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1
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Wu S, Zhang X, Bao J, Sun N, Guo W, Wang B, Yang X. Hepatocellular carcinoma‑cavernous hemangioma collision tumor: A case report. Oncol Lett 2024; 27:74. [PMID: 38192672 PMCID: PMC10773184 DOI: 10.3892/ol.2023.14207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/24/2023] [Indexed: 01/10/2024] Open
Abstract
Collision tumors consisting of hepatocellular carcinoma (HCC) and cavernous hemangioma (CH) are rare and the clinicopathological characteristics or cause of the tumors remain unclear. The present study reports the case of a 71-year-old male patient who was admitted to Sunshine Union Hospital (Weifang, China) due to a liver mass found during a routine physical examination. computed tomography scans showed a main lesion of ~4.0×4.2×3.5 cm in segment IV of the patient's liver and a nodule of ~2.4×2.2×1.3 cm in the lower-left part of the lesion, which was clearly demarcated from the main lesion. The capsule of the lesion was found to be intact during the operation performed to remove the tumor. The final patient diagnosis was of a HCC-CH collision tumor based on pathology. The patient underwent follow-up for 6 months after surgery and no recurrence was observed.
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Affiliation(s)
- Shiheng Wu
- Department of Infectious Diseases, Fuyang People's Hospital, Fuyang, Anhui 236000, P.R. China
| | - Xinxing Zhang
- Department of Imaging Center, Sunshine Union Hospital, Weifang, Shandong 261000, P.R. China
| | - Jin Bao
- Department of Pathology, Fangzi People's Hospital, Weifang, Shandong 261200, P.R. China
| | - Naiying Sun
- Department of Pathology, Sunshine Union Hospital, Weifang, Shandong 261000, P.R. China
| | - Wenjun Guo
- Department of Pathology, Sunshine Union Hospital, Weifang, Shandong 261000, P.R. China
| | - Baogui Wang
- Department of Infectious Diseases, Fuyang People's Hospital, Fuyang, Anhui 236000, P.R. China
| | - Xingjie Yang
- Department of Pathology, Sunshine Union Hospital, Weifang, Shandong 261000, P.R. China
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Gao X, Wang H, Niu Z, Liu M, Kong X, Sun H, Ma C, Zhu H, Lu J, Zhou X. Case report: mixed large-cell neuroendocrine and hepatocellular carcinoma of the liver. Front Oncol 2024; 13:1309798. [PMID: 38264742 PMCID: PMC10803416 DOI: 10.3389/fonc.2023.1309798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] Open
Abstract
Background Cases of large-cell neuroendocrine carcinoma (NEC) concomitant hepatocellular carcinoma (HCC) are very rare. Based on the microscopic characteristics, mixed HCC-NEC tumors can be divided into collision type and combined type. We report a patient with both collision and combined type HCC-NEC tumor at the same time. Case presentation A 58-year-old man with hepatitis B and cirrhosis was found to have two masses in segment 5 and segment 8 of the liver, respectively. Preoperative imaging diagnosis was primary liver cancer. Indocyanine green retention test (ICG R15) <10% suggested that the patient can tolerate surgery. Partial hepatectomy was performed under the guidance of 3D reconstruction. Postoperative pathology showed that most of the tumors in S5 were large-cell neuroendocrine carcinoma (90%), and a small part were hepatocellular carcinoma (10%). The tumor in S8 of the liver was diagnosed as HCC combined with immunohistochemistry. After surgery, the patient underwent genetic testing, which indicated mutations in TP53 gene. The test of immune markers of the sample suggest that the patient may benefit little from immune checkpoint inhibitor therapy. The cisplatin and etoposide chemotherapy protocol to the patient following their surgery. Eight month later after the operation, Enhanced CT showed there was no recurrence or metastasis of the tumor. Conclusion The case at hand augments the understanding of HCC-NEC mixed tumors, offering pivotal insights into their precise diagnosis and treatment modalities. Furthermore, we document a favorable prognosis, marked by an absence of recurrence signs thus far-a rarity in comparable instances. This enlightenment stands to facilitate the handling of ensuing cases and enhance patient prognoses.
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Affiliation(s)
- Xin Gao
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Heng Wang
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Zheyu Niu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
- Department of Clinical Research, Qilu Synva Pharmaceutical Co. Ltd., Dezhou, China
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Meng Liu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Xiaohan Kong
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Hongrui Sun
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Chaoqun Ma
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Huaqiang Zhu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Jun Lu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
| | - Xu Zhou
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, Jinan, China
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong First Medical University, Jinan, China
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Mixed Primary Hepatocellular Carcinoma and Hepatic Neuroendocrine Carcinoma: Case Report and Literature Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59020418. [PMID: 36837619 PMCID: PMC9959776 DOI: 10.3390/medicina59020418] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 02/23/2023]
Abstract
Mixed hepatocellular carcinoma with neuroendocrine carcinoma (HCC-NEC) is extremely rare, comprising about 0.46% of primary hepatic tumors. A 63-year-old man who was a chronic alcoholic presented with a nine-centimeter-sized hepatic mass. His serum alpha-fetoprotein and protein induced by vitamin K antagonist-II levels were 22,815 ng/mL and 183 mAU/mL, respectively. The patient underwent a right hemihepatectomy, including the middle hepatic vein. The tumor consisted of poorly differentiated HCC (20%) and large- and small-cell-type NEC (80%) components as per the pathological examination. Immunohistochemically chromogranin and synaptophysin were positive in the areas of NEC and negative in the areas of HCC. Adjuvant chemotherapy with a combination of cisplatin and etoposide was administered after surgery. At postoperative 5 months, the patient complained of right flank pain, and CT showed a new mass measuring 7.3 cm in the right adrenal gland. Postoperatively, after 6.5 months, more recurred masses were noted on the posterior aspect of the right kidney and both lungs. Although the regimen was changed from etoposide to irinotecan, additional recurred masses were developed in the liver, lung, and brain. He passed away 12 months after the surgery. After reviewing and analyzing previous literature, the 1 and 2 year overall survival rates are 57.3 and 43.6%, respectively, and the 1 and 2 year disease-free survival rates are 36.2 and 29.0%, respectively. Mixed HCC-NEC is a very rare tumor, and the surgical outcome is poor.
