar carcinoma in a 23-year-old woman who presented with bilateral iliofemoral vein thrombosis. (a, b) Contrast-enhanced CT scans (a obtained at a higher level than b) show a 6.5-cm heterogeneous mass in the right hepatic lobe and an enlarged lymph node adjacent and posterior to the pancreas. The lymph node contains a central scar (arrow in b) and is compressing the inferior vena cava. (c) Hepatic angiogram (obtained with a superior mesentery artery injection) shows the intrahepatic vascular mass replacing the right hepatic artery and the posterior pancreatic lymph node with an enlarged supplying artery and neovascularity (arrowhead). The narrowing of the proximal replaced right hepatic artery (arrow) was caused by mass effect of the adjacent tumor and not direct arterial invasion. (d) Photograph of the resected lymph node shows the tumor, which has replaced the normal tissue and contains a central scar of fibrosis.
|
|
View larger version (133K):
[in a new window]
|
Figure 9c. Fibrolamellar carcinoma in a 23-year-old woman who presented with bilateral iliofemoral vein thrombosis. (a, b) Contrast-enhanced CT scans (a obtained at a higher level than b) show a 6.5-cm heterogeneous mass in the right hepatic lobe and an enlarged lymph node adjacent and posterior to the pancreas. The lymph node contains a central scar (arrow in b) and is compressing the inferior vena cava. (c) Hepatic angiogram (obtained with a superior mesentery artery injection) shows the intrahepatic vascular mass replacing the right hepatic artery and the posterior pancreatic lymph node with an enlarged supplying artery and neovascularity (arrowhead). The narrowing of the proximal replaced right hepatic artery (arrow) was caused by mass effect of the adjacent tumor and not direct arterial invasion. (d) Photograph of the resected lymph node shows the tumor, which has replaced the normal tissue and contains a central scar of fibrosis.
|
|
View larger version (143K):
[in a new window]
|
Figure 9d. Fibrolamellar carcinoma in a 23-year-old woman who presented with bilateral iliofemoral vein thrombosis. (a, b) Contrast-enhanced CT scans (a obtained at a higher level than b) show a 6.5-cm heterogeneous mass in the right hepatic lobe and an enlarged lymph node adjacent and posterior to the pancreas. The lymph node contains a central scar (arrow in b) and is compressing the inferior vena cava. (c) Hepatic angiogram (obtained with a superior mesentery artery injection) shows the intrahepatic vascular mass replacing the right hepatic artery and the posterior pancreatic lymph node with an enlarged supplying artery and neovascularity (arrowhead). The narrowing of the proximal replaced right hepatic artery (arrow) was caused by mass effect of the adjacent tumor and not direct arterial invasion. (d) Photograph of the resected lymph node shows the tumor, which has replaced the normal tissue and contains a central scar of fibrosis.
|
|
View larger version (123K):
[in a new window]
|
Figure 10a. Fibrolamellar carcinoma invading the portal vein. (a) T2-weighted spin-echo MR image (4,000/14) shows a heterogeneous hyperintense mass with a hypointense scar. (b) T1-weighted spin-echo MR image (550/15) shows soft tissue expanding the right and left portal veins (arrows). Cavernous transformation is present, with signal voids from blood flow surrounding the left portal vein (arrowhead). (c) Contrast-enhanced CT scan demonstrates the calcified fibrolamellar carcinoma, but portal vein invasion is more difficult to detect (arrow).
|
|
View larger version (117K):
[in a new window]
|
Figure 10b. Fibrolamellar carcinoma invading the portal vein. (a) T2-weighted spin-echo MR image (4,000/14) shows a heterogeneous hyperintense mass with a hypointense scar. (b) T1-weighted spin-echo MR image (550/15) shows soft tissue expanding the right and left portal veins (arrows). Cavernous transformation is present, with signal voids from blood flow surrounding the left portal vein (arrowhead). (c) Contrast-enhanced CT scan demonstrates the calcified fibrolamellar carcinoma, but portal vein invasion is more difficult to detect (arrow).
|
|
View larger version (138K):
[in a new window]
|
Figure 10c. Fibrolamellar carcinoma invading the portal vein. (a) T2-weighted spin-echo MR image (4,000/14) shows a heterogeneous hyperintense mass with a hypointense scar. (b) T1-weighted spin-echo MR image (550/15) shows soft tissue expanding the right and left portal veins (arrows). Cavernous transformation is present, with signal voids from blood flow surrounding the left portal vein (arrowhead). (c) Contrast-enhanced CT scan demonstrates the calcified fibrolamellar carcinoma, but portal vein invasion is more difficult to detect (arrow).
