OBJECTIVE: To assess the incidence and prognosis of fibrolamellar hepatic carcinoma in a defined population. DESIGN: Retrospective study of histological slides. SETTING: University hospital, Sweden. SUBJECTS: The 532 patients (out of a total of 711 who were treated at the university hospital during a 22 year period 1 January 1958-31 December 1979) whose primary hepatocellular carcinoma was confirmed on review of the histological slides. MAIN OUTCOME MEASURES: Incidence and prognosis of fibrolamellar hepatic carcinoma. RESULTS: Two patients (women aged 22 and 46) were found to have fibrolamellar tumours and in both they were advanced and the patients died 2 weeks and 9 months, respectively, after exploratory laparotomy. If these are taken as a proportion of the 18 patients who were under the age of 50 at the time of diagnosis then the incidence of the fibrolamellar type of hepatocellular carcinoma is 11%. Since then (in 1993) we have come across one further case, a woman of 39 who was well 22 months after operation though she had metastatic disease. CONCLUSIONS: The fibrolamellar type of hepatocellular carcinoma is rare, and all three of our cases were young women (under the age of 50). It seems to have a slightly better prognosis than other types of primary hepatic tumours.