Primary Squamous Cell Carcinoma of the Liver: An Uncommon Finding in Contrast-Enhanced Ultrasonography Imaging

Abstract

Primary squamous cell carcinoma (SCC) of the liver is rare tumor with an unfavorable prognosis. We report a case of advanced primary SCC of the liver arising adjacent to a nonparasitic liver cyst, invading into the right diaphragm and the right lung tissue. Contrast-enhanced ultrasonography (CE-US) demonstrated unique enhancement in the late vascular phase, which was incompatible with those observed in hepatocellular carcinoma, cholangiocellular carcinoma, or metastatic adenocarcinoma. The patient underwent surgical resection of the tumor followed by systemic chemotherapy with 5-fluorouracil (5-FU) and cisplatin (CDDP), while radiation chemotherapy was not applied because of relatively poor performance status. Although postoperative image analysis revealed no recurrence 4 months later, the patient died 13 months after the operation from recurrence. Immunohistological analysis of the resected specimen revealed that this SCC contained many capillary endothelial vessels expressing CD31 or CD34, possibly reflecting the unique imaging pattern in the late vascular phase of CE-US, which has been reported in choangiolocellular carcinoma. In addition, we reviewed which kind of treatment would be suitable for advanced hepatic primary SCC in the literature. From the review, it could be proposed that a combination of radiation therapy, systemic chemotherapy (5-FU and CDDP) and surgical resection, if possible, is appropriate for advanced primary SCC of the liver.

The comparison of surgical patients with primary hepatic squamous cell carcinoma or adenosquamous carcinoma and surgical patients with hepatocellular carcinoma

“…Besides the resection, previously reported methods included transcatheter arterial infusion chemotherapy (TACE), which was considered to be useful for both primary hepatic SCC and ASC patients [ 22 ]. Systemic chemotherapy was also reported in the therapeutic course of SCC and ASC [ 21 , 33 ]. Although these therapeutic methods were reported to have significant treatment effects, they usually were adopted just as adjuvant therapy [ 29 ].…”

Primary squamous cell carcinoma of the liver: a case report

“…Like most of the hepatic malignancy, surgical resectability and operability is one of the most important factors deciding prognosis [ 8 ]. If surgical resection could be performed before tumor invading surrounding liver parenchyma, this could lead to a good prognosis [ 9 - 11 ]. Weimann et al performed surgical resection for primary SCC of the liver, without any adjuvant chemotherapy or radiation therapy, and patient survived more than 4 years [ 10 ].…”

“…Banbury et al also performed surgical resection for primary SCC of the liver, and patient survived more than 16 months without any adjuvant therapy [ 9 ]. But most of the cases of primary SCC of the liver are advanced, surgical resection alone cannot promise good prognosis and improve overall survival, and that radiation therapy or chemotherapy with 5-FU and/or CDDP should be considered with complete surgical resection [ 11 ]. Boscolo et al reported to have successfully treated advanced primary SCC of the liver with systemic CDDP and 5-FU therapy with surgical resection [ 12 ].…”

Primary Squamous Cell Carcinoma of Liver

“… 28 Chemotherapy, TACE, and even radiation could be used in these inoperable patients or as adjuvant treatments before and after surgery. 20 , 23 , 25 , 27 – 29…”

“… 1 – 27 The prognosis of this tumor is extremely poor, only a few patients survived more than 12 months even after treatment as reported. 10 , 12 , 23 – 26 , 28 – 30 Therefore, primary liver SCC is extremely rare occurred and different from other primary liver cancers.…”