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Wilhelm AB, Cunningham AG, Kassab C, Fitz EC, Dong J, Radhakrishnan RS, Ranganathan S, Tan D, Stevenson HL. Pediatric combined hepatocellular-cholangiocarcinoma (cHCC-CC) with neuroendocrine features: distinguishing genetic alterations detected by chromosomal microarray. Diagn Pathol 2023; 18:20. [PMID: 36782322 PMCID: PMC9926826 DOI: 10.1186/s13000-023-01305-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 01/26/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Liver tumors exhibiting hepatocellular, cholangiocarcinoma, and neuroendocrine features are extremely rare, with only five cases reported in the literature. CASE PRESENTATION We present an unusual case of a combined hepatocellular-cholangiocarcinoma (cHCC-CC) with neuroendocrine features in a pediatric patient. A 16-year-old presented with abdominal pain and a 21.0 cm mass in the right hepatic lobe with extension into the left lobe. Histology showed a poorly differentiated tumor with a solid, tubuloglandular, and microcystic architecture. Immunohistochemistry results were negative for hepatic markers, positive for markers of biliary differentiation, and positive for neuroendocrine differentiation. The neoplasm was reviewed at several institutions with differing diagnoses. Single nucleotide polymorphism (SNP) chromosomal microarray (CMA) showed large deletions within chromosomes 6q and 13q in both the hepatocellular-like areas and the cholangiocarcinoma-like areas, with additional large deletions in the cholangiocarcinoma-like areas, supporting origin from hepatocellular carcinoma. The final diagnosis was a cHCC-CC with neuroendocrine features. CONCLUSIONS Diagnosis of cHCC-CCs relies predominately on histomorphology, as per the 2018 International Consensus Group on the nomenclature of cHCC-CC. These findings in this case support that the pathological classification of these lesions be based on molecular data, which could better direct treatment. Further classification of cHCC-CCs and determination of their clinicopathological relevance will require more interobserver consistency and continued molecular profiling of these lesions.
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Affiliation(s)
- Alyeesha B Wilhelm
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Arwyn G Cunningham
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Cynthia Kassab
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
| | - Eric C Fitz
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Jianli Dong
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX, USA
| | - Ravi S Radhakrishnan
- Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA
| | | | - Dongfeng Tan
- Department of Pathology, M.D. Anderson Cancer Center, Houston, TX, USA
| | - Heather L Stevenson
- Department of Pathology, The University of Texas Medical Branch, Galveston, TX, USA.
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Tanaka H, Sugo H, Iwanaga N, Machida M, Watanobe I, Okubo H, Hotchi S, Ogura K. Mixed neuroendocrine carcinoma and hepatocellular carcinoma in the liver. Cancer Rep (Hoboken) 2022; 6:e1772. [PMID: 36547520 PMCID: PMC9875614 DOI: 10.1002/cnr2.1772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 11/24/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Mixed neuroendocrine carcinoma (NEC) and hepatocellular carcinoma (HCC) is extremely rare, thus radiological features have not been fully clarified. CASE A male patient (age: 70 years) visited our hospital due to a tumor in the liver. Examination using contrast-enhanced computed tomography (CT) revealed a tumor (diameter: 5.0 cm) in hepatic segment 5, with early enhancement of the peripheral area and slight internal heterogeneous enhancement in the arterial and delayed phases, respectively. F-18 fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT revealed intratumoral heterogeneity, characterized by increased uptake (standardized uptake value, 12.10) in the corresponding low-density area detected using enhanced CT relative to the surrounding areas of the tumor. On magnetic resonance imaging, diffusion-weighted imaging also showed high intensity in the corresponding low-density area detected using CT. Preoperatively, the patient was diagnosed with HCC and underwent anterior sectionectomy. Pathological findings revealed both HCC and NEC components, and the patient was diagnosed with mixed NEC and HCC. Comparison of component distribution with FDG-PET/CT revealed an increased uptake area was congruent with the NEC component in the tumor. CONCLUSION In this case, the difference in tumor components affected the uptake in FDG-PET/CT. Such heterogeneous uptake with an enhanced spot may be useful for suspecting the presence of mixed NEC and HCC in patients with atypical HCC.
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Affiliation(s)
- Haruka Tanaka
- Department of General SurgeryJuntendo University Nerima HospitalTokyoJapan
| | - Hiroyuki Sugo
- Department of General SurgeryJuntendo University Nerima HospitalTokyoJapan
| | - Naoki Iwanaga
- Department of General SurgeryJuntendo University Nerima HospitalTokyoJapan
| | - Michio Machida
- Department of General SurgeryJuntendo University Nerima HospitalTokyoJapan
| | - Ikuo Watanobe
- Department of General SurgeryJuntendo University Nerima HospitalTokyoJapan
| | - Hironao Okubo
- Department of GastroenterologyJuntendo University Nerima HospitalTokyoJapan
| | - Shiori Hotchi
- Department of Diagnostic PathologyJuntendo University Nerima HospitalTokyoJapan
| | - Kanako Ogura
- Department of Diagnostic PathologyJuntendo University Nerima HospitalTokyoJapan
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Jeng KS, Huang CC, Chung CS, Chang CF. Liver collision tumor of primary hepatocellular carcinoma and neuroendocrine carcinoma: A rare case report. World J Clin Cases 2022; 10:13129-13137. [PMID: 36569002 PMCID: PMC9782927 DOI: 10.12998/wjcc.v10.i35.13129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/08/2022] [Accepted: 11/22/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) can occasionally develop with other non-HCC cell types, either in a combined type or collision type. A collision tumor is defined as two histopathologically distinct tumors of the same organ lacking a clear transition zone. Hepatic collision tumors are rare. Among them, “hepatocellular carcinoma-hepatic neuroendocrine carcinoma” (HCC-NEC) collision tumors are especially rare and information about them is rarely published.
