Fibrolamellar variant of hepatocellular carcinoma presenting during pregnancy: management dilemmas.
The Fibrolamellar variant of Hepatocellular Carcinoma (FLHCC) is a rare form of liver cancer that presents in the 3rddecade of life, is rarely associated with cirrhosis or chronic Hepatitis B/C virus infection, and usually presents with normal serum alpha-fetoprotein (AFP) levels. FLHCC presenting during pregnancy is extremely rare, with only 4 cases reported. We present a case of FLHCC in pregnancy and discuss the dilemmas in management. A 26 year-old primigravida, 26 weeks of gestation presented with a month's history of obstructive jaundice secondary. Investigations revealed a mass in the left lateral segment of the liver with extension down the left hepatic duct into the common bile duct. Following an emergency caesarean section at 31 weeks, she underwent a left hepatectomy with extrahepatic bile duct excision. The postoperative course was uneventful. Histopathology showed FLHCC. In conclusion, liver tumors presenting during pregnancy should be managed in a multidisciplinary setup with facilities for neonatal intensive care. Management depends on the presumed pathology, period of gestation and family preferences.
Department of HPB and Liver Transplantation, PSG Institute of Medical Sciences and Research, Avinashi Road, Coimbatore, India.
Nagalapuram
N
Vishnu
Department of Gastroenterology, PSG Institute of Medical Sciences and Research, Avinashi Road, Coimbatore, India.
Aditya V
AV
Kulkarni
Department of Pathology, PSG Institute of Medical Sciences and Research, Avinashi Road, Coimbatore, India.
Sreenivasan
S
Vidhyalakshmi
Department of HPB and Liver Transplantation, PSG Institute of Medical Sciences and Research, Avinashi Road, Coimbatore, India.
Swaminathan
S
Sambandam
Department of Radiology, PSG Institute of Medical Sciences and Research, Avinashi Road, Coimbatore, India.
Prerna
P
Garg
Department of Gastroenterology, PSG Institute of Medical Sciences and Research, Avinashi Road, Coimbatore, India.
Venkatakrishnan
V
LeelaKrishnan
Department of Gastroenterology, PSG Institute of Medical Sciences and Research, Avinashi Road, Coimbatore, India.
Krishnaveni
K
Janarthan
Department of HPB and Liver Transplantation, PSG Institute of Medical Sciences and Research, Avinashi Road, Coimbatore, India.
Gursharan
G
Singh
Department of Anaesthesiology and Critical Care, PSG Institute of Medical Sciences and Research, Avinashi Road, Coimbatore, India.
Maninder
M
Kaur
Department of Obstetrics and Gynaecology, PSG Institute of Medical Sciences and Research, Avinashi Road, Coimbatore, India.
T V
TV
Chitra
Department of HPB and Liver Transplantation, PSG Institute of Medical Sciences and Research, Avinashi Road, Coimbatore, India.
Biku Joseph
BJ
John
Fibrolamellar; Hepatocellular cancer; Liver; Pregnancy; Tumor