Clear Cell Hepatocellular Carcinoma Research Articles

Clear cell hepatocellular carcinoma: Gd-EOB-DTPA-enhanced MR imaging features and prognosis.

To investigate imaging findings on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (Gd-EOB-DTPA-enhanced MRI) and prognosis of clear cell hepatocellular carcinoma (CCHCC) comparing with non-otherwise specified hepatocellular carcinoma (NOS-HCC). The clinical, pathological and MR imaging features of 42 patients with CCHCC and 84 age-matched patients with NOS-HCC were retrospectively analyzed from January 2015 to October 2021. Univariate and multivariate logistic regression and Cox regression analyses were performed to identify independent diagnostic and prognostic factors for CCHCC. Disease-free survival (DFS) and overall survival (OS) were determined by Kaplan-Meier analysis. CCHCC showed fat content more frequently (P < 0.001) and relatively higher Edmondson tumor grade (P = 0.001) compared with NOS-HCC. The lesion-to-muscle ratio (LMR) and lesion-to-liver ratio (LLR) of CCHCC on pre-enhancement T1-weighted imaging (pre-T1WI) (P = 0.001, P = 0.003) and hepatobiliary phase (HBP) (P = 0.007, P = 0.048) were significantly higher than those of NOS-HCC. The area under the curve (AUC) for fat content, LLR on pre-T1WI and their combination with better diagnostic performance in predicting CCHCC were 0.678, 0.666, and 0.750, respectively. There was no statistically significant difference in clinical outcomes between CCHCC and NOS-HCC. Multivariate Cox analysis confirmed that tumor size > 2cm and enhancing capsule were independent prognostic factors for DFS and OS among CCHCC patients. Fat content and adjusted lesion signal intensity on pre-T1WI and HBP could be used to differentiate CCHCC from NOS-HCC. CCHCC had similar prognosis with NOS-HCC.

Steatohepatitic hepatocellular carcinoma: Two cases report with literature review

Steatohepatitic hepatocellular carcinoma (SH-HCC) is one of the most common hepatocellular carcinoma (HCC) subtypes, with a frequency of 5-20%. These tumor are well-differentiated and show distinct histologic features resembling steatohepatitis: Macrovesicular steatosis, inflammation, balloon cells, Mallory-Denk bodies and pericellular fibrosis. Because of their similar characteristics, distinguishing SH-HCC from background fatty liver can be a diagnostic challenge. The histology of SH-HCC has been described in resection specimens. Unfortunately, diagnostic criteria to aid in the evaluation of biopsy specimens have not been well established; therefore, the diagnosis of SH-HCC in biopsies remains challenging. On diagnostic imaging tests, SH-HCC may be difficult to distinguish from surrounding liver parenchyma in patients with severe hepatic steatosis or other fat-containing liver lesions such as angiomyolipoma or clear cell HCC. We report two cases of SH-HCC that we documented along with diagnostic difficulties.

The Liver and Glycogen: In Sickness and in Health

The liver is a major store of glycogen and is essential in maintaining systemic glucose homeostasis. In healthy individuals, glycogen synthesis and breakdown in the liver are tightly regulated. Abnormal glycogen metabolism results in prominent pathological changes in the liver, often manifesting as hepatic glycogenosis or glycogen inclusions. This can occur in genetic glycogen storage disease or acquired conditions with insulin dysregulation such as diabetes mellitus and non-alcoholic fatty liver disease or medication effects. Some primary hepatic tumors such as clear cell hepatocellular carcinoma also demonstrate excessive glycogen accumulation. This review provides an overview of the pathological manifestations and molecular mechanisms of liver diseases associated with abnormal glycogen accumulation.

Competing risk model for prognostic comparison between clear cell type and common type hepatocellular carcinoma: A population-based propensity score matching study.

