Incidental finding of a hepatic lesion: differential diagnostic problems for fibrolamellar hepatic carcinoma

We report the case of a 39-yr-old female with a liver lesion that was incidentally detected by ultrasound. Examination of biopsy specimens revealed focal nodular hyperplasia. A metastatic tumor in the right os ilium developed in the following weeks and showed specific uptake of 99mTc-hepatic 2,6-dimethyliminodiacetic acid (HIDA), suggesting metastasis from a differentiated hepatocellular carcinoma. The final pathologic diagnosis was multifocal, solid and glandular hepatocellular carcinoma, partly differentiated as fibrolamellar carcinoma, and an osseous metastasis from the differentiated hepatocellular carcinoma.