Primary Clear Cell Carcinoma Of The Liver Research Articles

Imaging features of concurrent scirrhous hepatocellular carcinoma and primary clear cell carcinoma of the liver: A case report and literature review

Multiple lesions commonly appear in the liver of patients with hepatocellular carcinoma (HCC), and the prognosis is associated with the subtype. However, simultaneous occurrence of scirrhous HCC (SHCC) and primary clear cell carcinoma of the liver (PCCCL) has not been reported to date. The diagnosis of SHCC and PCCCL is uncommon using the traditional imaging examination methods such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging. We herein summarize the imaging features of SHCC and PCCCL to provide a reference for accurate preoperative diagnosis and appropriate treatment. A 55-year-old male was diagnosed with two hepatic tumors by the US examination. On the 2nd day after the US examination, he was diagnosed with HCC with intrahepatic metastasis by enhanced CT examination. His alpha-fetoprotein level was 3272 ng/mL (reference range, 0–7 ng/mL). Two weeks after enhanced CT examination, the patient underwent hepatectomy and cholecystectomy. Pathological examination showed that the tumor in liver segments 2 and 3 was SHCC and that the tumor in liver segment 4 was PCCCL. One year postoperatively, digital subtraction angiography showed no obvious tumor staining. Five years postoperatively, enhanced CT examination showed no recurrence or metastasis. Radiologists usually diagnose multiple tumors in the liver as malignant tumors with intrahepatic metastasis. Simultaneous occurrence of SHCC and PCCCL in the liver is occasionally found. The US imaging features, CT enhancement types, and location of the tumors can help radiologists to accurately diagnose SHCC and PCCCL, allowing clinicians to choose appropriate treatment.

Influence of clear cell carcinoma on the post-hepatectomy prognosis of patients with hepatocellular carcinoma.

Aim: The authors aimed to identify factors that independently influence the survival of patients with primary clear cell carcinoma of the liver (PCCCL). Methods: A total of 470 patients with hepatocellular carcinoma were retrospectively analyzed. Multivariate Cox analysis was used to identify potential factors associated with prognosis of PCCCL. Results: Patients with PCCCL showed significantly higher disease-free survival (DFS) and overall survival (OS) compared with patients with non-clear cell hepatocellular carcinoma. Multivariate analysis revealed that AFP level, tumor size, liver cirrhosis and portal vein tumor thrombosis were risk factors for DFS. Tumor size, capsule formation and Ki-67 were risk factors for OS. Satellite nodules acted as a protective factor for DFS and OS. Conclusion: PCCCL is associated with betterprognosis in hepatocellular carcinoma. Tumor size and satellite nodules may be independent predictors of OS and DFS.

Predictors and survival of primary clear cell carcinoma of liver: a population-based study of an uncommon primary liver tumor.

BackgroundThe clinicopathological features and prognostic factors of primary clear cell carcinoma of the liver (PCCCL) remain unknown for the rarity. We aimed to determine the clinical and therapeutic characteristics of PCCCL and the effects of these factors on the prognosis.MethodsPatients were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Data were analyzed with the Kaplan-Meier, Cox proportional hazards regression analyses and the multivariable competing risk model.ResultsWe included 223 PCCCL patients and the majority of them had an age under 75 years (82.5%). Most patients were white people (63.2%). The patients diagnosed at localized stage (63.7%), T1 (49.8%), N0 (96.0%), M0 (87.4%) and American Joint Committee on Cancer (AJCC) I (44.4%) made up the majority of the population. More PCCCL tumors had a size beneath 4 cm (74.9%) and no vascular invasion (63.2%). The 3-, 5-, and 10-year overall survival (OS) probabilities and disease-specific survival (DSS) rates were 35.8%, 24.3%, 14.4%, and 41.6%, 29.4%, 22.2%, respectively. The patients with tumor ≥1 cm [OS, hazard ratio (HR) =1.822; DSS, HR =1.959] had a higher risk of death than those patients with tumor <1 cm. Among surgical means, hepatectomy (OS, HR =0.070; DSS, HR =0.050) and total hepatectomy plus transplant (OS, HR =0.074; DSS, HR =0.065) were more beneficial to PCCCL.ConclusionsPCCCL patients were inclined to be young, white people-prevalent, localized and early. PCCCL tend to had a slow growth and be weakly aggressive. However, comparing with previous reports, we found that PCCCL had a relatively poor outcome. Tumor size and surgery were the independent prognostic factors for OS and DSS.