CASE SUMMARY A 48-year-old man with typical findings of HCC underwent consecutive therapies, including radiofrequency ablation and embolization prior to resection. Diagnosis of the HCC-NEC collision tumor in the right liver and another HCC in the left liver was established following surgical resection. The patient displayed NEC metastasis following resection and succumbed to septicemia after 2 more rounds of chemotherapy. To our knowledge, this is the 25th reported case of mixed HCC-NEC tumor. The rarity of HCC-NEC collision tumors and the absence of diagnostic criteria make it difficult to differentiate this condition from simple liver tumors, especially in patients with chronic liver disease.
CONCLUSION Our case highlights the difficulty in accurately diagnosing HCC-NEC in the absence of histological evidence. The prognosis is poor for this condition, although ultrasound-guided liver biopsy can be helpful to establish a prompt diagnosis. Further accumulation of such cases could help establish an accurate diagnosis earlier. Early discovery of NEC may allow for better treatment strategies and better prognoses.
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Affiliation(s)
- Kuo-Shyang Jeng
- Department of General Surgery, Far Eastern Memorial Hospital, New Taipei 220, Taiwan
| | - Chun-Chieh Huang
- Department of Radiology, Far Eastern Memorial Hospital, New Taipei 220, Taiwan
| | - Chen-Shuan Chung
- Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei 220, Taiwan
| | - Chiung-Fang Chang
- Department of Medical Research, Far Eastern Memorial Hospital, New Taipei 220, Taiwan
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Nakano S, Minaga K, Tani Y, Tonomura K, Hanawa Y, Morimura H, Terashita T, Matsumoto H, Iwagami H, Nakatani Y, Akamatsu T, Uenoyama Y, Maeda C, Ono K, Watanabe T, Yamashita Y. Primary Hepatic Neuroendocrine Carcinoma with Thrombocytopenia Due to Diffuse Bone Marrow and Splenic Infiltration: An Autopsy Case. Intern Med 2022; 61:3361-3368. [PMID: 35400708 PMCID: PMC9751712 DOI: 10.2169/internalmedicine.9465-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
An 82-year-old man with fever and back pain was referred to our hospital and was thus found to be thrombocytopenic. A bone marrow biopsy revealed the diffuse infiltration of poorly differentiated neuroendocrine carcinoma (NEC). Computed tomography revealed a large hepatic mass. Considering the risk of bleeding due to thrombocytopenia, a needle biopsy was not performed. The patient rapidly deteriorated and died 10 days after presentation. An autopsy confirmed the diagnosis of primary hepatic NEC, with diffuse metastasis to the spleen, bone marrow, and systemic lymph nodes. This is an extremely rare case of NEC presenting with thrombocytopenia due to extensive bone marrow and splenic infiltration.
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Affiliation(s)
- Shogo Nakano
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Kosuke Minaga
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Yasuhiro Tani
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Kohei Tonomura
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Yusuke Hanawa
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Hiroki Morimura
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Tomoko Terashita
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Hisakazu Matsumoto
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Hiroyoshi Iwagami
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Yasuki Nakatani
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Takuji Akamatsu
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Yoshito Uenoyama
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
| | - Chikara Maeda
- Department of Radiology, Japan Red Cross Wakayama Medical Center, Japan
| | - Kazuo Ono
- Department of Pathology, Japan Red Cross Wakayama Medical Center, Japan
| | - Tomohiro Watanabe
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, Japan
| | - Yukitaka Yamashita
- Department of Gastroenterology, Japan Red Cross Wakayama Medical Center, Japan
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Wu Y, Xie CB, He YH, Ke D, Huang Q, Zhao KF, Shi RS. Three-in-one incidence of hepatocellular carcinoma, cholangiocellular carcinoma, and neuroendocrine carcinoma: A case report. World J Clin Cases 2022; 10:10575-10582. [PMID: 36312494 PMCID: PMC9602243 DOI: 10.12998/wjcc.v10.i29.10575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 03/26/2022] [Accepted: 08/30/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Primary hepatic neuroendocrine carcinoma (NEC) is rare, and a combination with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) is extremely rare. To date, only four combination cases have been reported. The present paper describes the fifth patient.
CASE SUMMARY A 32-year-old Chinese man with chronic hepatitis B was hospitalized for persistent upper abdominal pain. Abdominal computed tomography (CT) examination revealed a liver mass. The tumor was located in the 7th and 8th segments of the liver, and CT and magnetic resonance imaging findings were consistent with the diagnosis of HCC. Laboratory examinations revealed the following: Alanine aminotransferase, 243 U/L; aspartate aminotransferase, 167 U/L; alpha-fetoprotein, 4519 μg/L. Laparoscopic right lobe hepatectomy was performed on the liver mass. Postoperative pathology showed low differentiation HCC plus medium and low differentiation CCA combined with NEC. One month after the surgery, the patient suffered from epigastric pain again. Liver metastasis was detected by CT, and tumor transcatheter arterial chemoembolization was performed. Unfortunately, the liver tumor was progressively increased and enlarged, and after 1 mo, the patient died of liver failure.
