本文旨在对纤维板层癌(FLC)进行详细的概述,一种肝细胞癌(HCC)的变体,约占所有病例的1-9%。根据SEER数据库。尽管正在进行研究,FLC肿瘤的病因尚不清楚.然而,FLC被认为比其他原发性肝肿瘤有更好的整体预后。如肝细胞癌(HCC)和肝内胆管癌。本研究旨在对纤维板层癌(FLC)进行全面概述,专注于其流行病学,发病机制,诊断,治疗,和预后。FLC经常合并胃痛的特征,减肥,以及临床症状和体征的不适,它们通常是非特异性的,最终,最常见的物理发现是腹部肿块或肝肿大。这句话说,已经记录了一些不寻常的表现,例如BuddChiari综合征,严重贫血,非细菌性血栓性心内膜炎等等。关于这个肿瘤的遗传分析,它的特征是在19号染色体上的400kb缺失导致功能性DNAJB1-PRKACA嵌合转录物以及在50%的情况下的四倍体。与典型的HCC相比,FLC是染色体稳定的。已经发现mTOR途径激活在47%的这些肿瘤中起关键作用,并且EFGR过表达也是明显的。纤维层癌(FLC)表现出独特的总体外观,以黄色至浅褐色为特征,具有从软到硬的一致性。此外,在60-70%的FLC病例中观察到中央瘢痕。中央疤痕通常为白色或灰色,并具有纤维状外观,通常被结节包围,肿瘤样组织.其组织学外观的特点是大的多边形细胞与丰富的嗜酸性细胞浆,大的囊泡状核,大核仁,并排列在胶原纤维的层状带中。纤维化的层状带,由I型胶原蛋白组成,III和IV,也被确定为在低倍率下观察到的独特组织学特征。超声波,CT和MRI以及图像引导活检是诊断的主要方式。目前的管理选择包括全身性治疗,迄今为止,以铂为基础的治疗以及与干扰素α-2b的联合治疗是最成功的选择。手术切除仍然是主要的治疗方式,并且在靶向治疗方面没有进展。尽管FLC的预后与其他肝癌亚型如肝内胆管癌相比是有利的,复发率高,范围为33%~100%,中位无复发生存期为20~48个月.因此,与这种肿瘤类型相关的总体治愈率很低,需要更多的研究来深入了解发生的分子机制,以便为患有这种疾病的患者提供更充分的治疗。
This paper aims to present a detailed overview of fibrolamellar carcinoma (FLC), a variant of hepatocellular carcinoma (HCC) that accounts for approximately 1-9% of all cases a. according to the SEER database. Despite ongoing research, the aetiology of FLC tumours remains unclear. Nevertheless, FLC is believed to have a better overall prognosis than other primary liver tumours, such as hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma. This study aims to present a comprehensive overview of fibrolamellar carcinoma (FLC), with a focus on its epidemiology, pathogenesis, diagnosis, treatment, and prognosis. FLC frequently incorporate features of stomach pain, weight loss, and malaise in their clinical signs and symptoms, which are generally nonspecific Ultimately, the most common physical finding is an abdominal mass or hepatomegaly. With this said, several unusual presentations have been documented such as Budd Chiari syndrome, severe anaemia, non-bacterial thrombotic endocarditis and many more. In regards to this tumour\'s genetic analysis, it is characterised by a 400 kb deletion on chromosome 19 leading to a functional DNAJB1-PRKACA chimeric transcript in addition to tetraploidy in 50% of cases. FLC is chromosomally stable as compared to typical HCC. mTOR pathway activation has also been found to play a critical role in 47% of these tumours and EFGR over-expression is also evident. Fibrolamellar carcinomas (FLCs) exhibit a distinctive gross appearance, characterized by a yellow to pale tan colour, with a consistency that can vary from soft to firm and hard. In addition, a central scar is observed in 60-70% of FLC cases. The central scar is typically white or grey in colour and has a fibrous appearance, which is often surrounded by nodular, tumour-like tissue. Its histologic appearance is characterized by large polygonal cells with abundant eosinophilic cytoplasm, large vesiculated nuclei, large nucleoli, and arranged in lamellar bands of collagen fibres. Lamellar bands of fibrosis, consisting of collagen type I, III and IV, have also been identified as a distinctive histologic feature that is observed under low power magnification. Ultrasound, CT and MRI along with image guided biopsy are the primary modalities in diagnosis. Current management options include systemic therapy which has thus far been unremarkable with platinum-based therapies as well combination therapy with interferon alpha-2b being the most successful options. Surgical resection remains the primary treatment modality and there have been no advances in targeted therapies. Although the prognosis for FLC is favourable as compared to other hepatic cancer subtypes such as intrahepatic cholangiocarcinoma, there is a high rate of recurrence ranging from 33% to 100% with a median recurrence-free survival of 20-48 months. As a result of this there is a low overall cure rate associated with this tumour type and much more research is required to gain an in-depth understanding of the molecular mechanisms occurring in order to provide more adequate treatment to patients who suffer from this condition.