Clear cell hepatocellular carcinoma: sudden death from severe hypoglycemia

Hypoglycemia is a frequent paraneoplastic complication of hepatocellular carcinoma occurring in up to 30% of cases of this neoplasm. The clear cell carcinoma, a notable histological subtype of hepatocellular carcinoma, however, has been associated with hypoglycemia in only two previously reported patients from Japan. We report herein the first American case of clear cell hepatocellular carcinoma with severe hypoglycemia. The patient also suffered from hypercholesterolemia and erythrocytosis. Fine needle aspiration cytology, conventional histopathology, and immunohistochemical studies of this neoplasm are described. Possible explanations for the clear cell appearance and a comparison of the clinical and morphological features of clear cell and nonclear cell hepatocellular carcinoma is made. Potential pathophysiological mechanisms for the paraneoplastic complications of hypoglycemia, hypercholesterolemia, and erythrocytosis are discussed.