Clear cell type hepatocellular carcinoma (HCC) is an uncommon neoplasm with an ambivalent prognosis compared to common type HCC. First, patients with clear cell or common type HCC were enrolled from the Surveillance, Epidemiology, and End Results (SEER) database, and their demographic and clinical characteristics were identified. Next, overall survival (OS), disease-specific survival (DSS), and subgroup analysis of the two types of HCC were performed. Next, we utilized a competing risk model to focus on cancer-caused death. Finally, propensity score matching (PSM) was employed to reduce the confounding factors based on the histopathological type, and sensitivity analysis was conducted. A total of 205 cases of clear cell type HCC and 29,954 cases of common type HCC were enrolled in our study. Patients with clear cell type HCC were older and predominantly female than those with common type HCC. OS and DSS were not significantly different between the two groups, and histopathological type was not a prognostic factor of HCC, as verified by the competing risk model. Patient characteristics adjusted by PSM and sensitivity analysis confirmed this conclusion. In subgroup analysis, patients with clear cell type HCC at grade III ~ IV and with lymph nodes metastasis had a better prognosis compared to common type HCC. This study revealed that the prognosis of clear cell type HCC is similar to common type HCC. Tumor differentiation grade and status of lymph node metastasis affect the prognosis of HCC.

State-of-the-art review on the correlations between pathological and magnetic resonance features of cirrhotic nodules.

Hepatocellular carcinoma (HCC) has become the second greatest cause of cancer-related mortality worldwide and the newest advancements in liver imaging have improved the diagnosis of both overt malignancies and premalignant lesions, such as cirrhotic or dysplastic nodules, which is crucial to improve overall patient survival rate and to choose the best treatment options. The role of Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) has grown in the last 20 years. In particular, the introduction of hepatospecific contrast agents has strongly increased the definition of precursor nodules and detection of high-grade dysplastic nodules and early HCCs. Nevertheless, the diagnosis of liver tumours in cirrhotic patients sometimes remains challenging for radiologists, thus, in doubtful cases, biopsy and histological analysis become critical in clinical practice. This current review briefly summarizes the history of imaging and histology for HCC, covering the newest techniques and their limits. Then, the article discusses the links between radiological and pathological characteristics of liver lesions in cirrhotic patients, by describing the multistep process of hepatocarcinogenesis. Explaining the evolution of pathologic change from cirrhotic nodules to malignancy, the list of analyzed lesions provides regenerative nodules, low-grade and high-grade dysplastic nodules, small HCC and progressed HCC, including common subtypes (steatohepatitic HCC, scirrhous HCC, macrotrabecular massive HCC) and more rare forms (clear cell HCC, chromophobe HCC, neutrophil-rich HCC, lymphocyte-rich HCC, fibrolamellar HCC). The last chapter covers the importance of the new integrated morphological-molecular classification and its association with radiological features.

CLEAR CELL HEPATOCELLULAR CARCINOMA, A CASE REPORT

Clear Cell Hepatocellular Carcinoma (CCHCC) represents 2.2 to 6.7% of all Hepatocellular Carcinomas (HCC), affects mostly women and is frequently associated with liver cirrhosis, viral infections (HBV, HCV), aflatoxins, hemochromatosis, oral contraceptives, obesity and type 2 diabetes mellitus. The most frequent manifestation is a solitary tumor with a pseudocapsule, which is more frequent than in other subtypes of HCC. Histologically, CCHCC can be observed as cells with an empty appearance with abundant cytoplasm, vacuolated and foamy due to the accumulation of glycogen and fat, constituting more than 50% of the total cells. Differential diagnosis with liver metastases can be difficult, so immunohistochemistry is an important diagnostic tool. 69-year-old female with a history of hepatitis C virus infection in 2018 receiving direct-acting antiviral treatment for 12 weeks with sustained viral response-12, Child Pugh B liver cirrhosis is documented. 2 years later, the follow-up ultrasound reports liver injury cystic and alpha-fetoprotein at 84.27 ng / ml, so a triphasic tomography was performed, observing liver lesion in segment VII of 35 × 27 × 31 mm suggestive of hepatocellular carcinoma with atypical characteristics, no tumors were reported in another abdominal site, as there was no conclusive radiological criterion for hepatocellular carcinoma, a liver lesion biopsy was performed with a histological report of moderately differentiated clear cell carcinoma and immunohistochemistry with Hepatocyte antigen positive, Carcino-embryonic antigen negative, internal Arginase 1 positive, Glypican 3 positive and Internal renal carcinoma antigen negative, concluding diagnosis of clear cells hepatocellular carcinoma T1B, N0, M0, therefore the patient was referred for transarterial chemoembolization of the lesion. The importance of the current report is to identify histopathological characteristics and establish the usefulness of Immunohistochemistry to make a differential diagnosis with other tumors that can metastasize to and be confused with a primary CCHCC of the liver. CHCC is a rare subtype of HCC with a more favorable prognosis than other forms of hepatocellular carcinoma, the histological differential diagnosis through immunohistochemistry should be performed with renal cell carcinoma, adrenal cortical carcinoma, clear cell sarcoma, angiolipomas, pulmonary and neuroendocrine clear cell variant, which can metastasize to the liver and be confused. The immunohistochemical study was decisive for the treatment and favorable prognosis of the patient. The authors declare that there is no conflict of interest.