|
|
View larger version (115K):
[in a new window]
|
Figure 11a. Fibrolamellar carcinoma in a 22-year-old woman. (a) T1-weighted gradient-echo MR image (90/150, 4° flip angle) demonstrates a slightly hypointense mass with a central hypointense scar. (b) On the T2-weighted spin-echo MR image (3,800/90), the mass is hyperintense and the scar remains hypointense. (c, d) On gadolinium-enhanced T1-weighted gradient-echo images (90/150, 4° flip angle) obtained in early (c) and delayed (d) phases, the mass heterogeneously enhances during the early phase and becomes increasingly homogeneous in the late phase. (e) Photograph of the cut gross specimen shows the lobulated, well-demarcated mass with a central scar and visible bile staining.
|
|
View larger version (78K):
[in a new window]
|
Figure 11b. Fibrolamellar carcinoma in a 22-year-old woman. (a) T1-weighted gradient-echo MR image (90/150, 4° flip angle) demonstrates a slightly hypointense mass with a central hypointense scar. (b) On the T2-weighted spin-echo MR image (3,800/90), the mass is hyperintense and the scar remains hypointense. (c, d) On gadolinium-enhanced T1-weighted gradient-echo images (90/150, 4° flip angle) obtained in early (c) and delayed (d) phases, the mass heterogeneously enhances during the early phase and becomes increasingly homogeneous in the late phase. (e) Photograph of the cut gross specimen shows the lobulated, well-demarcated mass with a central scar and visible bile staining.
|
|
View larger version (93K):
[in a new window]
|
Figure 11c. Fibrolamellar carcinoma in a 22-year-old woman. (a) T1-weighted gradient-echo MR image (90/150, 4° flip angle) demonstrates a slightly hypointense mass with a central hypointense scar. (b) On the T2-weighted spin-echo MR image (3,800/90), the mass is hyperintense and the scar remains hypointense. (c, d) On gadolinium-enhanced T1-weighted gradient-echo images (90/150, 4° flip angle) obtained in early (c) and delayed (d) phases, the mass heterogeneously enhances during the early phase and becomes increasingly homogeneous in the late phase. (e) Photograph of the cut gross specimen shows the lobulated, well-demarcated mass with a central scar and visible bile staining.
|
|
View larger version (106K):
[in a new window]
|
Figure 11d. Fibrolamellar carcinoma in a 22-year-old woman. (a) T1-weighted gradient-echo MR image (90/150, 4° flip angle) demonstrates a slightly hypointense mass with a central hypointense scar. (b) On the T2-weighted spin-echo MR image (3,800/90), the mass is hyperintense and the scar remains hypointense. (c, d) On gadolinium-enhanced T1-weighted gradient-echo images (90/150, 4° flip angle) obtained in early (c) and delayed (d) phases, the mass heterogeneously enhances during the early phase and becomes increasingly homogeneous in the late phase. (e) Photograph of the cut gross specimen shows the lobulated, well-demarcated mass with a central scar and visible bile staining.
|
|
View larger version (102K):
[in a new window]
|
Figure 11e. Fibrolamellar carcinoma in a 22-year-old woman. (a) T1-weighted gradient-echo MR image (90/150, 4° flip angle) demonstrates a slightly hypointense mass with a central hypointense scar. (b) On the T2-weighted spin-echo MR image (3,800/90), the mass is hyperintense and the scar remains hypointense. (c, d) On gadolinium-enhanced T1-weighted gradient-echo images (90/150, 4° flip angle) obtained in early (c) and delayed (d) phases, the mass heterogeneously enhances during the early phase and becomes increasingly homogeneous in the late phase. (e) Photograph of the cut gross specimen shows the lobulated, well-demarcated mass with a central scar and visible bile staining.
|
|
View larger version (109K):
[in a new window]
|
Figure 12a. Fibrolamellar carcinoma in a 26-year-old patient. (a, b) Contrast-enhanced CT scans (a obtained at a higher level than b) demonstrate an enhancing mass with a calcified, low-attenuation scar. Adjacent to the mass is a satellite lesion of fibrolamellar carcinoma (arrowhead in b). Within the anterior liver is a wedge-shaped defect (arrow in b) corresponding to focally increased arterial flow. The area of increased vascularity likely reflects subsegmental portal vein occlusion with compensatory increased arterial flow. This finding is not specific for malignant invasion. (c, d) On dynamic (c) and static (d) Tc-99m–labeled red blood cell images, the hypervascular mass has increased uptake during the dynamic phase but not during the delayed phase. This finding of early increased vascularity with washout is not consistent with a diagnosis of hepatic hemangioma.
