APPLICATION OF INTRAOPERATIVE ULTRASONOGRAPHY TO ACHIEVE MARGINAL CLEARANCE IN FIBROLAMELLAR HEPATOCELLULAR CARCINOMA: CASE REPORT 0240023@up.edu.mx

PE016

APPLICATION OF INTRAOPERATIVE ULTRASONOGRAPHY TO ACHIEVE MARGINAL CLEARANCE IN FIBROLAMELLAR HEPATOCELLULAR CARCINOMA: CASE REPORT

3

Mexico

Poster Exhibition only

Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare idiopathic primary liver malignancy, representing ~1% of cases, typically affecting adolescents and young adults without underlying liver disease. Recurrent DNAJB1-PRKACA fusion is commonly identified, though its significance remains uncertain. At presentation, 70–75% of patients are candidates for resection, establishing surgery as the cornerstone of treatment, with negative margins essential for long-term survival. Diagnosis relies on clinical and imaging findings, often with negative AFP, but confirmation requires histopathology. Intraoperative ultrasonography (IOUS) has been shown to identify 28.6% additional lesions and improve anatomic delineation. We present a case in which IOUS was instrumental in surgical planning and oncologic margin clearance.

A 39-year-old female without liver disease presented with right upper quadrant pain and weight loss, with unremarkable laboratory tests. Ultrasound with biopsy identified a 6 × 5 × 6 cm segment VII lesion, confirmed as FL-HCC. The patient was initially managed with lenvatinib and transarterial chemoembolization, followed by open central hepatectomy. Intraoperative ultrasound with a T-probe delineated tumor extension and vascular involvement, demonstrating invasion of the middle hepatic vein and anterior portal branches while preserving the right and left hepatic veins, thereby enabling precise resection. Pathology confirmed fibrolamellar hepatocellular carcinoma with negative surgical margins.

This case emphasizes the value of intraoperative ultrasonography in complex hepatic resections for fibrolamellar carcinoma. Ultrasonography allows precise delineation of tumor margins and vascular anatomy, thereby facilitating safe parenchymal preservation and oncologic clearance. Intraoperative imaging should be considered an essential adjunct in the surgical management of FL-HCC to optimize outcomes.