Long-term survival and prognosis for primary clear cell carcinoma of the liver after hepatectomy

BackgroundThe aim of this study was to investigate the long-term survival and prognosis for primary clear cell carcinoma of the liver (PCCCL) of the liver after hepatectomy.MethodsOur study retrospectively analyzed the clinicopathological data of 64 patients with PCCCL (PCCCL group) and 247 with nonclear cell hepatocellular carcinoma (NHCC group) after hepatectomy between January 1996 and December 2006. The overall survival (OS) and disease-free survival of the two groups was compared using the Kaplan–Meier method. Prognostic factors of survival were identified by multivariate analysis.ResultsThe 1-, 3-, and 5-year OS (P=0.016) and disease-free survival (P<0.001) of the PCCCL group were significantly higher than that of the NHCC group. In mutivariate analysis, tumor size >5 cm, presence of portal vein tumor thrombosis and proportion of clear cells ≤70% were risk factors for OS of the PCCCL group. The prognosis of a subgroup with higher proportion of clear cells was markedly better than that of the subgroup with a lower proportion of clear cells.ConclusionOur results suggested that the prognosis of patients with PCCCL was better than that of the patients with NHCC. The higher the proportion of clear cells, the better the prognosis.

A Giant Primary Clear Cell Hepatocellular Carcinoma in a Young Woman without Cirrhosis

Primary clear cell carcinoma of the liver (PCCCL) is an uncommon variant of hepatocellular carcinoma, usually occurring in older patients with longstanding cirrhosis. We report a case of a giant PCCCL rupturing in a young woman without cirrhosis. A 29 year-old female who presented with a three month history of abdominal pain, nausea, vomiting, food intolerance, and unintentional weight loss, was found to have gastric varices and a large liver mass measuring 22.8cm × 17.8 cm × 13.8 cm. The tumor was comprised of sheets of clear cells with delicate vesicular architecture, and was positive for Hepar 1, Glypican 3, and CD34 in a diffuse staining pattern and CD10 in a canalicular staining pattern, establishing the diagnosis of PCCCL. The patient died of hemorrhagic shock secondary to tumor rupture within two weeks of diagnosis. Conclusion: Although PCCCL most often occurs in older patients with cirrhosis, this uncommon variant of HCC can arise in younger patients without a history of liver disease. It is important to diagnose PCCCL early due to the potentially favorable prognosis of this specific cancer and in order to prevent catastrophic complications.

CT findings of primary clear cell carcinoma of liver: with analysis of 19 cases and review of the literature

To analyze CT characteristics of primary clear cell carcinoma of the liver (PCCCL) and improve the current understanding and diagnose accuracy of the tumor. Pre- and post-contrast CT images of 19 patients with pathology proven PCCCL were retrospectively analyzed. The clinical data and CT findings as well as relevant literature reports were reviewed. Thirteen patients were tested positive for HBsAg, and two patients were positive for HCVAb. The serum alpha-fetoprotein (AFP) levels of most tumors (14/19) were ≤20 ng/ml with 14 cases were associated with liver cirrhosis. All lesions were solitary intraparenchymal mass lesions which have well-defined boarders. On pre-contrast CT scans, 15 lesions appeared as hypo-attenuation and four lesions appeared as isointensity to the adjacent liver parenchyma. On post-contrast CT scans, 16 lesions showed avid enhancement on the hepatic arterial phase, of which 6 lesions were hypo-attenuation, and 10 lesions remained slightly hyper-attenuation or iso-attenuation on the portal venous phase images. Three lesions showed only mild enhancement on the hepatic arterial phase and hypo-attenuation on the portal venous phase. All lesions demonstrated hypointensity on the equilibrium phase. There are 12 lesions showed pseudocapsules. None of patients showed signs of portal vein thrombosis. There was no distal metastasis except only one patient had lymph node metastasis. The characteristics of CT imaging of PCCCL, such as tend to form pseudocapsules and less involved with vascular invasion, could be useful in differentiating from common type hepatocellular carcinoma (CHCC). Some CT imaging characteristics of PCCCL are similar to CHCC, such as prone to occur in patients with liver cirrhosis and early enhancement pattern on the hepatic arterial phase as well as hypo-attenuation on the equilibrium phase. Those features could be useful in differentiating PCCCL from other liver tumors, such as hemangioma and hepatic metastases.

