Squamous cell cancer of the liver arising from an epidermoid cyst: case report and review of the literature

Primary hepatic squamous cell carcinoma: case report and systematic review of the literature

Primary hepatic squamous cell carcinoma (SCC) is extremely rare, and only a few dozen cases have been reported to date. It can barely be diagnosed before histopathological examination, which necessitates the exclusion of metastatic tumors. In this case, we present a 60-year-old female patient with no comorbidity. As laboratory tests and imaging examinations were not diagnostic, ultrasonography (US)-guided liver biopsy was performed and eventually revealed a definitive pathological diagnosis of hepatic SCC. After excluding metastasis, the diagnosis of primary hepatic SCC was established, and then chemotherapy and immunotherapy were performed. Additionally, a comprehensive literature search was conducted on primary hepatic SCC using PubMed, Google Scholar, and Web of Science, and a total of 53 articles were retrieved with a time range from 1972 to 2022. A critical analysis was then performed to evaluate previous literature focusing on the clinical characteristics, imaging features, treatments, and prognosis.

Survival After Resection for Epidermoid Cyst-originated Squamous Cell Carcinoma of the Liver: Case Report and Review of the Literature

Epidermoid cyst is a rare type of congenital hepatic cyst. Reports on squamous cell carcinoma (SCC) of the liver are very limited and mostly have poor outcomes. We present a 45-year-old woman who came to our hospital due to obstructive jaundice caused by an epidermoid cyst-originated SCC. She underwent radical resection and lived for two years without signs of recurrence. The presentation, treatment, pathological results, as well as literature review, are provided below.

Curative surgery for primary squamous cell carcinoma of the liver: a rare case study

Primary squamous cell carcinoma (SCC) of the liver is an extremely rare disease with a very poor prognosis. An 83-year-old woman was referred to our hospital with left abdominal pain. Laboratory data showed mildly elevated C-reactive protein and biliary enzymes. The tumor markers carcinoembryonic antigen, alpha-fetoprotein, and carbohydrate antigen 19-9 were within normal ranges. Contrast-enhanced computed tomography revealed a 60 mm-sized low-density mass with poor contrast enhancement located in the lateral segment of the liver. The tumor showed low signal on T₁-weighted magnetic resonance imaging (MRI) and high signal on T₂-weighted MRI. The cytology of bile juice showed no malignant findings. Endoscopic ultrasound-guided fine-needle aspiration biopsy was performed, which was suggestive of primary hepatic SCC. Tumor markers cytokeratin 19 fragment (CYFRA) and SCC-related antigen were elevated, at 25.2 ng/mL and 14.7 ng/mL, respectively. Left lobectomy and hilar lymph node dissection were performed. One month after surgery, the tumor marker values showed a marked decrease of 1.8 ng/mL for CYFRA and 0.3 ng/dL for SCC-related antigen. The patient has been without recurrence for more than one and half year postoperatively. SCC-related antigen and CYFRA were markedly decreased after tumor resection in this case, which may suggest their utility as tumor markers for SCC of liver origin.

Primary squamous cell carcinoma of the liver: a case report

Primary squamous cell carcinoma of the liver is extremely rare, very difficult to diagnose, and carries an extremely poor prognosis. In this study, we discuss the imaging features of a patient with primary hepatic squamous cell carcinoma. The patient was admitted to hospital owing to discomfort in the right upper abdominal quadrant and a loss of appetite. He had no previous risk factors associated with hepatic squamous cell carcinoma and no history of systemic squamous cell carcinoma. We diagnosed primary hepatic squamous cell carcinoma by pathological analysis. Primary hepatic squamous cell carcinoma is rare, and its histological features are controversial, which makes the clinical and imaging diagnosis difficult. Therefore, it is urgent to improve the understanding of this disease in clinical practice to avoid misdiagnosis, and to identify the best treatment. This case provides a basis for the clinical diagnosis of primary hepatic squamous cell carcinoma.

Primary squamous cell carcinoma of the liver: an unexpected pathological finding

Background

Primary squamous cell carcinoma of the liver is a very rare cancer requiring a complete diagnostic investigation, as it presents some differences from other primary hepatic malignancies. We describe the case of an elderly patient with primitive squamous cell carcinoma of the liver treated by percutaneous microwave ablation and transarterial chemoembolization.

Case presentation

Although the pathogenesis remains uncertain, a possible transformation of the biliary epithelium caused by chronic inflammation or metaplasia and subsequent malignant transformation of preexisting benign hepatic cysts has been suggested. A critical review of the existing literature was performed by focusing on the pathogenesis, clinical presentation, and the suggested therapeutic strategies.

Conclusion

A multidisciplinary approach is needed to face rare hepatic malignancies where there are no clear guidelines.

