Non-islet cell tumour hypoglycaemia due to clear cell hepatocellular carcinoma

Abstract

Background Hepatocellular carcinoma (HCC) is a common primary liver cancer worldwide with increasing incidence in Australia. 1 Methods and Results We report a case of a 72-year-old female who presented with profound, treatment-refractory hypoglycaemia and on subsequent investigation a liver mass and omental metastasis was found. Hormonal analysis was consistent with non-islet cell tumour hypoglycaemia (NICTH) mediated by insulin-like growth factor-II (IGF-II). Biopsy of the omental lesion showed extensive necrosis and areas of sclerotic stroma infiltrated by cohesive groups of neoplastic clear cells. An immunohistochemical (IHC) panel demonstrated staining of tumour cells with HepPar1, alpha fetoprotein, cytokeratins and canalicular staining for pCEA suggestive of HCC. The patient succumbed despite aggressive management. A post-mortem examination demonstrated a non-cirrhotic liver with a 23 cm mass in the left lobe, multiple intrahepatic metastases, and a 13 cm omental metastasis with histological and IHC features consistent with a primary clear cell HCC. Discussion NICTH resulting from tumour mediated overproduction of precursor IGF-II is an uncommon complication of malignancy. 2 It has only been rarely reported with clear cell HCC of the liver. 3 Moreover, clear cell HCC is infrequently described 4,5 and is rare in non-cirrhotic liver disease. 5,6