Repeated metastasectomy in an adolescent with fibrolamellar hepatocellular carcinoma: A case report

The fibrolamellar variant of hepatocellular carcinoma (FL-HCC) is a primary malignancy of the liver classically identified in the non-cirrhotic liver. By virtue of the non-cirrhotic liver background, patients with FL-HCC are more likely to be selected for surgical resection as primary treatment than in classic HCC. Synchronous and metachranous metastasis of FL-HCC can be treated with either resection, chemotherapy, or both. We present here an adolescent who underwent resection of a large FL-HCC following neo-adjuvant chemotherapy. The patient went on to receive surveillance and resection of five serially identified metastasis. Despite repeated aggressive metastasectomy, we observed survival in this case surpassing the median reported survival for adolescents with FL-HCC. This case supports the hypothesis proposed previously that aggressive surgical resection, including metastasectomy in the thoracic and abdominal cavity, should be offered to patients with this rare tumor.