The histopathologic and clinical indicators of prognosis in hepatoma

Two histopathologic subtypes of hepatoma, clear cell type and fibrolamellar type, have been reported to indicate a longer survival. Although data on the prognostic value of clear cell histology is equivocal, evidence for prolonged survival (mean survival: 32-68 months) for patients with fibrolamellar type is impressive. Aggressive surgical intervention, including resection of metastases, appears indicated in fibrolamellar hepatocellular carcinoma. Bilirubin determination may be a reliable indicator of survival, but conflicting results are reported for most reputed clinical prognostic markers. Discrepancies may reflect regional and ethnic differences in the pathogenesis of hepatoma. We present an illustrative case of fibrolamellar hepatoma discovered in a 24-year-old woman with migratory thrombophlebitis. The patient successfully underwent an extended right hepatic lobectomy and is currently free of disease. We review the histopathologic and clinical prognostic features of fibrolamellar carcinoma and hepatoma.