Transformation of fibrolamellar carcinoma to common hepatocellular carcinoma in the recurrent lesions of the rectum and the residual liver: a case report.

A zt-year-oldman had undergone central bisegmentectomy of the liver due to fibrolamellar carcinoma (FLC). Twice, 24 and 30 monthsafterthe firstoperation, lymphnodemetastases were removed. We have reported this case previously and this is the secondreport of the samecase. Forty-two months after the second operation to remove lymph node metastases, a recurrence occurred in the rectum and was excised. However, the tumor also recurred in the residual liver. The patient underwent hepatectomy for a palliative purpose but died 16 months after the last operation. Histopathologically, the primarytumorwasdiagnosed as pureFLC, butthe lymph node metastases hadfoci of the common hepatocellular carcinoma (HCC) mixedwithFLC. Incontrast, the recurrent tumors in the rectum and the residual livershowedthe histopathological features of common HCC. Thus,duringrepeated recurrences, histopathological features changed from pure FLC to common HCC.