Microscopic description and IHC:

Histologic sections show a cystic tumor with surrounding fibrosis composed of epidermoid, intermediate and mucous cells.

Scant tumor stroma, sinusoids lined by flat endothelial cells.

Neoplasm composed of epithelioid cells with central nucleus and clear cytoplasm.

IHC positive stains:
  • HepPar-1/Hepatocyte (granular cytoplasmic staining)
  • Arginase
  • Glypican-3
  • CK 8/18
  • AE 1/3
  • Glutamine synthetase (diffuse)

IHC negative stains:
  • PAX 8

Discussion:

Clear cell hepatocellular carcinomas are well to moderately differentiated HCCs with moderate to abundant cytoplasm that appears “clear” on H&E stains. - At least 50% of the tumor should have clear cells

Clear cell carcinomas stain like typical HCCs.

Clear cell HCC of cirrhotic patients is difficult to distinguish from clear cell renal cell carcinoma.

References:

Emile, J-F, et al. Histological, genomic and clinical heterogeneity of clear cell hepatocellular carcinoma. Histopathology. March 2001. volume 38, Issue 3, pages 225-231.

Torbenson, Michael. Biopsy Interpretation of the Liver. Philadelphia: Wolters Kluwer, 2015. Print.

CASE IMAGES