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Aggressive surgical management of recurrent lymph node and pancreatic head metastases of resected fibrolamellar hepatocellular carcinoma: a case report.

Plain English Summary
Surgery is almost always performed when Fibrolamellar is found to be exclusively in the liver.  In cases where the Fibrolamellar has metastasized elsewhere, the course of action is less clear.  The authors present a case of a women who was diagnosed with Fibrolamellar at the age of 28.  Upon removal (resection) of the tumor, one of her lymph nodes was found to contain signs of the tumor cells (they were rated "positive" for the disease).  A metastatic tumor was removed 23 months after the initial surgery, then a second 18 months later, then third sixteen months later.  At the 90-month mark, a tumor was found in the pancreas.  This was removed and 18 months later the patient is still clear. While this is just one example, the results suggest that continued surgical removal may continue to be warranted, even after repeated metastases.
 
Authors' Abstract
JOP. 2012 Sep 10;13(5):529-32. doi: 10.6092/1590-8577/839.
Aggressive surgical management of recurrent lymph node and pancreatic head metastases of resected fibrolamellar hepatocellular carcinoma: a case report.Wojcicki MLubikowski JPost MChmurowicz TWiechowska-Kozlowska AKrawczyk M.
Department of Hepatobiliary Surgery and Liver Transplantation, Marie Curie Hospital. Szczecin, Poland. drmwojcicki@wp.pl.
Context Fibrolamellar hepatocellular carcinoma is a rare liver tumor with the propensity to metastasize to the lymph nodes months or years after initial surgery. However, its metastatic spread to the pancreas was previously reported only in a child. 
Case report We present an unusual case of a young female patient who was repeatedly treated by surgical excision of abdominal and mediastinal lymph node recurrences between 2 and 6 years after left hepatic lobectomy for fibrolamellar hepatocellular carcinoma. At 8 years following her initial surgery, the patient was diagnosed with pancreatic head metastasis and a pancreaticoduodenectomy was performed. Postoperative course was uneventful and the patient did not experience recurrence within the last 18 months. 
Conclusion The metastasis of fibrolamellar hepatocellular carcinoma to the pancreas is highly exceptional but possible and its excision appears warranted as well.