Fibrolamellar Hepatocellular Carcinoma: A Case Report of 25-Year Postoperative Survival.

Fibrolamellar hepatocellular carcinoma (FLHCC) is a rare hepatocellular carcinoma (HCC) variant. We report a 46-year-old patient with FLHCC who has achieved 25 years of postoperative survival, the longest reported to date. The patient underwent a right hepatic lobectomy, lymph node resection, and peritoneal dissemination removal. Over the years, he underwent seven additional surgeries for recurrences in various sites, including the intraperitoneal area, left lung, mediastinal lymph nodes, spleen, and transverse colon. To date, he has undergone a total of 14 surgeries, including eight for recurrences. FLHCC frequently recurs postoperatively despite its indolent nature. The patient's cancer antigen 125 (CA125) levels correlated well with recurrence and treatment efficacy, confirming it to be a reliable tumor marker. Currently, the patient is undergoing radiation therapy for recurrence in the mediastinal lymph nodes. This case highlights the potential for long-term survival with aggressive surgical intervention and vigilant follow-up, emphasizing the importance of surgical resection and monitoring in FLHCC management.