Primary squamous cell carcinoma arising in the liver: A case report and review of literature

Table 1 Treatment timeline, imaging follow-up, and clinical outcome

Date	Treatment and medication	Imaging follow-up/clinical outcome
October 23, 2022		Baseline contrast-enhanced CT: The selected target lesion in the left hepatic lobe measured 166.71 mm in longest diameter
November 4, 2022	TACE	/
December 13, 2022	Camrelizumab 200 mg	/
December 25, 2022	TACE	/
March 22, 2023	TACE	/
March 25, 2023	Camrelizumab 200 mg	/
July 24, 2023	/	Target lesion decreased to 95.38 mm (-42.8% from baseline); PR according to RECIST 1.1.
July 28, 2023	TACE	/
November 6, 2023	TACE	/
March 10, 2024	/	Target lesion increased to 116.55 mm (+22.2% from nadir; absolute increase, 21.17 mm), with multiple new intrahepatic lesions; PD according to RECIST 1.1.
March 14, 2024 to March 16, 2024	HAIC, FOLFOX-based regimen	/
April 15, 2024 to April 17, 2024	HAIC, FOLFOX-based regimen	/
After April 17, 2024	Patient declined further antitumor treatment	/
February 2025	Supportive care during hospitalization	Presented with loss of appetite; subsequently died of gastrointestinal bleeding; overall survival was 28 months

All five transarterial chemoembolization sessions were performed using the same regimen: Lipiodol 10 mL, 5-fluorouracil 0.75 g, epirubicin 30 mg, and lobaplatin 40 mg, followed by embolization with gelatin sponge particles. CT: Computed tomography; TACE: Transarterial chemoembolization; RECIST: Response Evaluation Criteria in Solid Tumors; PR: Partial response; PD: Progressive disease; HAIC: Hepatic arterial infusion chemotherapy; FOLFOX: Leucovorin, 5-fluorouracil, and oxaliplatin.

Table 2 Previously reported cases of primary hepatic squamous cell carcinoma treated with immunotherapy and/or locoregional therapy and the present case

Ref.	Age/sex	Tumor characteristics	Treatment	Molecular or immune biomarkers	Follow-up duration	Status at last follow-up
Arase et al[30], 1988	69/M	Right hepatic lobe; 8 cm at detection and 13 cm at autopsy; portal vein tumor thrombus	Single transarterial infusion of mitomycin C (16 mg)	-	1 month	Deceased (acute myocardial infarction)
Kaji et al[36], 2003	67/F	Bilobar hepatic lesions; maximum diameter approximately 10 cm; hilar lymph-node metastasis	HAIC with low-dose cisplatin (10 mg/day) and 5-FU (250 mg/day)	-	23 months	Deceased
Yuki et al[35], 2006	63/M	Segment VI; 6 cm at diagnosis, increasing to 13 cm; underlying cirrhosis	Transarterial infusion of epirubicin, 5-FU, and mitomycin C followed by TAE; subsequent continuous intra-arterial cisplatin	-	8 months	Deceased
Zhao et al[37], 2012	60/F	Junction of the left medial and right anterior hepatic segments; recurrent lesion 1.5 cm × 1.2 cm × 0.5 cm with extrahepatic extension	Prior hepatic resection; radiofrequency ablation and local radiotherapy (36 Gy/20 fractions) for recurrence	-	NR	Alive at publication
Wilson et al[5], 2013	34/M	Segments IV, V, and VIII; 10 cm on initial imaging and 14 cm at resection; ciliated hepatic foregut cyst-associated	TACE followed by PVE and right trisectionectomy; carboplatin plus paclitaxel after recurrence	-	6 months	Alive with lung and abdominal recurrence
Zhang et al[1], 2015, case 2	70/F	Multiple lesions involving both lobes; maximum diameter 15 cm	Three sessions of TACE with 5-FU, cisplatin, doxorubicin, and lipiodol, followed by SOX chemotherapy	-	9 months	Deceased
Zhang et al[1], 2015, case 4	73/F	Multiple cystic lesions involving the whole liver; maximum diameter 11 cm	Palliative unroofing of four large cysts with intralesional injection of alcohol (20 mL) and 5-FU (0.4 g)	-	4 months	Deceased
Tuminello et al[34], 2020	79/M	Segments IV-VIII; 15 cm × 12 cm; multiple hepatic cysts	Percutaneous microwave ablation combined with TACE/arterial embolization	-	9 months	Deceased
Xiao et al[8], 2021, case 2	47/M	Solitary lesion in segments VI/VII; 10 cm	Right hepatectomy and cholecystectomy, followed by TACE and two cycles of gemcitabine plus 5-FU	PD-L1 positive in tumor cells	35 months1	Alive at last follow-up
Sun and Jin[33], 2021	73/M	Right hepatic lobe; 7.3 cm × 3.8 cm at diagnosis, increasing to 10.1 cm × 5.2 cm after 2 months	Argon-helium cryoablation	-	NR	Alive with clinical deterioration at last report
Kang et al[16], 2022	73/M	Left caudate lobe; approximately 3.8 cm	Laparoscopic left caudate lobectomy followed by sintilimab (200 mg every 3 weeks)	-	8 months	Alive without recurrence
Zhao et al[6], 2023	60/F	Right posterior lobe; 6.3 × 6.8 cm; segments V, VII, and VIII; right portal vein branch involvement and lymph-node metastases	Gemcitabine plus cisplatin, followed by pembrolizumab plus nab-paclitaxel	PD-L1 TPS 1%; TMB 24.93 mutations/Mb; MSI-H	15 months	Deceased
Jiang et al[31], 2025	72/M	Multiple right-lobe lesions; largest 8.2 cm × 7.8 cm; portal vein tumor thrombus; lymph-node and bone metastases	Envafolimab plus nab-paclitaxel and cisplatin	PD-L1 CPS 5	18 months	Alive with sustained partial response
Antzoulas et al[32], 2025	50/M	Central liver; 10.5 cm × 9.8 cm; segments IVa, IVb, V, and VIII; subsequent peritoneal metastases	Five cycles of carboplatin plus paclitaxel, followed by pembrolizumab	PD-L1 positive; MMR proteins retained	4 months	Deceased
Present case	62/M	Left lobe and right anterior segment; 16.2 cm × 7.2 cm; multiple intrahepatic lesions; indistinct interface with the gastric wall	Repeated TACE and camrelizumab, followed by HAIC after intrahepatic progression	PD-L1, TMB, MSI status, and NGS not assessed	28 months	Deceased

¹For Xiao et al[8] (2021), the narrative text reports 35 months of survival, whereas Table 1 of the same article lists 17 months; the narrative value was used. For Zhao et al[37] (2012) and Sun and Jin[33] (2021), precise follow-up durations were not reported. The present case was included to facilitate direct comparison.

Follow-up duration refers to the interval reported in the original article and may end at death or the last available assessment, as applicable. 5-FU: 5-fluorouracil; CPS: Combined positive score; F: Female; M: Male; HAIC: Hepatic arterial infusion chemotherapy; NR: Not reported; MMR: Mismatch repair; MSI-H: Microsatellite instability-high; MSI: Microsatellite instability; NGS: Next-generation sequencing; PD-L1: Programmed death ligand 1; PVE: Portal vein embolization; SOX: S-1 plus oxaliplatin; TACE: Transarterial chemoembolization; TAE: Transarterial embolization; TMB: Tumor mutational burden; TPS: Tumor proportion score.