CONCLUSION This is a rare case, wherein the tumor is highly aggressive, grows rapidly, and metastasizes in a short period. Imaging and laboratory tests can easily misdiagnose or miss such cases; thus, the final diagnosis relies on pathology.
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Affiliation(s)
- Yang Wu
- Department of Intervention, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Chao-Bang Xie
- Department of Intervention, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Yi-Huai He
- Department of Infection, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Di Ke
- Department of Intervention, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Qiong Huang
- Department of Pathology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Kai-Fei Zhao
- Department of Intervention, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Rong-Shu Shi
- Department of Intervention, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
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Huang K, Lan Z, Chen W, Zhang J, Wang J, Zhu H, Xu B, Zhang L, Lu T, Guo Y, Wen Z. Hepatectomy and pneumectomy combined with targeted therapy for primary hepatic neuroendocrine carcinoma: Case report and review of the literature. Front Surg 2022; 9:920276. [PMID: 35910478 PMCID: PMC9334775 DOI: 10.3389/fsurg.2022.920276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Primary hepatic neuroendocrine carcinoma (PHNEC) manifests as a rare type of liver tumor. PHNEC is not specifically clinical or radiographical and is often misdiagnosed and mistreated. Here, we present a case report of PHNEC in a 50-year-old woman who was admitted to our department with concealed pain in the right upper abdomen. The initial diagnosis was a probable hepatic space-occupying lesion with tumor bleeding. The patient was subjected to a partial right hemihepatectomy, cholecystectomy, partial resection of the lower lobe of the right lung, partial resection of the diaphragm, and resection of the right perirenal fat sac to alleviate her symptoms. After surgery, gene sequencing was performed to determine the possible cause of the condition. However, five months after discharge, the patient was hospitalized again because of retroperitoneal and peritoneal multiple metastases. Nine months after surgery, the patient died. This case is likely to aid in furthering our understanding of PHNEC to improve the future diagnosis and treatment of this disease.
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Affiliation(s)
- Keyu Huang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhujing Lan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Weitao Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jianyong Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jilong Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hai Zhu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Banghao Xu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ling Zhang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tingting Lu
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ya Guo
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhang Wen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Correspondence: Zhang Wen
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10
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Ikeda A, Aoki K, Terashima T, Itokawa Y, Kokuryu H. A fat containing combined neuroendocrine carcinoma and hepatocellular carcinoma in the liver: A case report. Ann Hepatol 2021; 22:100183. [PMID: 32111487 DOI: 10.1016/j.aohep.2020.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/20/2020] [Accepted: 01/23/2020] [Indexed: 02/04/2023]
Abstract
A 79-year-old man was admitted to our hospital because of increased hepatobiliary enzyme levels. Dynamic computed tomography and magnetic resonance imaging showed a liver tumor measuring 60mm containing fat foci at the cranial aspect of the tumor. We diagnosed the patient with hypovascular hepatocellular carcinoma (HCC) and fat deposition, and performed a caudate lobe resection. Pathology examination revealed two intermingled components: moderately differentiated HCC with fat deposition and neuroendocrine carcinoma (NEC). Primary combined NEC and HCC is extremely rare. To our knowledge, this is the first report of combined NEC and HCC including a fat component. HCC is the most common primary hepatic malignancy with fat. HCC might include fat, even if HCC coexists with another type of cancer. The imaging characteristics of and HCC with another type of cancer vary depending on the amount of each component. We should not simply diagnose such tumors as HCC, but think about the possibilities of HCC with another type of cancer, because there is a fat component.
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Affiliation(s)
- Atsuyuki Ikeda
- Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto, Japan.
| | - Kentaro Aoki
- Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto, Japan
| | | | - Yoshio Itokawa
- Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto, Japan
| | - Hiroyuki Kokuryu
- Department of Gastroenterology and Hepatology, Kyoto Katsura Hospital, Kyoto, Japan
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11
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Noreikaite J, Albasha D, Chidambaram V, Arora A, Katti A. Indeterminate liver lesions on gadoxetic acid-enhanced magnetic resonance imaging of the liver: Case-based radiologic-pathologic review. World J Hepatol 2021; 13:1079-1097. [PMID: 34630876 PMCID: PMC8473497 DOI: 10.4254/wjh.v13.i9.1079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 06/24/2021] [Accepted: 08/06/2021] [Indexed: 02/06/2023] Open
Abstract
Different histopathological manifestations of focal liver lesions show varying common and uncommon imaging findings and some pathologies may show similar appearance despite of different histopathology. It is necessary to characterise focal liver lesions accurately as not only benign and malignant lesions are managed differently, but also certain benign lesions have differing management. These lesions are increasingly being detected due to rapid growth of use of cross-sectional imaging as well as improvement in image quality and new imaging techniques. Contrast enhanced magnetic resonance imaging (MRI) is considered the gold standard technique in characterising focal liver lesions. Addition of gadoxetic acid has been shown to significantly increase diagnostic accuracy in the detection and characterization of liver abnormalities. Classic imaging characteristics of common liver lesions, including their behaviour on gadoxetic acid enhanced MRI, have been described in literature over recent years. It is important to be familiar with the typical aspects of these lesions as well as know the uncommon and overlapping imaging features to reach an accurate diagnosis. In this article, we will review the well-described characteristic imaging findings of common and rare focal liver lesions and present several challenging cases encountered in the clinical setting, namely hepatocellular adenoma, focal nodular hyperplasia, hepatic angiomyolipoma, hepatocellular carcinoma, intrahepatic cholangiocarcinoma, neuroendocrine tumours as well as a pleomorphic liposarcoma of the liver.
