CLEAR CELL HEPATOCELLULAR CARCINOMA, A CASE REPORT

Introduction and Objectives

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.

Clinical Case

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.

Discussion

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.

Conclusions

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.