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Epidemiology of fibrolamellar hepatocellular carcinoma in the USA, 2000–10
  1. Tobias Eggert1,2,
  2. Katherine A McGlynn3,
  3. Austin Duffy1,
  4. Michael Peter Manns2,
  5. Tim F Greten1,
  6. Sean F Altekruse4
  1. 1Gastrointestinal Malignancy Section, Medical Oncology Branch, National Cancer Institute, Bethesda, Maryland, USA
  2. 2Department of Gastroenterology, Hepatology and Endocrinology, School of Medicine, Hannover, Germany
  3. 3Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
  4. 4Division of Cancer Control and Population Sciences, National Cancer Institute Rockville, Rockville, Maryland, USA
  1. Correspondence to Professor Tim F Greten, Gastrointestinal Malignancy Section, Medical Oncology Branch, National Cancer Institute, Building 10, Room 12N226, 9000 Rockville Pike, Bethesda, MD 20892, USA; tim.greten{at}

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We read with great interest the article by Tremosini et al1 in Gut, which prospectively validated the use of a panel of three antibodies (glypican 3, heat shock protein 70 and glutamine synthetase) for the histopathological diagnosis of hepatocellularcarcinoma (HCC). According to the international classification of diseases for oncology,2 HCC are classified into HCC not otherwise specified (HCC-NOS), which accounts for the vast majority of HCC, fibrolamellar HCC (fHCC), scirrhous HCC, spindle cell variant HCC, clear cell HCC and pleomorphic HCC. While many studies including that by Tremosini and colleagues1 restrict their focus to HCC-NOS, we decided to study fHCC in more depth. fHCC is a rare tumour with limited clinical information available. Current data suggest that demographic attributes of fHCC cases are very different …

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