Surgical resection combined with TACE for primary clear cell carcinoma of the liver: a case report and literature review.
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BACKGROUND: Primary clear cell carcinoma of the liver (PCCCL) is an uncommon hepatocellular carcinoma (HCC) subtype that resembles extrahepatic clear cell tumors, posing diagnostic challenges. CASE PRESENTATION: A 74-year-old woman with hepatitis B-related cirrhosis (Child-Pugh class A) presented with acute abdominal pain and vomiting. Imaging revealed a hypervascular hepatic lesion with intralesional fat, while serum AFP was normal and CA125 mildly elevated. Laparoscopic partial hepatectomy was performed. Histology confirmed PCCCL, and immunohistochemistry supported hepatic origin while excluding metastatic renal carcinoma. The patient subsequently received two sessions of postoperative TACE as an individualized treatment and remained free of recurrence or metastasis during surveillance from 2022 to 2025. CONCLUSION: PCCCL is rare and difficult to distinguish from conventional HCC or metastatic clear cell carcinoma. Histopathology with immunohistochemistry is essential for diagnosis. Surgical resection is the mainstay of treatment. Although this patient remained recurrence-free after postoperative TACE, the role of TACE cannot be determined based on a single case, and studies with larger sample sizes are still needed.