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Affiliation(s)
- Jurate Noreikaite
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, United Kingdom
| | - Dekan Albasha
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, United Kingdom
| | - Vijay Chidambaram
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, United Kingdom
| | - Ankur Arora
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, United Kingdom
| | - Ashok Katti
- Department of Radiology, Liverpool University Hospitals NHS Foundation Trust, Liverpool L7 8XP, United Kingdom
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12
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Wang H, Yang D, Wu Z, Luo Y, Ling W. Contrast-Enhanced Ultrasound Findings of Hepatocellular Carcinoma With Neuroendocrine Carcinoma: A Case Report. Front Med (Lausanne) 2021; 8:602346. [PMID: 34485317 PMCID: PMC8415301 DOI: 10.3389/fmed.2021.602346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/13/2021] [Indexed: 02/05/2023] Open
Abstract
Hepatocellular carcinoma (HCC) with the concurrent occurrence of primary hepatic neuroendocrine carcinoma (NEC) of the liver is extremely rare. Preoperative diagnosis of HCC combined with NEC is very difficult. Here, we presented a case report of HCC combined with NEC. A 33-year-old male was admitted to our hospital due to focal liver lesion. To further the diagnosis, he received laboratory tests, conventional ultrasound, contrast-enhanced ultrasound (CEUS), and magnetic resonance imaging (MRI). Grayscale ultrasound showed a hypoechoic nodule with peripheral hypoechoic halo and central small patches of anechoic area in the hepatic segment VI, and the liver background was cirrhosis. In the CEUS, the solid component of the nodule was rapidly homogeneous hyper-enhancement in the arterial phase. Then, the enhancement of the nodule was washed out slowly and gradually; the nodule presented heterogeneously mild enhancement in the portal phase, and slight hypo-enhancement was showed in the late phase. The hypo-enhanced area was mainly located in the surrounding space. Meanwhile, there was a small piece of non-enhanced area within the lesion center in the whole three-phase imaging. MRI showed a lobular contoured mass in segment VI. The patient underwent middle liver resection, splenectomy, and cholecystectomy. The pathological diagnosis was a HCC with NEC. At the time of the preparation of this manuscript, the patient has been alive without recurrence or distant metastases for 6 months since the surgery. We mainly focus on the ultrasound imaging characteristics, especially its enhancement manifestations on CEUS. In this report, since this article is a case report, which is based on the clinical information of the patient and does not involve the patient's privacy, informed consent is not necessary. In addition, the patient agreed to publish the case. To the best of our knowledge, this report is the first to describe the CEUS patterns of the HCC combined with NEC. Herein, we report a case that provides novel insights that will improve clinicians' awareness of the clinical and ultrasound manifestations of this mixed tumor, resulting in improved diagnosis, treatment, and outcomes.
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Affiliation(s)
- Hong Wang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Dan Yang
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Zhenru Wu
- Key Laboratory of Transplantation Engineering and Transplantation Immune, The Ministry of Health, West China Hospital of Sichuan University, Chengdu, China
- Laboratory of Pathology, West China Hospital of Sichuan University, Chengdu, China
| | - Yan Luo
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
| | - Wenwu Ling
- Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China
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13
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Lan J, Guo D, Qin X, Chen B, Liu Q. Mixed Neuroendocrine Carcinoma and Hepatocellular Carcinoma: A Case Report and Literature Review. Front Surg 2021; 8:678853. [PMID: 34336917 PMCID: PMC8316597 DOI: 10.3389/fsurg.2021.678853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 06/14/2021] [Indexed: 12/19/2022] Open
Abstract
Background: Neuroendocrine tumors are heterogeneous malignancies that originate from the neuroendocrine system. Previous studies show that this cancer type mainly localizes in the gastrointestinal tract and often metastasizes to the liver. Primary liver neuroendocrine tumors are very rare and primary hepatic neuroendocrine tumors (PHNET) with concurrent hepatocellular carcinoma (HCC) are extremely rare. To the best of our knowledge, only few PHNET cases have been identified, making their diagnosis difficult. Here, we report the biggest ever reported and “deceiving” lesion of a mixed neuroendocrine-non-neuroendocrine neoplasm in the liver, aiming to raise awareness and improve treatment of the disease. Case Presentation: Here, we report a preoperative misdiagnosed case that presented with hepatocellular carcinoma clinical features and no extrahepatic tumors. Postoperative pathology confirmed that it was a mixed neuroendocrine-non-neuroendocrine neoplasm. The patient was then referred for etoposide and cisplatin-based chemotherapy. No disease recurrence was observed at the 6-month follow-up. Conclusion: We report a very rare and easily misdiagnosed case and we speculate that there were “undifferentiated cells” undergoing neuroendocrine and hepatocellular carcinoma differentiation, during which some hepatocellular carcinoma cells express neuroendocrine features. We recommend proper surgery and postoperative platinum-based chemotherapy in the management of this disease.
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Affiliation(s)
- Jianwei Lan
- Department of Hepatobiliary and Pancreatic Surgery, Research Center of Digestive Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Deliang Guo
- Department of Hepatobiliary and Pancreatic Surgery, Research Center of Digestive Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Xian Qin
- Department of Hepatobiliary and Pancreatic Surgery, Research Center of Digestive Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Baiyang Chen
- Department of General Surgery, Xiangyang Central Hospital, Affiliated of Hubei University of Arts and Science, Xiangyang, China
| | - Quanyan Liu
- Department of Hepatobiliary and Pancreatic Surgery, Research Center of Digestive Diseases, Zhongnan Hospital of Wuhan University, Wuhan, China.,Department of General Surgery, Tianjin Medical University General Hospital, Tianjin, China
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14
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Dimopoulos YP, Winslow ER, He AR, Ozdemirli M. Hepatocellular carcinoma with biliary and neuroendocrine differentiation: A case report. World J Clin Oncol 2021; 12:262-271. [PMID: 33959479 PMCID: PMC8085510 DOI: 10.5306/wjco.v12.i4.262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/07/2021] [Accepted: 03/22/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver tumors with dual differentiations [combined hepatocellular carcinoma (HCC) and cholangiocarcinoma] are common. However, liver tumors that exhibit hepatocellular, biliary, and neuroendocrine differentiation are exceedingly rare, with only three previous case reports in the literature.