A clear cell hepatocellular carcinoma in an obese dog with hyperlipidemia: a case report

An 11-year-old obese dog was referred for a liver mass. Cytologic examination revealed vacuolated hepatocytes with mild pleomorphism. A partial liver lobectomy was performed. On histopathologic examination, the mass was diagnosed as hepatocellular carcinoma composed of hepatocytes with clear vacuoles. These findings were consistent with clear cell hepatocellular carcinoma (CCHCC). The CCHCC is a rare subtype of hepatocellular carcinoma in dogs, and clinical features are poorly defined. This is the first report on the cytological, histological and clinical aspects of CCHCC, suggesting that obesity and hyperlipidemia are potential risk factors for CCHCC in dogs.

Co-existence of clear cell hepatocellular carcinoma and scirrhous hepatocellular carcinoma in the same liver segment: A case report

Co-existence of clear cell hepatocellular carcinoma and scirrhous hepatocellular carcinoma in the same liver segment: A case report

New Names for Old Tumors.

Previous studies described "clear cell" hepatocellular carcinoma (HCC), although definitions have varied. New clear cell subtypes of HCC have been proposed, including chromophobe (C-HCC), steatohepatitic (SH-HCC), and steatotic (S-HCC), and this study assessed the utility and clinical-pathologic profile of these subtypes. Current histologic definitions, including 3 separate proposed definitions for SH-HCC, were applied to tumors previously characterized as clear cell HCC. Histologic and clinical variables were analyzed. Of 66 HCCs, 51 (77%) were classified using modern definitions, including 34 SH-HCCs, 15 S-HCCs, and 2 C-HCCs. Compared with the most permissive SH-HCC definition, the other 2 definitions designated 30 and 25 SH-HCCs (-12% and -26% cases, respectively). Unsurprisingly, S-HCC and SH-HCC were associated with steatotic clear cells (P < .0001). S-HCC was also more typically early type and low grade (P = .0017). The remaining unclassified clear cell HCCs were associated with flocculent (rather than steatotic or optically clear) cytoplasm (P < .0001) but otherwise demonstrated no discrete clinical-pathologic profile. Current definitions could be used to reclassify the majority of "clear cell" HCCs. The subtypes are significantly correlated with a few variables, suggesting valid differences of the subtypes, although additional study is warranted, particularly to standardize the definition of SH-HCC.