Congenital Epidermoid Cyst of the Liver: A Rare Entity Characterized by Antenatal Onset, Slow Postnatal Growth, and Consistent Histologic and Immunohistologic Features

BACKGROUND

There are only 15 reported hepatic epidermoid cysts; they include patients presenting congenitally through adulthood, with varied speculations about pathogenesis. Aside from recently reported pancytokeratin staining, no other descriptions have included immunohistochemistry. Splenic epidermoid cysts were recently characterized as positive for HBME-1, p63, CEA, CK7 (luminal), and CK19. We interrogate 2 hepatic epidermoid cysts with a broad panel of immunohistochemistry, with the aim of elucidating histogenesis.

METHODS

Archives were searched for "liver," "hepatic," and "cyst." Hepatic cysts lined by squamous epithelium were included. Clinical records, macroscopic findings, and hematoxylin and eosin and immunohistochemically stained slides were reviewed.

RESULTS

We identified 2 patients with epidermoid cysts of the liver, first detected on antenatal ultrasound. Both were females and asymptomatic; neither had other congenital abnormalities. Cysts enlarged slowly after birth. Resection was at ages 2 and 6 months, done to avoid potentially more difficult surgery in the future. Cysts were unilocular (4.8 cm) and multilocular (7.0 cm). Both were lined by stratified nonkeratinizing squamous to focally transitional-like epithelium and surrounded by paucicellular fibrous stroma. In the multilocular cyst, hepatocytes and fibrous stroma populated septa. Epithelium was positive for HBME-1, p63, CK19, CEA, Cam5.2, and CK7, negative for EMA, D2-40, WT-1, calretinin, and Ca19-9. Cytogenetic analysis of one showed a normal female karyotype. During the study period, 22 other pediatric liver cysts were diagnosed.

CONCLUSION

Hepatic epidermoid cyst is a distinct entity, rare but nevertheless constituting 8% of pediatric hepatic cysts at our institution. It is characterized by intrauterine onset and growth roughly commensurate with that of the fetus/infant; it is apparently unsyndromic. It may be unilocular or multilocular. It stains for an array of epithelial markers as well as HBME-1. Strong immunohistochemical overlap with splenic epidermoid cyst points to a shared pathogenesis and detracts from hypotheses that hepatic epidermoid cysts derive from hepatic elements.

Is Routine Pathologic Evaluation of Sebaceous Cysts Necessary?: A 15-Year Retrospective Review of a Single Institution

A question arose in our practice of whether all cysts considered sebaceous should be sent for pathologic evaluation. To address this controversial topic, we performed a retrospective study of our single institution's histopathology database. A natural language search of the CoPath database across the institution was undertaken using the diagnosis of sebaceous cyst, epidermal cyst, epidermoid cyst, epithelial cyst, infundibular cyst, pilar cyst, trichilemmal cyst, and steatocystoma. A surgical pathologic review of all specimens with one of these preexcision diagnoses was included in the 15-year retrospective study of 1998 to 2013. All slides were confirmed to have undergone histopathologic review, and the preexcision diagnoses were compared with the postexcision diagnoses. Chart review was undertaken in instances of a diagnosis of malignancy. A total of 13,746 samples were identified. Forty-eight specimens had histopathologic diagnosis of malignancy, for an incidence of 0.3% and with the most common malignancy being squamous cell carcinoma. Chart review showed that for all cases, the surgeons reported uncertainty with regard to the diagnosis because of history or physical characteristics, or both. In addition, a comprehensive literature review showed results consistent with our data and illustrated 19 cases during the past 10 years in which most of the findings were squamous cell carcinoma. We propose the recommendation that routine pathologic evaluation of sebaceous cysts is necessary only when clinical suspicion exists.

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

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.

Squamous cell carcinoma arising from a presacral epidermoid cyst: CT and MR findings

We report CT and MRI findings in a case of squamous cell carcinoma arising from a presacral epidermoid cyst, which has not been previously reported. CT findings revealed a focal wall thickening of the anterior wall of the huge presacral cystic mass. The squamous cell carcinoma was more hypointense than the cystic fluid on T1- and T2-weighted images and showed heterogeneous enhancement on contrast enhanced T1-weighted image.

[Hepatic cysts: diagnosis and management]

Cystic lesions of the liver are common and usually benign. The most frequent lesion is simple hepatic cyst: typical imaging findings make their diagnosis easy and they require no treatment. Complicated hepatic cysts (i.e., compression, hemorrhage, infection) have more variable imaging findings making diagnosis more difficult; they may evoke other diagnoses. Asymptomatic hepatic cysts do not require any treatment or follow-up. Symptomatic cysts may benefit from simple follow-up or may be treated by laparoscopic fenestration or alcohol sclerotherapy. The differential diagnosis of complicated hepatic cysts includes cystadenoma, cystadenocarcinoma, hydatid cyst, or cystic metastasis; surgical resection is usually indicated for these lesions.