CASE SUMMARY A 65-year-old female with a previous history of hepatitis C and a distant history of low grade, well-differentiated rectal neuroendocrine tumor was found to have two liver lesions in segment 4 and segment 7 on imaging. Serum alpha-fetoprotein and chromogranin A were elevated. Biopsy of the larger lesion in segment 4 revealed a high-grade tumor, with morphologic and immunohistochemical features of a neuroendocrine tumor. Given the previous history of rectal neuroendocrine tumor, imaging investigation, serologic markers, and biopsy findings, metastatic neuroendocrine tumor was considered. Subsequent regional resection of these hepatic lesions revealed the segment 4 lesion to be a HCC with additional biliary and neuroendocrine differentiation and the segment 7 lesion to be a cholangiocarcinoma with neuroendocrine differentiation. Follow-up of the patient revealed disease recurrence in the dome of the liver and metastasis in retro-pancreatic lymph nodes. The patient eventually expired due to complications of chemotherapy.
CONCLUSION HCC cases with additional biliary and neuroendocrine differentiation are exceedingly rare, posing a diagnostic challenge for clinicians and pathologists.
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Affiliation(s)
- Yiannis Petros Dimopoulos
- Department of Pathology and Laboratory Medicine, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Emily R Winslow
- Medstar Center for Liver and Pancreas Surgery, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Aiwu Ruth He
- Lombardi Comprehensive Cancer Center, Medstar Georgetown University Hospital, Washington, DC 20007, United States
| | - Metin Ozdemirli
- Department of Pathology and Laboratory Medicine, Medstar Georgetown University Hospital, Washington, DC 20007, United States
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15
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Nakano A, Hirabayashi K, Yamamuro H, Mashiko T, Masuoka Y, Yamamoto S, Ozawa S, Nakagohri T. Combined primary hepatic neuroendocrine carcinoma and hepatocellular carcinoma: case report and literature review. World J Surg Oncol 2021; 19:78. [PMID: 33726764 PMCID: PMC7968236 DOI: 10.1186/s12957-021-02187-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 03/04/2021] [Indexed: 12/14/2022] Open
Abstract
Background Hepatocellular carcinoma (HCC) can grow in a mosaic pattern, often combined with various non-hepatocellular cells. However, HCC combined with a neuroendocrine carcinoma (NEC) component is rarely reported, and its clinical features, origin, diagnosis, and behavior have not been established. In the literature, mixed HCC–NEC tumors are categorized as either collision type or combined type, depending on their microscopic features. Here, we report a patient with a combined-type HCC–NEC tumor. Case presentation An asymptomatic 84-year-old woman was found to have a solid mass in the right lobe of the liver. Laboratory and radiologic examinations showed typical findings of HCC, including arterial-phase enhancement, and portal- and delay-phase washout. She was treated by partial laparoscopic hepatectomy of segment 5. Pathological examination showed that the tumor was predominantly HCC, partly admixed with an NEC component. A transitional zone between the HCC and NEC tissues was also observed. The tumor was finally diagnosed as a combined-type primary mixed NEC–HCC tumor. After the preoperative diagnosis, the patient underwent somatostatin receptor scintigraphy to detect the primary NEC lesion, but no accumulation was found in any other part of her body. She has been free of recurrence for 9 months since the surgery. Conclusion Mixed HCC–NEC tumors are extremely rare, and correct diagnosis requires multidisciplinary collaboration. The accumulation of further cases is needed to help understand the exact pathology, diagnosis, and treatment of this disease.
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Affiliation(s)
- Akira Nakano
- Department of Digestive Surgery, Tokai University Hospital, Shimokasuya 143, Isehara, Kanagawa, 259-1143, Japan.
| | - Kenichi Hirabayashi
- Department of Pathology, Tokai University Hospital, Shimokasuya 143, Isehara, Kanagawa, 259-1143, Japan
| | - Hiroshi Yamamuro
- Department of Radiology, Tokai University Hospital, Shimokasuya 143, Isehara, Kanagawa, 259-1143, Japan
| | - Taro Mashiko
- Department of Digestive Surgery, Tokai University Hospital, Shimokasuya 143, Isehara, Kanagawa, 259-1143, Japan
| | - Yoshihito Masuoka
- Department of Digestive Surgery, Tokai University Hospital, Shimokasuya 143, Isehara, Kanagawa, 259-1143, Japan
| | - Seiichiro Yamamoto
- Department of Digestive Surgery, Tokai University Hospital, Shimokasuya 143, Isehara, Kanagawa, 259-1143, Japan
| | - Soji Ozawa
- Department of Digestive Surgery, Tokai University Hospital, Shimokasuya 143, Isehara, Kanagawa, 259-1143, Japan
| | - Toshio Nakagohri
- Department of Digestive Surgery, Tokai University Hospital, Shimokasuya 143, Isehara, Kanagawa, 259-1143, Japan
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16
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Mixed hepatocellular carcinoma-neuroendocrine carcinoma—A diagnostic and therapeutic challenge. CURRENT PROBLEMS IN CANCER: CASE REPORTS 2020. [DOI: 10.1016/j.cpccr.2020.100020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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Oh KS, Bahmad HF, Febres-Aldana CA, Safdie FM, Sriganeshan V. Collision tumors of the lung: A case report of urothelial carcinoma metastasizing to renal cell carcinoma with heterotopic ossification. Respir Med Case Rep 2020; 31:101297. [PMID: 33304806 PMCID: PMC7718149 DOI: 10.1016/j.rmcr.2020.101297] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/07/2020] [Accepted: 11/16/2020] [Indexed: 02/06/2023] Open
Abstract
Collision tumors are rare entities that consist of at least two or more histologically and ontologically distinct tumor types within the same organ. It is still not well understood how collision tumors form; yet, three main theories have been proposed to explain the pathogenesis, including the “random collision effect,” “field cancerization,” and “tumor-to-tumor carcinogenesis.” Collision tumors have been encountered in various body organs, including the lung. They either consist of a metastasizing tumor colliding with primary cancer or distinct primary or metastatic cancers colliding together. Here, we describe a rare case of collision tumors of the lung that consists of two metastatic carcinomas, namely renal cell carcinoma and urothelial carcinoma of the bladder. We propose that the urothelial carcinoma disseminated into several pre-existing pulmonary metastases of renal cell carcinoma with heterotopic bone formation. The possible mechanisms underlying the development of this peculiar tumor are discussed.
