A Rare Case of Fibrolamellar Hepatocellular Carcinoma in an Elderly Patient With Prior Hepatitis C Achieving Sustained Virologic Response.

Background/aim: Fibrolamellar hepatocellular carcinoma (FLHCC) is a rare histological variant of hepatocellular carcinoma (HCC) that typically affects adolescents and young adults without underlying liver disease. In elderly patients, particularly those with a history of chronic hepatitis C virus (HCV) infection, FLHCC is extremely rare and presents diagnostic challenges.

Case report: A 67-year-old woman with a history of chronic HCV infection and sustained virologic response (SVR) was incidentally found to have two hepatic lesions during routine follow-up imaging. Contrast-enhanced studies revealed early arterial enhancement and delayed washout, suggestive of conventional HCC. She underwent open segmentectomy of segment 7 and radiofrequency ablation (RFA) of the segment 4/8 lesion. Histopathological examination of the resected specimen confirmed the diagnosis of FLHCC. The patient experienced three recurrences, treated with two laparoscopic RFAs and one open systematic liver resection. The third recurrence was histologically confirmed as FLHCC. Although the ablated lesions were not biopsied, the clinical course and tumor marker trends supported a diagnosis of metastatic and multicentric FLHCC. The patient subsequently received two sessions of transarterial chemoembolization. At seven years and two months after the initial surgery, she remains alive with disease and maintains a performance status of 0.

Conclusion: We report an extremely rare case of FLHCC in an elderly patient with a history of HCV infection and SVR. Long-term disease control was achieved through multidisciplinary treatment centered on surgical resection and RFA. Surgical pathology and local ablation play important roles in managing recurrent disease.