Squamous cell carcinoma as a rare entity of primary liver tumor with grave prognosis

The development of primary squamous cell carcinoma (SCC) of the liver has only rarely been reported in association with pre-existing hepatic cysts and biliary tract diseases. This report describes an unusual case of SCC originating in a cirrhotic liver. A 63-year-old male alcoholic was incidentally found to have a 6-cm liver tumor which showed mixed echogenic by sonography and a low-density area with rim enhancement by computed tomography. Tumor biopsy led to a diagnosis of SCC with a sarcomatoid change. The tumor showed fatal rapid growth accompanied by abdominal pain. Transcatheter arterial embolization and chemotherapy were not effective, and the tumor increased to 13 cm in diameter over an 8-month period. A post-mortem search revealed no alternative primary tumor site other than liver. Review of the literature shows that abdominal pain is a chief symptom of primary liver SCC. Only three of the nine patients treated with hepatic resection survived without recurrence during 8 months to 4 years of follow-up. We propose that SCC with a grave prognosis should be considered as a rare entity of primary liver tumor even in cirrhotic patients.