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Affiliation(s)
- Kei Shing Oh
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Hisham F Bahmad
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Christopher A Febres-Aldana
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Fernando M Safdie
- Department of Thoracic and Cardiovascular Surgery, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Vathany Sriganeshan
- Arkadi M. Rywlin M.D. Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, FL, USA.,Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
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18
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Mao JX, Teng F, Sun KY, Liu C, Ding GS, Guo WY. Two-in-one: A pooled analysis of primary hepatic neuroendocrine carcinoma combined/collided with hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 2020; 19:399-403. [PMID: 32359724 DOI: 10.1016/j.hbpd.2020.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 03/23/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Jia-Xi Mao
- Department of Liver Surgery and Organ Transplantation, Changzheng Hospital, Navy Medical University, Shanghai 200003, China
| | - Fei Teng
- Department of Liver Surgery and Organ Transplantation, Changzheng Hospital, Navy Medical University, Shanghai 200003, China
| | - Ke-Yan Sun
- Department of Liver Surgery and Organ Transplantation, Changzheng Hospital, Navy Medical University, Shanghai 200003, China
| | - Cong Liu
- Department of Liver Surgery and Organ Transplantation, Changzheng Hospital, Navy Medical University, Shanghai 200003, China
| | - Guo-Shan Ding
- Department of Liver Surgery and Organ Transplantation, Changzheng Hospital, Navy Medical University, Shanghai 200003, China
| | - Wen-Yuan Guo
- Department of Liver Surgery and Organ Transplantation, Changzheng Hospital, Navy Medical University, Shanghai 200003, China.
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19
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Xin Q, Lv R, Lou C, Ma Z, Liu GQ, Zhang Q, Yu HB, Zhang CS. Primary hepatic neuroendocrine carcinoma coexisting with distal cholangiocarcinoma: A case report and review of the literature. Medicine (Baltimore) 2020; 99:e20854. [PMID: 32590784 PMCID: PMC7328923 DOI: 10.1097/md.0000000000020854] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Although primary hepatic neuroendocrine carcinomas, whose prognostic mechanisms remain unclear, are rare, coexistence of neuroendocrine carcinomas and other tumors is rarer. In this report, we describe a unique case of coexistence between primary hepatic neuroendocrine carcinoma and a distal cholangiocarcinoma in the pancreas. PATIENT CONCERNS A 64-year-old woman with a history of diabetes, but none of hepatitis, was admitted to hospital because of intermittent epigastric distension and pain discomfort for more than 1 month aggravated 1 day. A contrast-enhanced computed tomography (CT) scan of the upper abdomen and abdominal magnetic resonance imaging (MRI) revealed a thickening of the bile duct wall in the middle and lower segment of common bile duct and the corresponding lumen is narrow and low-density tumors with ring enhancement (1.83 cm × 1.9 cm) in lobi hepatis dexte. DIAGNOSIS Primary neuroendocrine carcinoma of the liver was diagnosed to be coexisting with a distal cholangiocarcinoma, which had invaded the pancreas. Immunohistochemical examination revealed that the neoplastic cells strongly expressed chromogranin A, synaptophysin, and CD56 proteins. The tumor cells did not express HepPar-1, glypican-3, S-100, CK7, and CK19 in the liver tumor. A distal bile duct in pancreatic tissues shows the characteristics of typical bile duct carcinoma, as an invasion of carcinoma is also seen in the pancreatic tissues. Gastrointestinal endoscopy, chest and abdominal CT, abdominal MRI, and positron emission tomography (PET)-CT were used to exclude metastatic neuroendocrine tumors of the liver. INTERVENTIONS Resection of the pancreas-duodenum, the right anterior lobe of the liver, and regional lymph nodes was performed in patients. OUTCOMES The patient had survived for 5 months after the operation. CONCLUSION A unique case of a coexistence of primary hepatic neuroendocrine carcinoma and a distal cholangiocarcinoma, which had invaded the pancreas. No treatment guidelines are established for the treatment of the unique case.
