# A Case of a Boy With Undiagnosed Fibrolamellar Carcinoma Who Died Due to Severe Hemorrhage From Diaphragm

## TL;DR

An 11-year-old boy with undiagnosed fibrolamellar carcinoma died from a severe diaphragm hemorrhage, highlighting the disease's unpredictable and potentially fatal complications.

## Contribution

This case report adds to the limited understanding of fibrolamellar carcinoma's possible role in unexplained hemorrhage.

## Key findings

- The boy's death was caused by a 1,900 mL hemorrhage from the diaphragm with strong coagulation.
- Fibrolamellar carcinoma was identified postmortem, but its connection to the hemorrhage remains unclear.
- No traumatic injury or bleeding disorder was found, and most DIC criteria were not met.

## Abstract

An 11-year-old boy presented with vomiting and abdominal pain. Ultrasonography and blood tests revealed no abnormalities. He was diagnosed with viral gastroenteritis; however, the following morning, he was found dead in bed. Postmortem examination revealed that a 1,900 mL hemorrhage with strong coagulation from the diaphragm was the cause of death. He had no traumatic episodes, injuries, or a medical history of hemorrhagic diathesis. The presence of a fibrin-like clot indicated coagulation activation; however, most criteria for disseminated intravascular coagulation were not observed. Fibrolamellar carcinoma, a rare hepatocellular carcinoma, was found; however, liver disorder was not estimated based on the pathological findings. In conclusion, the mechanism of hemorrhage could not be explained. Although we were unable to identify the cause of the hemorrhage, we could not completely rule out the possibility that fibrolamellar carcinoma had an unknown influence on the hemorrhage. Given the limited number of studies on fibrolamellar carcinoma, we present a case of a boy with undiagnosed fibrolamellar carcinoma who died due to severe hemorrhage.