hepatic fibrolamellar carcinoma
Introduction
Introduction to liver fiber lamellar cancer Fibrolamellar carcinoma of the liver is a rare malignant tumor that originates in the liver and is more common in young patients without cirrhosis. The degree of malignancy is lower than that of primary hepatocellular carcinoma and the tumor is often limited. Therefore, the disease usually has the chance of surgical resection and the prognosis is good. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of infection: non-infectious complication:
Cause
Causes of hepatic fibrolamellar cancer
(1) Causes of the disease
The etiology of FLC is still unclear. The incidence of the two hemispheres is different, suggesting that there may be racial or environmental factors. FLC does not have hepatitis B virus infection and cirrhosis background, mainly occurs in young people under 35 years old. The ratio of human to male is 1:1.07, which is similar. The age and gender distribution are similar to benign tumors. Some scholars believe that FLC is transformed from focal nodular hyperplasia. Other scholars believe that FLC is derived from epithelial cells. Proliferation, followed by fiber growth leads to fibrous lamellar formation and cell carcinogenesis.
(two) pathogenesis
FLC occurs mostly in the liver without hard deformation. Most of the tumors are located in the left hepatic lobe. They are usually single, the tumor is clear, the edges are fan-shaped, the texture is hard, and the cross-section sees the fiber spacing across the tumor. Under the microscope, the tumor cells are nested. Some of the tumor cells are in line with each other, and the surrounding fibrous tissue is surrounded by lamellar cells. The tumor cells are large, cubic or polygonal, rich in cytoplasm, strong eosinophilic, nucleoli, and blood in the tumor tissue. The sinus is rich.
Prevention
Hepatic fibrolamellar cancer prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Hepatic fibrolamellar complication Complication
People can appear fatigue, loss of appetite, weight loss and so on.
Symptom
Hepatic fibrous lamellar cancer symptoms common symptoms abdominal discomfort jaundice anorexia abdominal pain bloating liver drooping
FLC often occurs in children and adolescents aged 5 to 35, occasionally in middle-aged and elderly people, but the author reports that only 1 of 3 FLC patients are under 35 years old, with an average age of 45.6 years. The incidence rate of men and women is about the same, abdominal discomfort, abdominal pain. Abdominal distension, fatigue, anorexia, weight loss are common complaints, two-thirds of patients can touch the abdominal mass, jaundice is less common, the above symptoms and signs have appeared on average 11 months before diagnosis, earlier than general hepatocellular carcinoma 2.8 months.
Examine
Examination of hepatic fibrolamellar cancer
1. Liver function tests such as ALT, AKP and serum bilirubin may have mild to moderate elevation; a small number of FLC patients (10%) have elevated serum AFP, and about 14% of patients have HBsAg positive.
2. Some tumor markers are often helpful in diagnosis, such as serum unsaturated vitamin B12 binding, vitamin B12 concentration and plasma neurotensin (neurotensin), CEA, etc., due to the lack of clinical features of FLC and liver tumors to be identified A lot.
3. The pathological diagnosis of FLC is:
(1) HE staining showed abundant strong eosinophilic granules in the tumor cell slurry.
(2) Collagen fibers and fibroblasts are arranged in parallel to form a nested, cord-like or flaky tumor cell group.
4. The flat film shows calcification in the tumor.
5. Ultrasound examination can show the characteristics of homogeneity and fibrosis in the tumor. The homogeneous strong echo mass and the strong echo back shadow caused by calcification are typical characteristics.
6. CT enhanced scan showed a significant increase in fiber layer cancer density.
7. Angiographic examination showed multiple vascular masses with significant coloration and often visible intervals during the capillary phase.
8. Radionuclide imaging shows radioactive defects.
Diagnosis
Diagnosis and diagnosis of hepatic fibrola
Diagnostic criteria
Young patients, especially female patients, should have the above-mentioned symptoms and signs, and some relevant examinations should be done in a targeted manner. The histological examination can confirm the diagnosis.
1. Clinical manifestations.
2. Laboratory and other auxiliary inspections.
Differential diagnosis
FLC should be differentiated from common hepatocellular carcinoma (Table 1), liver focal nodular hyperplasia, hepatic adenoma and metastatic liver cancer.
The diagnosis of focal nodular hyperplasia of the liver is difficult, but imaging examination can help identify with FLC. Ultrasound of focal nodular hyperplasia can be found in CT, but radionuclide imaging indicates excessive or normal intake. Ingestion, while FLC is a radioactive defect. Hepatic adenoma is mainly seen in women of childbearing age who have a history of oral contraceptives. 99mTc-PMT delayed imaging suggests that liver adenoma is strongly positive, pathological examination can make a definite diagnosis, but the differential diagnosis of FLC is sometimes More difficult, still need to rely on electron microscopy and histochemical staining to further confirm the diagnosis. Secondary liver cancer has a history or evidence of primary cancer. The ultrasound image mainly shows multiple round lesions. When the tumor is small, the hypoechoic is more common. When it is large, it is mostly high echo, and the CT image shows multiple circular or irregular low-density lesions.