The diagnosis and clinical value of imaging for primary clear cell carcinoma of the liver

Objective To investigate the imaging features of primary clear cell carcinoma of the liver (PCCCL) and its clinical value.Methods MRI and CT finding of 12 patients with PCCCL proved by pathology were analyzed retrospectively.8 patients underwent plain and dynamically enhanced MRI and 10 patients underwent plain and dynamically enhanced CT scanning.Results The numbers were 67％ (8/12) in the right lobe,25％ (3/12) in the left lobe,and 8％(1/12) in the caudate lobe.Tumor diameters were 1.6 to 9.8 cm,and the average was 3.6 cm.For the MRI examination,75 ％ (6/8) showed a mixed high signal on T2WI and an equal or slightly lower signal on T1WI.All of the signal was reduced on anti-phase T1WI,67 ％ (4/6)was obviously reduced,and all showed high signal on DWI.The 75 ％ (4/6) slightly enhanced at the arterial phase continued to enhance at the portal venous phase.The pathology confirmed that there was a higher proportion of clear cell.25 ％ (2/8) showed an equal signal on T2WI and a slightly higher signal on T1WI,all of the signal reduced on anti-phase T1WI,and all showed equal or slightly higher signal on DWI.All were significantly enhanced at the arterial phase and clearanced at the portal venous phase.The pathology confirmed that there was a relative lower proportion of clear cell.50％ (4/8) could be seen with the capsule and ring enhanced.All showed low-density on CT scan,80％ (8/10) were slightly enhanced at arterial phase and the signals continued to strengthen at the portal venous phase.The pathology confirmed that 75％ (6/8) had a higher proportion of clear cell and 25％ (2/8) had a relatively low proportion of clear cell.20％ (2/10) showed significantly uneven enhancement at the arterial phase and the degree of enhancement decreased at the portal venous phase.The pathology confirmed that there was a lower proportion of clear cell.20％ (2/10) could be seen with the capsule with the ring enhanced.Conclusions Plain and dynamically enhanced MRI and CT scans could show the pathological features and tissue composition of PCCCL fully and accurately.They were effective methods and each had certain characteristics.The combination of these had important values to diagnosis PCCCL and could provide important information for clinics to develop the best treatment plan and prognostic evaluation. Key words: Liver neoplasm; Clear cell carcinoma; X-ray computed; Magnetic resonance imaging

Clinicopathological and prognostic analysis of primary clear cell carcinoma of the liver

To investigate the clinicopathological features and prognostic factors of primary clear cell carcinoma of the liver (PCCCL). The clinical data of 41 PCCCL patients who underwent hepatic resection for PCCCL from October 1998 to June 2012 in our department were retrospectively analyzed. There were 31 male and 10 female patients. The median age was 56 years (range, 25 to 80 years), and the diagnosis was confirmed by postoperative pathological examination. The data of 106 well or moderately differentiated non-clear cell hepatocellular carcinoma (HCC) patients and 86 poorly differentiated non-clear cell HCC patients who underwent hepatic resection in the same period in our hospital in the same period were compared. The χ(2) test or Fischer's exact test, as appropriate, was used to compare group frequencies. Survival analysis was estimated by Kaplan-Meier method. Cox proportional hazards model was used in multivariate analysis. The proportion of fibrous capsule formation in the PCCCL tumors (46%, 19/41) was significantly higher than that of the other two groups (P < 0.05), whereas the PCCCL group had a lower rate of intravascular tumor embolus (2/41) and vascular invasion (1/41) (P < 0.05). The median survival time of PCCCL group was 65 months, the 1-, 3-, 5-year survival rates for PCCCL patients were 90.2%, 67.4% and 42.0%, significantly better than that of poor differentiated NCCHCC group's (82.9%, 33.3%, 7.2%, P < 0.01). However, there were no statistic significant differences between PCCCL group and well or moderately differentiated NCCHCC group (84.7%, 55.7%, 34.4%, P > 0.05). Tumor capsule formation was an independent favorable prognostic factor. In contrast, preoperative serum α-fetoprotein (AFP) level and hepatitis B virus infection were independent unfavorable prognostic factors for PCCCL. PCCCL is a rare, low degree malignant pathological subtype of HCC. Surgical resection may achieve favorable prognosis and even long-term survival.