Abstract A20: Dietary ingestion of aristolochic acid: Mechanisms of exposure

Abstract Aristolochic acids (AA) are human carcinogens and nephrotoxins found in Aristolochia plants, including herbs used in traditional medicines throughout the world. Aristolochic acids can also be ingested as an environmental contaminant in food, which forms the basis of Balkan endemic nephropathy and associated upper tract urothelial cancer. Aristolactam DNA-adducts, formed after metabolism of AA, are promutagenic and are resistant to repair and readily detected in human tissue sample DNA decades after exposure. Thus, AL-DNA adducts are excellent biomarkers of exposure to this carcinogen. The mutational signature of AA is distinct for an environmental carcinogen and is recognized as Signature 22 in the COSMIC mutational signature database. Molecular epidemiology using the presence of adducts and/or the presence of Signature 22 has implicated AA in the etiology of several cancers, including upper-tract urothelial cancer, bladder cancer, renal cell clear cell carcinoma, hepatocellular carcinoma, and cholangiocarcinomas. In regions of the world reliant on traditional medicines, including much of Asia, the AA contribution to incidence of these cancers is significant. In the Balkan countries of Europe, the route of exposure is thought to occur via contamination of wheat harvests with Aristolochia plant material from weed growth. In endemic villages farming families traditionally have ingested primarily wheat flour milled from their own harvests. An alternative hypothesis is that decaying Aristolochia plants release the chemically stable aristolochic acids into the soil, and these are then taken up and concentrated by food plants. To distinguish between these hypotheses, we have obtained 25 flour samples from individual farms along the Croatia/Bosnia and Herzegovina border. To identify AA-contaminated flour, aristolochic acids were extracted from aliquots of the flour, reduced to aristolactams, and quantitated with an LC-ESI-MS/MS method. Several flour samples were indeed contaminated with AA in the range of 10–100 parts per billion. Secondly, we also extracted DNA from each flour sample. The direct contamination hypothesis predicts the presence of Aristolochia DNA in contaminated flour samples; the indirect contamination via decay hypothesis does not. Using widely accepted plant “barcode” PCR protocols, we amplified a portion of the rbcLa gene with generic primers that amplify the gene from all species. Within this PCR amplicon each plant species has a constellation of specific base-pairs. Thus, the contribution of all plant species to the flour sample can be determined by highly parallel sequencing of the amplicon. We will present the results of this next-gen sequencing to determine the contribution of Aristolochia to Balkan flour samples and correlation with aristolochic acid content. Citation Format: Viktoriya Sidorenko, Robert Rieger, Bojan Jelakovic, Thomas Rosenquist. Dietary ingestion of aristolochic acid: Mechanisms of exposure [abstract]. In: Proceedings of the AACR Special Conference on Environmental Carcinogenesis: Potential Pathway to Cancer Prevention; 2019 Jun 22-24; Charlotte, NC. Philadelphia (PA): AACR; Can Prev Res 2020;13(7 Suppl): Abstract nr A20.

Histology of Hepatocellular Carcinoma: Association with Clinical Features, Radiological Findings, and Locoregional Therapy Outcomes.

Objective:The objective of the study was to investigate whether hepatocellular carcinoma (HCC) histology is associated with clinical and computed tomographic/magnetic resonance imaging features and locoregional therapy (LRT) outcomes.Subjects and Methods:This single-center retrospective study included 124 consecutive patients (92 men, median age 59 years) with 132 HCC diagnosed by biopsy between 2008 and 2017 before LRT. Patients underwent chemoembolization (n = 51, 41%), ablation (n = 41, 33%), yttrium-90 radioembolization (n = 17, 13%), and chemoembolization/ablation (n = 15, 12%). Barcelona clinic liver cancer (BCLC) stage was 0/A (n = 48, 38%), B (n = 33, 26%), C (n = 27, 22%), and D (n = 16, 13%). Edmondson-Steiner (ES) grade and cytology were correlated with baseline features and radiologic response using logistic regression. Time to progression (TTP) and transplant-free survival (TFS) were analyzed using Cox proportional hazard models.Results:High ES grade was associated with α-fetoprotein (AFP) >50 ng/ml (odds ratio [OR] 4.6, 95% confidence interval [CI]: 1.5–13.9; P < 0.01), tumor diameter >5 cm (OR 3.1, 95% CI: 1.1–9.0; P < 0.05), infiltrative appearance (OR 5.0, 95% CI: 1.5–16.2; P < 0.01), and BCLC Stage C (OR 4.5, 95% CI: 1.3–16.4; P = 0.02). Clear-cell subtype was associated with non-viral cirrhosis (OR 5.3, 95% CI: 1.6–17.2; P < 0.01) and atypical enhancement (OR 3.1, 95% CI: 1.0–9.3; P < 0.05). AFP, BCLC Stage B, and diameter were associated with reduced TTP and TFS (P < 0.05). Neither ES grade nor clear-cell subtype was associated with objective response (OR 2.3, 95% CI: 0.7– 7.4; P = 0.15 and OR 1.1, 95% CI: 0.4–3.4; P = 0.87, respectively), TTP (P > 0.20), or TFS (P > 0.90) on univariate or stratified analysis.Conclusion:Histologic grade is associated with aggressive tumor features, while clear-cell HCC is associated with non-viral cirrhosis and atypical enhancement. Unlike AFP, BCLC stage, and tumor size, histologic features were not associated with LRT outcomes, supporting biopsy deferral for imaging diagnosed HCC.