|
|
View larger version (118K):
[in a new window]
|
Figure 12b. Fibrolamellar carcinoma in a 26-year-old patient. (a, b) Contrast-enhanced CT scans (a obtained at a higher level than b) demonstrate an enhancing mass with a calcified, low-attenuation scar. Adjacent to the mass is a satellite lesion of fibrolamellar carcinoma (arrowhead in b). Within the anterior liver is a wedge-shaped defect (arrow in b) corresponding to focally increased arterial flow. The area of increased vascularity likely reflects subsegmental portal vein occlusion with compensatory increased arterial flow. This finding is not specific for malignant invasion. (c, d) On dynamic (c) and static (d) Tc-99m–labeled red blood cell images, the hypervascular mass has increased uptake during the dynamic phase but not during the delayed phase. This finding of early increased vascularity with washout is not consistent with a diagnosis of hepatic hemangioma.
|
|
View larger version (123K):
[in a new window]
|
Figure 12c. Fibrolamellar carcinoma in a 26-year-old patient. (a, b) Contrast-enhanced CT scans (a obtained at a higher level than b) demonstrate an enhancing mass with a calcified, low-attenuation scar. Adjacent to the mass is a satellite lesion of fibrolamellar carcinoma (arrowhead in b). Within the anterior liver is a wedge-shaped defect (arrow in b) corresponding to focally increased arterial flow. The area of increased vascularity likely reflects subsegmental portal vein occlusion with compensatory increased arterial flow. This finding is not specific for malignant invasion. (c, d) On dynamic (c) and static (d) Tc-99m–labeled red blood cell images, the hypervascular mass has increased uptake during the dynamic phase but not during the delayed phase. This finding of early increased vascularity with washout is not consistent with a diagnosis of hepatic hemangioma.
|
|
View larger version (111K):
[in a new window]
|
Figure 12d. Fibrolamellar carcinoma in a 26-year-old patient. (a, b) Contrast-enhanced CT scans (a obtained at a higher level than b) demonstrate an enhancing mass with a calcified, low-attenuation scar. Adjacent to the mass is a satellite lesion of fibrolamellar carcinoma (arrowhead in b). Within the anterior liver is a wedge-shaped defect (arrow in b) corresponding to focally increased arterial flow. The area of increased vascularity likely reflects subsegmental portal vein occlusion with compensatory increased arterial flow. This finding is not specific for malignant invasion. (c, d) On dynamic (c) and static (d) Tc-99m–labeled red blood cell images, the hypervascular mass has increased uptake during the dynamic phase but not during the delayed phase. This finding of early increased vascularity with washout is not consistent with a diagnosis of hepatic hemangioma.
|
|
View larger version (112K):
[in a new window]
|
Figure 13a. FNH in a 10-year-old girl evaluated with multiphasic CT. (a) Color flow Doppler US scan (shown in black and white) shows a subtle isoechoic mass with prominent central vessels corresponding to a central scar. (b) Contrast-enhanced arterial-phase CT scan demonstrates the densely enhancing, 5-cm mass with a central scar. (c, d) Contrast-enhanced portal-phase (c) and delayed-phase (d) CT scans show washout of contrast material from the tumor with nonvisualization of the scar. (e) Tc-99m–labeled sulfur colloid scan demonstrates increased activity in the mass in comparison with the normal liver (arrow).
|
|
View larger version (119K):
[in a new window]
|
Figure 13b. FNH in a 10-year-old girl evaluated with multiphasic CT. (a) Color flow Doppler US scan (shown in black and white) shows a subtle isoechoic mass with prominent central vessels corresponding to a central scar. (b) Contrast-enhanced arterial-phase CT scan demonstrates the densely enhancing, 5-cm mass with a central scar. (c, d) Contrast-enhanced portal-phase (c) and delayed-phase (d) CT scans show washout of contrast material from the tumor with nonvisualization of the scar. (e) Tc-99m–labeled sulfur colloid scan demonstrates increased activity in the mass in comparison with the normal liver (arrow).
