Primary Squamous Cell Carcinoma of Liver: Case Series and Review of Literatures

Abstract

Primary squamous cell carcinoma (SCC) of liver is rare, and its prognosis is extremely poor. This study aims at reviewing the clinical data of all pathologically diagnosed liver cancer in our institute, and discussing the clinical presentation, diagnosis, treatment, and prognosis of our cases of SCC and the literatures reported previously. All the patients undergoing liver surgery or biopsy for liver cancers from 2002 to 2013 in our hospital were reviewed, and the liver specimens were examined pathologically. A literature search for case reports of primary SCC of liver published until December 31, 2014, was performed on PubMed, MEDLINE, Scopus Elsevier, Cochrane, and Google Scholar. The primitive data of the case reports were all included and analyzed if available. From January 2002 to October 2013, 2210 cases of liver cancer were diagnosed pathologically in our hospital. Among, 4 cases (0.2%) were diagnosed as primary SCC of liver. All were negative for hepatitis B infection, but present with liver cyst and/or hepatolithiasis. One patient underwent radical resection, but died of tumor recurrence 18 months postoperatively. One patient received transcatheter arterial chemoembolization and 1 patient received laparotomy and alcohol injection, but died 9 and 4 months after surgery, respectively. The last patient received only biopsy and supportive treatment, and finally died of tumor metastasis 6 months later. From 1970 to 2014, 31 cases of primary liver SCC have been published in English previously. Thirty one cases and the 4 cases in the present study were included. The average age of the patients were 54 years (range 18-83), with a male to female ratio of 19:16. Twenty patients had liver cysts, 7 had bile duct stones, and 2 cases had both. Patients undergoing radical surgery had better prognosis than those undergoing palliative treatments (median survival 17 vs 5 months, P = 0.005, log-rank test). Patients with liver cysts seemed to have worse prognosis than those with bile duct stones (median survival 7 vs 18 months, P = 0.090, log-rank test). Primary liver SCC seems to be mostly originated from liver cyst or hepatolithiasis. Radical surgery should be firstly recommended, although the prognosis might be unfavorable.

FIGURE 1

Abdominal computed tomography (CT) shows a 5 cm × 5 cm cystic mass in the right lobe with unevenly enhancement at arterial phase (A) but slight retrieve at venous phase (B). Microscopic findings of aspirated liver tumor specimen (HE staining, C 10×, D 20×). The tumor is composed of squamous cells with keratinization (D, arrowhead).

FIGURE 2

Abdominal computed tomography (CT) shows multiple cystic lesions in the right lobe with slight enhancement at the edge at arterial phase (A). After transcatheter hepatic arterial embolization, a lot of lipiodol deposition was seen in the right lobe of the liver (B). Angiography shows multiple nodular tumors dyeing, which was weak centrally but strong peripherally in the right lobe (C). Microscopic findings of the tumor revealed squamous cells with keratinization (HE staining, D 4×, E 20×, arrowhead).

FIGURE 3

Abdominal computed tomography (CT) shows multilocular cystic lesions and dilated intrahepatic bile ducts with high-density lesions in the ducts (A, B). Microscopic findings of the resected tumor revealed sparse distribution of squamous cell carcinoma with keratinization (HE staining, C, D, arrowhead). Some normal bile ducts could be seen (C, arrows). Squamous cells express negative alpha-fetoprotein staining, but strong positive CK14, CK 56, and CK 19 staining immunohistochemically (E–H).

FIGURE 4

Microscopic findings of the resected cystic wall revealed squamous cell carcinoma with keratinization (HE staining, A 4×, B 20×, arrowhead).

FIGURE 5

Kaplan-Meier survival curves of the patients categorized by treatments (A), etiology (B), and gender (C).