Clarity on Clear Cell Hepatocellular Carcinoma: A Rare Occurrence in an Individual with Chronic Hepatitis C Without Cirrhosis

Clarity on Clear Cell Hepatocellular Carcinoma: A Rare Occurrence in an Individual with Chronic Hepatitis C Without Cirrhosis

Demographic and clinical outcomes of patients with hepatocellular carcinoma nos compared with clear cell hepatocellular carcinoma: a United States population based analysis (SEER 1973-2013)

Introduction: Clear cell HCC is a rare variant of HCC, accounting for 7.5%-12.5% of all liver cancer cases with a better prognosis compared to other variants. Our study compares the demographic, clinical differences between Clear cell HCC & HCC NOS using population based database. Material and methods: Surveillance, Epidemiology, & End results (SEER) database (1973 - 2013) was abstracted to understand the demographic & clinical differences between Clear cell HCC & HCC NOS. Student t-test was used to compare continuous variables & Chi squared test for categorical variables. Cumulative life table analysis was used to compare long term survival. Results: Mean age at presentation was 63± 12.2 years for HCC NOS compared to 65.7 ± 12.8 for Clear cell HCC patients. Both entities were more common in Caucasians males. Resection was performed more often for Clear cell HCC patients (39.7%) compared to HCC NOS patients (20.8%). Cancer specific & overall mortality was higher for HCC NOS patients (61.5%, 81.4%) compared to Clear cell HCC patients (52%, 71.1%). The mean survival in months and the overall 5 year cancer specific survival was higher for Clear cell HCC patients (22.2±30.2 months & 23%) compared to HCC NOS patients (16.2±28.4 months & 15%). Conclusions: Clear cell variant accounts for very few patients with HCC (0.4%) especially in older patients & has better long term survival compared to HCC NOS. Understanding of this rare variant is ever evolving with a need to improve screening protocols, aiming at early diagnosis & timely surgical intervention.

3:45 PM Abstract No. 376 Clear cell hepatocellular carcinoma is associated with non-viral cirrhosis and arterial-phase hypo-enhancement but does not predict outcome after locoregional therapy

Clear cell hepatocellular carcinoma (HCC) is a less common HCC cytologic variant associated with improved outcomes in studies prior to the advent of locoregional therapy (LRT). This study was undertaken to determine whether clear cell HCC predicts better outcomes after LRT. We retrospectively identified 124 consecutive patients (92 men, 32 women; median age 59 y) with 132 HCC (mean diameter 4.8 ± 3.9 cm) diagnosed by percutaneous biopsy between 2008-2017 prior to transarterial chemoembolization (TACE) (n = 51, 41%), yttrium-90 radioembolization (n = 17, 13%), percutaneous thermal ablation (n = 41, 33%), and combination TACE/ablation (n = 15, 12%). Baseline Barcelona Clinic Liver Cancer (BCLC) stage was 0/A (n = 48, 38%), B (n = 33, 26%), C (n = 27, 22%), and D (n = 16, 13%). Cytological subtype was determined from percutaneous core needle biopsy as 100% clear cells, focal clear cells, or no clear cells. Baseline clinical and imaging features, and radiologic response by mRECIST were correlated with cytological subtype using multinomial regression analysis. Time to progression (TTP) and transplant free survival (TFS) were analyzed by Cox proportional hazard models. Percutaneous core biopsies comprised entirely of clear cell subtype were associated with non-viral etiologies of HCC (OR 5.3 95% CI 1.64-17.16; p = 0.005), solid histological arrangement (OR 4.32 95% CI 1.14-16.37; p = 0.031), and hypo-enhancement on arterial phase CT or MRI images (OR 3.08 95% CI 1.02-9.3; p = 0.046). The clear cell subtype was not associated with improved objective response by mRECIST (OR 0.93 95% CI 0.37-2.33; p = 0.87), delayed TTP (HR 1.17 95% CI 0.86-1.6; p = 0.32), or better TFS (HR 1.01 95% CI 0.69-1.47; p = 0.96) in comparison to specimens with focal or no clear cells. There remained no significant association between the clear cell subtype and TTP or TFS after stratifying by LRT modalities. Clear cell HCC is more common in non-viral etiologies of cirrhosis and is associated with atypical enhancement on radiologic images. It does not, however, impart independent prognostic information prior to LRT.