Risk Factors, Prognosis, and Management of Early and Late Intrahepatic Recurrence After Resection of Primary Clear Cell Carcinoma of the Liver

Primary clear cell carcinoma of the liver (PCCCL) is an uncommon variant of hepatocellular carcinoma (HCC). The prognostic factors influencing its recurrence and survival are not clarified. This study is to evaluate the predictive factors, the therapy, and prognosis of intrahepatic recurrences after resection of PCCCL. A total of 214 PCCCL patients treated by curative resection from January 1996 to March 2006 were retrospectively analyzed. Intrahepatic recurrences were classified into early (≤1 year) and late (>1 year) recurrences. The 1-, 3-, and 5-year overall survival (OS) rates for PCCCL patients were significantly better than those of HCC patients (P = .001). Serum a-fetoprotein (AFP) level, tumor size, liver cirrhosis, and vascular invasion were independent risk factors for both OS and disease-free survival (DFS) of PCCCL. Early and late intrahepatic recurrences developed in 28 patients and 71 patients, respectively. In multivariate analysis, ALT level and vascular invasion were independent risk factors for early recurrence, whereas age was the only significant risk factor for late recurrence. OS of late-recurrence group was significantly better than that of early-recurrence group (P = .001), and re-resection rate was higher in late than in early-recurrence group (P = .04). The 1-, 3-, and 5-year OS of patients with recurrence who received curative treatment was comparable to those who never had tumor recur (P = .71). PCCCL has a better prognosis and tends to recur later than HCC. Early and late recurrences of PCCCL are linked to different predictive factors. The time to recurrence and feasibility of curative treatment are the best determinants for the prognosis.

Primary clear cell carcinoma in the liver: CT and MRI findings

To retrospectively analyze the computed tomography (CT) and magnetic resonance imaging (MRI) appearances of primary clear cell carcinoma of the liver (PCCCL) and compare the imaging appearances of PCCCL and common type hepatocellular carcinoma (CHCC) to determine whether any differences exist between the two groups. Twenty cases with pathologically proven PCCCL and 127 cases with CHCC in the Second Affiliated Hospital of Sun Yat-sen University were included in this study. CT or MRI images from these patients were retrospectively analyzed. The following imaging findings were reviewed: the presence of liver cirrhosis, tumor size, the enhancement pattern on dynamic contrast scanning, the presence of pseudo capsules, tumor rupture, portal vein thrombosis and lymph node metastasis. Both PCCCL and CHCC were prone to occur in patients with liver cirrhosis, the association rate of liver cirrhosis was 80.0% and 78.7%, respectively (P > 0.05). The mean sizes of PCCCL and CHCC tumors were (7.28 ± 4.25) cm and (6.96 ± 3.98) cm, respectively. Small HCCs were found in 25.0% (5/20) of PCCCL and 19.7% (25/127) of CHCC cases. No significant differences in mean size and ratio of small HCCs were found between the two groups (P = 0.658 and 0.803, respectively). Compared with CHCC patients, PCCCL patients were more prone to form pseudo capsules (49.6% vs 75.0%, P = 0.034). Tumor rupture, typical HCC enhancement patterns and portal vein tumor thrombosis were detected in 15.0% (3/20), 72.2% (13/18) and 20.0% (4/20) of patients with PCCCL and 3.1% (4/127), 83.6% (97/116) and 17.3% (22/127) of patients with CHCC, respectively. There were no significant differences between the two groups (all P > 0.05). No patients with PCCCL and 2.4% (3/127) of patients with CHCC showed signs of lymph node metastasis (P > 0.05). The imaging characteristics of PCCCL are similar to those of CHCC and could be useful for differentiating these from other liver tumors (such as hemangioma and hepatic metastases). PCCCLs are more prone than CHCCs to form pseudo capsules.

