We report a rare case of combined hepatocellular carcinoma and fibrolamellar carcinoma arising in a noncirrhotic liver, in a 14-year-old boy who underwent right hepatectomy. We discuss the clinicopathological and immunohistochemical features and the clinical outcome in this unusual tumor. 1. Introduction Hepatocellular carcinoma of adult type (HCC) and fibrolamellar carcinoma (FLC) are two distinct entities unique in their clinical, histological, and biological aspects [1]. There have been occasional reports of combined occurrence of FLC and HCC [2–5]. However, as the criteria to diagnose combined occurrence is not yet established in the literature, there seem to be cases which in a true sense are not combined occurrence of FLC-HCC but rather an admixture of FLC-like areas in the usual HCC thus confusing the literature. Here, we report a rare case of a separate FLC and HCC presenting synchronously in a 14-year-old boy, with well-characterized morphology and treatment outcome, and discuss the distinctive features which would help in the correct identification of such unusual lesions. 2. Case Report A 14-year-old boy presented with history of right sided abdominal pain for 2 months. On examination there was an irregular, firm, swelling palpable in the liver extending up to 7？cm below the right costal margin. Computed tomography (CT) of the abdomen showed a large 9.6 × 10.2 × 10.5？cm well-defined, heterogeneously enhancing mass in the right lobe of liver in segments 6 and 5 and another lobulated 9.8 × 6.7？cm mass with homogenous enhancement in segments 8 and 7 suggestive of malignant liver masses with intrahepatic metastases. Investigations showed no elevation of serum alphafetoprotein (AFP), beta human chorionic gonadotrophin, or carcinoembryonic antigen. Hepatitis B surface antigen, hepatitis C antibody, and human immunodeficiency virus antibody were negative. Liver function tests at the time of admission showed total serum bilirubin level of 0.4？mg/dL, direct 0.2？mg/dL, total protein 8.2？g/dL, albumin 3.8？g/dL, aspartate aminotransferase (AST) 289？U/L, alanine aminotransferase (ALT) 99？U/L and alkaline phosphatase (ALP) 143？U/L, and INR of 0.96. There was no history of parasitic infestation or known exposure to environmental toxins. A wedge biopsy from the liver mass revealed a moderately differentiated hepatocellular carcinoma following which the patient underwent right hepatectomy. Histopathological findings: grossly, the right lobe of the liver weighed 1000？g. The external surface was focally nodular and on sectioning revealed a circumscribed tumor
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