IDH1 R132C mutation is detected in clear cell hepatocellular carcinoma by pyrosequencing

BackgroundIsocitrate dehydrogenase 1 (IDH1) mutation is common in low-grade glioma (approximately 80%) and acute myeloid leukemia (approximately 10%). Other than brain tumor or hematologic malignancies, intrahepatic cholangiocarcinoma (iCC) is a well-known solid tumor with IDH1 mutation (6.8–20%). Histologically, poor differentiation and clear cell change are associated with IDH1 mutation in iCC. Since hepatocellular carcinoma (HCC) shares histologic features with iCC, some specific subtypes of HCC might show a higher IDH1 mutation rate than reported before (0.5–1.5%).MethodsForty-six cases of iCC and 48 cases of HCC (including 20 cases of clear cell type and 13 cases of pseudoglandular pattern) were tested for IDH1 mutation by pyrosequencing.ResultsThree cases in iCC (6.5%) and five cases in HCC (10.4%) had IDH1 mutation, all of which were Arg132Cys. IDH1 mutant HCCs were all clear cell type. Although the IDH1 mutation rate between iCC and HCC demonstrated no significant difference, clear cell HCC revealed statistically increased mutation rate compared to that of HCC without clear cell change (P = 0.009). Presence of IDH1 mutation was related with poor survival in clear cell HCC patients (P = 0.004).ConclusionsClear cell HCC showed higher frequency of IDH1 mutation rate than other variants of HCC. This result consolidates the assumption that morphological features of tumors reflect molecular alterations.

Promoter mutations and cellular distribution of telomerase in non-clear cell and clear cell hepatocellular carcinoma.

Reactivation of telomerase is a critical step in the development of hepatocellular carcinoma (HCC). Here we identified the frequency of mutations in telomerase reverse transcriptase (TERT) promoter was 34% in non-clear cell HCC (NCCHCC, n = 259) and 26.3% in clear cell HCC (CCHCC, n = 57). The mutations were independently associated with poor recurrence-free survival of HCCs. Interestingly immunohistochemical analysis demonstrated a higher positive rate of TERT cytoplasmic localization (95%) than nuclear localization (64%) in HCCs. In NCCHCCs, the mutations correlated with higher TERT nuclear expression and increased telomere-dependent telomerase activity. Higher cytoplasmic expression was found in adjacent tissues compared to tumor tissues, and was associated with tumor well-differentiation and lower level of α-fetoprotein. NCCHCCs with low nuclear as well as high cytoplasmic expression correlated with better prognosis. In CCHCCs, elevated TERT cytoplasmic expression was observed in CCHCCs harboring mutations. Higher TERT cytoplasmic expression was found in tumor tissues compared to adjacent tissues, and was associated with multiple numbers of tumors and poor prognosis of CCHCCs. In conclusion, mutations in TERT promoter disclose the significance of both nuclear and cytoplasmic TERT in HCC. Cytoplasmic TERT should also be considered when determining prognosis and treatment of HCCs.

Clear Cell Hepatocellular Carcinoma with Associated Tuberculosis-A Case Report

Clear cell hepatocellular carcinoma (CCHCC) is a rare variant of classical hepatocellular carcinoma (CHCC). Most of these cases pose a histological diagnostic dilemma with broad range of differentials of tumor with clear cell morphology. Use of immunostains or presence of classical hepatocellular carcinoma morphology focally aids in accurate diagnosis of these lesions. We report a case of a 62-year-old male who presented with loss of appetite and altered bowel habits for last 3 months. On investigation he was found to be HCV positive with genotype 1a and viral load of 3853865 IU/ml. His CECT revealed a well-defined hyper dense lesion of size 38 x 34 mm in segment V with a thin hypo dense rim. Contrast studies were suggestive of hepatocellular carcinoma with chronic liver disease. His PET CT revealed an FDG avid lesion in lung, biopsy from which showed caseating epithelioid granulomas. He underwent living donor related liver transplant. Explant liver tissue examined showed CCHCC with cirrhosis and several epithelioid granulomas. Occurrence of CCHCC with tuberculosis is a rare with no similar case has been reported in indexed English literature till date. We herein report the first case of CCHCC with coincidental Tuberculosis in an elderly male.