Therapy and prognostic features of primary clear cell carcinoma of the liver

To clarify the therapeutic strategies and prognosis factors of primary clear cell carcinoma of the liver (PCCCL). The clinical pathological data of 64 patients with PCCCL treated with hepatectomy in our hospital from January 2000 to January 2006 were analyzed retrospectively. The patients were divided into two groups to make treatment analysis: curative resection only (n = 40); and curative resection and postoperative chemotherapy with calcium folinate and tegafur (n = 24). Meanwhile, the PCCCL patients were subdivided into two subgroups on the basis of the proportion of clear cells in the tumor for pathological analysis. There were 36 cases in subgroup A for which the proportion of clear cells was more than 70%, and 28 cases in subgroup B for which the proportion was less or equal to 70%, comparing analysis of median survival time of the counterpart groups. Univariate and multivariate analyses were performed to examine factors that affected clinical prognosis, recurrence and metastasis. Median survival period of the curative surgery group was 38 mo, while the counterpart was 41 mo. Median survival period for group A was 41 mo, while group B was 19 mo. The Kaplan-Meier method showed that capsule formation, preoperative liver function, hepatitis C virus infection, large vascular invasion and multiple tumor occurrences were related to disease-free survival. Cox regression analysis showed that the clear cell ratio, capsule formation, preoperative liver function and large vascular invasion were independent risk factors for overall survival. Postoperative chemotherapy has no obvious effect on survival of patients with PCCCL. Clear cell ratio, capsule formation, preoperative liver function, and vascular invasion were independent risk factors for prognosis.

Diagnosis and treatment of primary clear cell carcinoma of the liver

To investigate the clinicopathological features, diagnosis, treatment and prognosis of primary clear cell carcinoma of the liver (PCCCL). The clinicopathological data of 24 cases with pathologically proven PCCCL in the First Affiliated Hospital of Guangxi Medical University from May 1996 to December 2003 were collected and analyzed. There were 21 males and 3 females in this group, with an average age of 46 years (range: 30 approximately 78 years). HBV infection was detected in 83.3%, and AFP expression was found in 75.0% of them. Of the 24 cases, 28 tumors were found with an average size of (6.64 +/- 5.54) cm. Liver cirrhosis was found in 75.0% of the patients. Macroscopic and microscopic tumor thrombi were found in 20.8% and 29.2%, respectively. Lymph node metastasis was found in 4.2% of the patents. The 1-, 3-, and 5-year overall survival rates of the 24 cases were 75.0%, 41.7% and 27.8%, respectively, with a median survival time of 29 months. The clinical characteristics of primary clear cell carcinoma of the liver are similar to that of common hepatocellular carcinoma. It is difficult to be diagnosed preoperatively and final diagnosis depends on pathological examination. Surgical resection is an effective way to achieve favorable treatment outcome and even long-term survival.

Clinicopathological and prognostic features of primary clear cell carcinoma of the liver

Primary clear cell carcinoma of the liver (PCCCL) is a subgroup of primary hepatocellular carcinoma (HCC), pathologically characterized by diffuse clear cells of the tumor, showing a clear cytoplasm that does not stain with hematoxylin-eosin. At present, its clinicopathological and prognostic features are not fully clarified. This study aims to clarify the clinicopathological and prognostic features of PCCCL. The clinicopathological data of 43 patients with PCCCL treated with hepatectomy in our hospital from January 1999 to December 2003 were retrospectively analyzed. The chi(2)-test showed a positive rate of hepatitis C virus (HCV) infection and capsule formation in the PCCCL group, which was markedly higher than in the common type HCC (CHCC) group (P = 0.000 and P = 0.005). Meanwhile, the vascular invasion rate was notably lower in the PCCCL group, but there were no significant differences between the twogroups (P = 0.129). The Kaplan-Meier method showed that the 1-, 3-, and 5-year survival rates were significantly higher in the PCCCL group than in the CHCC group (P = 0.021). The prognosis of patients in the PCCCL group was related to capsule formation, vascular invasion, liver cirrhosis, and clear cell ratio. The 1-, 3-, and 5-year survival rates were markedly higher in the group with a higher clear cell ratio than in the group with a lower clear cell ratio (P = 0.011). The notable clinicopathological features of the patients in the PCCCL group included a higher rate of HCV infection, capsule formation, and a lower rate of vascular invasion. The prognosis was better than that of the patients in the CHCC group and related to the ratio of clear cells.