|
|
View larger version (119K):
[in a new window]
|
Figure 13c. FNH in a 10-year-old girl evaluated with multiphasic CT. (a) Color flow Doppler US scan (shown in black and white) shows a subtle isoechoic mass with prominent central vessels corresponding to a central scar. (b) Contrast-enhanced arterial-phase CT scan demonstrates the densely enhancing, 5-cm mass with a central scar. (c, d) Contrast-enhanced portal-phase (c) and delayed-phase (d) CT scans show washout of contrast material from the tumor with nonvisualization of the scar. (e) Tc-99m–labeled sulfur colloid scan demonstrates increased activity in the mass in comparison with the normal liver (arrow).
|
|
View larger version (115K):
[in a new window]
|
Figure 13d. FNH in a 10-year-old girl evaluated with multiphasic CT. (a) Color flow Doppler US scan (shown in black and white) shows a subtle isoechoic mass with prominent central vessels corresponding to a central scar. (b) Contrast-enhanced arterial-phase CT scan demonstrates the densely enhancing, 5-cm mass with a central scar. (c, d) Contrast-enhanced portal-phase (c) and delayed-phase (d) CT scans show washout of contrast material from the tumor with nonvisualization of the scar. (e) Tc-99m–labeled sulfur colloid scan demonstrates increased activity in the mass in comparison with the normal liver (arrow).
|
|
View larger version (84K):
[in a new window]
|
Figure 13e. FNH in a 10-year-old girl evaluated with multiphasic CT. (a) Color flow Doppler US scan (shown in black and white) shows a subtle isoechoic mass with prominent central vessels corresponding to a central scar. (b) Contrast-enhanced arterial-phase CT scan demonstrates the densely enhancing, 5-cm mass with a central scar. (c, d) Contrast-enhanced portal-phase (c) and delayed-phase (d) CT scans show washout of contrast material from the tumor with nonvisualization of the scar. (e) Tc-99m–labeled sulfur colloid scan demonstrates increased activity in the mass in comparison with the normal liver (arrow).
|
|
View larger version (131K):
[in a new window]
|
Figure 14a. FNH in a 68-year-old woman. (a) SPIO-enhanced T1-weighted spin-echo MR image (500/20) demonstrates a 5-cm mass that is predominantly isointense relative to the adjacent liver and that contains a hypointense scar (arrow). (b) On the T2-weighted spin-echo MR image (4,000/80), the mass remains similar in signal intensity, but the scar is now hyperintense (arrow). (c) SPIO-enhanced T2-weighted spin-echo (4,000/80) demonstrates uptake of SPIO and significant negative enhancement of focal areas (arrows).
|
|
View larger version (123K):
[in a new window]
|
Figure 14b. FNH in a 68-year-old woman. (a) SPIO-enhanced T1-weighted spin-echo MR image (500/20) demonstrates a 5-cm mass that is predominantly isointense relative to the adjacent liver and that contains a hypointense scar (arrow). (b) On the T2-weighted spin-echo MR image (4,000/80), the mass remains similar in signal intensity, but the scar is now hyperintense (arrow). (c) SPIO-enhanced T2-weighted spin-echo (4,000/80) demonstrates uptake of SPIO and significant negative enhancement of focal areas (arrows).
|
|
View larger version (119K):
[in a new window]
|
Figure 14c. FNH in a 68-year-old woman. (a) SPIO-enhanced T1-weighted spin-echo MR image (500/20) demonstrates a 5-cm mass that is predominantly isointense relative to the adjacent liver and that contains a hypointense scar (arrow). (b) On the T2-weighted spin-echo MR image (4,000/80), the mass remains similar in signal intensity, but the scar is now hyperintense (arrow). (c) SPIO-enhanced T2-weighted spin-echo (4,000/80) demonstrates uptake of SPIO and significant negative enhancement of focal areas (arrows).
|
|
View larger version (112K):
[in a new window]
|
Figure 15a. Fibrolamellar carcinoma that recurred 16 months after initial hepatic segmentectomy. (a) Contrast-enhanced CT scan shows an enhancing intrahepatic mass with low attenuation. (b) Photograph of partial hepatectomy specimen shows the recurrent fibrolamellar carcinoma with central fibrosis.
|
|
View larger version (81K):
[in a new window]
|
Figure 15b. Fibrolamellar carcinoma that recurred 16 months after initial hepatic segmentectomy. (a) Contrast-enhanced CT scan shows an enhancing intrahepatic mass with low attenuation. (b) Photograph of partial hepatectomy specimen shows the recurrent fibrolamellar carcinoma with central fibrosis.
|
|
Copyright © 1999 by the Radiological Society of North America.