Hepatocellular carcinoma: a clinicopathological study of 64 cases.

Hepatocellular carcinoma (HCC) is the most common of all liver cancers and is a major worldwide public health problem. The aim of this study was to provide an updated overview on clinicopathological features, treatment and outcome of HCC. In our retrospective study, we reviewed 64 cases of HCC that were diagnosed at the pathology department of Mongi Slim hospital over a fifteen-year period (2000- 2014). Relevant clinical information and microscopic slides were retrospectively reviewed. Our study group included 38 men and 26 women (sex ratio M/F = 1,26) aged between 8 and 83 years (mean = 56,64 years). The presenting clinical symptoms were dominated by abdominal pain (n=34), followed by altered general health (n=25) and jaundice (n=4). Fifty-five patients underwent surgical treatment. Liver transplantation was performed in two cases and transarterial chemoembolization was achieved in seven cases. Histopathological examination of the surgical or biopsy specimen established the diagnosis of conventional HCC in 55 cases, fibrolamellar carcinoma in 6 cases and clear cell HCC in 3 cases. Seven patients with HCC died postoperatively. Local recurrence of the tumour occurred in three cases and two patients had distant metastases postoperatively. The other patients are still being followed-up. Hepatocellular carcinoma is associated with a high rate of mortality because of early invasion, widespread metastasis and lack of effective therapeutic modalities. Accurate diagnosis and staging of these tumours is critical for optimal treatment planning and for determining prognosis.

THU-040 - Clinical Features, Diagnosis and Therapeutic Associated Outcomes in Clear Cell Hepatocellular Carcinoma

THU-040 - Clinical Features, Diagnosis and Therapeutic Associated Outcomes in Clear Cell Hepatocellular Carcinoma

Expression of carbonic anhydrase IX, PAX2 and PAX8 and their association with clinicopathologic characteristics in renal epithelial tumors

To study the expression of carbonic anhydrase IX (CAIX), PAX2 and PAX8 in different types of renal epithelial tumor and their association with clinicopathologic characteristics. Immunohistochemical study by EnVision method was performed in order to assess the expression of CAIX, PAX2 and PAX8 in 155 cases of renal cell carcinoma and 4 cases of metastatic clear cell renal cell carcinoma (CCRCC). Ninety-six cases of non-neoplastic renal parenchymal tissue adjacent to CCRCC, 8 cases of clear cell hepatocellular carcinoma and 2 cases of clear cell hidradenoma were used as controls. CAIX was commonly expressed in CCRCC (94.0%, 63/67), of which 77.8% (49/63) showed strong positivity. CAIX was focally positive in papillary renal cell carcinoma, collecting duct carcinoma and urothelial carcinoma of renal pelvis. It was negative in chromophobe renal cell carcinoma, oncocytoma and adjacent non-neoplastic renal tissue. CAIX was also strongly expressed in the 4 cases of metastatic CCRCC. Focal expression of CAIX was demonstrated in the 8 cases of clear cell hepatocellular carcinoma and 2 cases of clear cell hidradenoma. The expression of CAIX in CCRCC did not correlate with tumor grading, clinical staging and presence of distal metastasis. On the other hand, PAX2 showed positive expression in different types of renal epithelial tumor, clear cell hepatocellular carcinoma and clear cell hidradenoma in various degrees. In contrast, PAX8 was commonly expressed in all types of renal epithelial tumor, with the exception of urothelial carcinoma of renal pelvis. PAX8 was not expressed in clear cell hepatocellular carcinoma and clear cell hidradenoma. Regarding diagnosis of CCRCC, CAIX demonstrated high sensitivity and specificity. PAX2 showed high specificity but low sensitivity. PAX8 was sensitive and specific in the diagnosis of renal epithelial tumor. CAIX is a useful immunohistochemical marker with high specificity and sensitivity in distinguishing CCRCC from other types of renal epithelial tumor and clear cell tumors of non-renal origin. PAX2 is a marker with high sensitivity and low specificity for diagnosis of renal epithelial tumors. PAX8 is typically expressed in renal epithelial tumors. The combined detection of CAIX, PAX2 and PAX8 is useful in the diagnosis and differential diagnosis of renal epithelial tumors.