Squamous Cell Carcinoma of the Liver

Abstract

Primary squamous cell carcinoma of the liver is rare. The prognosis is poor, and survival is typically no longer than one year. Since 1970, there have been no more than 35 cases reported in the literature. Currently, the pathophysiology of primary SCC of the liver is poorly understood. Previous reports suggest the majority of cases are associated with a history of hepatic cysts or chronic inflammation and metaplasia of the biliary epithelial cells. We are presenting a case of primary squamous cell carcinoma of the liver with no known inciting factors. A 68 year old male, with a history of prostate adenocarcinoma with metastatic bone disease, originally treated with prostatectomy, presented to our hospital with a 4 week history of abdominal pain. Family history was significant for pharyngeal and prostate cancer. Patient's blood work upon presentation was significant for an AST of 79, ALT 57 and ALKP of 508. CT of the abdomen and pelvis with contrast revealed extensive “liver metastatic disease”, with some contrast enhancing mass lesions in the liver, of which the largest was 8cm. Patient underwent ultrasound guided liver biopsy due to atypical appearing liver lesions. Immunohistochemical stains revealed 2-3+ positivity for CK5/6, 34Beta-E12, and p63, highly suggestive of squamous cell origin. Other positive tumor markers included CK-7 and CEA. Stains were negative for CK-20, PSA, and TTF-1. The diagnosis of poorly differentiated high grade carcinoma consistent with squamous cell carcinoma of the liver was established by two separate pathologists. Squamous cell cancer of the liver is very rare, representing approximately 0.2% of liver malignancies. Prior analysis of case reports revealed 29 of the 31 prior cases had a history of liver cysts, bile duct stones or both. It is unknown if our patient had any congenital liver cysts prior to his liver malignancy, but CT at our institution did not reveal any cysts, and the patient had no historical symptoms or imaging evidence of hepatobiliary stones. Despite treatment, the prognosis is poor with the majority of patients dying within 1 year.