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Affiliation(s)
- Qi Xin
- Department of Pathology, Third Central Hospital of Tianjin, Tianjin Third Central Hospital affiliated to Nankai University, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases
- Tianjin Key Laboratory of Brain Science and Neural Engineering, Academy of Medical Engineering and Translational Medicine, Tianjin University
| | | | - Cheng Lou
- Department of Hepatobiliary Surgery, Tianjin third central hospital, Tianjin Third Central Hospital affiliated to Nankai University, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases
| | - Zhe Ma
- Department of Pathology, Third Central Hospital of Tianjin, Tianjin Third Central Hospital affiliated to Nankai University, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases
| | - Gui-Qiu Liu
- Department of Pathology, Third Central Hospital of Tianjin, Tianjin Third Central Hospital affiliated to Nankai University, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases
| | - Qin Zhang
- Department of Pathology, Third Central Hospital of Tianjin, Tianjin Third Central Hospital affiliated to Nankai University, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases
| | - Hai-Bo Yu
- Kidney Disease and Blood Purification Treatment Department, the Second Hospital of Tianjin Medical University, Tianjin, China
| | - Chuan-Shan Zhang
- Department of Pathology, Third Central Hospital of Tianjin, Tianjin Third Central Hospital affiliated to Nankai University, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases
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Abstract
OBJECTIVES Patients with neuroendocrine tumors (NETs) are at increased risk of mortality from competing causes in light of the improvement in overall survival over recent decades. The purpose of this study was to explore the competing causes of deaths and the risk factors associated with competing mortality. MATERIALS AND METHODS The Surveillance, Epidemiology, and End Results database was used to identify patients diagnosed with NETs between 1973 and 2015. Risk of competing mortality was estimated by the standardized mortality ratios (SMRs) and by using the Fine and Gray multivariate regression model. RESULTS Of the 29,981 NET patients, 42.5% of the deaths that occurred during follow-up were attributed to competing causes (83.9% from noncancer causes and 16.1% from second primary neoplasms). Overall SMR of competing mortality was 2.50 (95% confidence interval [CI]: 2.43-2.56). The SMR of noncancer causes was 2.65 (95% CI: 2.58-2.73), with the highest risk present within the first year of diagnosis. The SMR of second primary neoplasms was 1.91 (95% CI: 1.79-2.04), with the highest risk observed after 10-year postdiagnosis. A drastic rise in competing mortality was observed in the last decade between 2005 and 2015. Advanced age, black race, small intestinal and gastric NETs, and surgery were significantly associated with competing mortality. Female, pancreatic and recto-anal NETs, distant and regional spread, chemotherapy and radiotherapy were significantly associated with lower competing mortality. CONCLUSIONS Competing mortality plays an increasingly significant role over the years and may hamper efforts made to improve survival outcomes in NET patients.
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21
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Ebisutani C, Yoon S, Hyodo T, Watanabe T, Okada H, Shirakawa Y, Sakamoto Y, Hirohata S. Primary hepatic neuroendocrine cancer coexisted with hepatocellular carcinoma: a case report. KANZO 2020; 61:122-128. [DOI: 10.2957/kanzo.61.122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
Affiliation(s)
- Chikara Ebisutani
- Department of Gastroenterology and Hepatology, Hyogo Prefectural Kakogawa Medical Center
| | - Seitetsu Yoon
- Department of Gastroenterology and Hepatology, Hyogo Prefectural Kakogawa Medical Center
| | - Toshiki Hyodo
- Department of Diagnostic Pathology, Hyogo Prefectural Kakogawa Medical Center
- Department of Diagnostic Pathology, Kobe University Hospital
| | - Takafumi Watanabe
- Department of Gastroenterology and Hepatology, Hyogo Prefectural Kakogawa Medical Center
| | - Hirofumi Okada
- Department of Gastroenterology and Hepatology, Hyogo Prefectural Kakogawa Medical Center
| | - Yutaka Shirakawa
- Department of Gastroenterology and Hepatology, Hyogo Prefectural Kakogawa Medical Center
| | - Yoshio Sakamoto
- Department of Gastroenterology and Hepatology, Hyogo Prefectural Kakogawa Medical Center
| | - Shigeya Hirohata
- Department of Gastroenterology and Hepatology, Hyogo Prefectural Kakogawa Medical Center
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22
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Yang C, Sun L, Lai JZ, Zhou L, Liu Z, Xi Y, Tao Y, Dooley E, Cao D. Primary Hepatoid Carcinoma of the Pancreas: A Clinicopathological Study of 3 Cases With Review of Additional 31 Cases in the Literature. Int J Surg Pathol 2019; 27:28-42. [PMID: 29961402 DOI: 10.1177/1066896918783468] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Primary pancreatic hepatoid carcinoma (PHC) is very rare. Here, we reported 3 such cases with review of additional 31 cases in the literature. Our 3 patients were male (83, 72, and 54 years old, respectively). Serum α-fetoprotein (AFP) was elevated in 1 patient (case 3, 8338 ng/mL) and not measured in the other two. The PHC in patient 1 (pathological stage pT2N0M0) and patient 2 (pT3N0M0) showed pure hepatocellular carcinoma (HCC)-like morphology, whereas in case 3 it was a PHC with true glandular differentiation (pT4N0M0). The diagnosis of PHC was confirmed with positive immunohistochemical staining in the tumor cells for AFP (2/3), Hep Par 1 (3/3), glypican-3 (2/3), arginase-1 (2/3), and Sal-like protein 4 (1/3). CD10 and polyclonal carcinoembryonic antigen stains show focal canalicular pattern in 2/3 tumors. Patient 1 did not receive further treatment after resection and was alive with no evidence of disease at 107 months. Patient 2 died of postoperative complications, whereas patient 3 received postsurgical chemoradiation and died of disease at 29 months. Our findings and literature review indicate that PHCs can be divided into 4 histological subtypes: with pure HCC-like morphology (n = 22), with neuroendocrine differentiation (n = 8), with true glandular differentiation (n = 3), and with acinar cell differentiation (n = 1). On univariate analysis, pure HCC-like morphology was associated with better disease-specific survival (DSS; P = .04), whereas lymph node and distant metastases were associated with worse DSS ( P = .002 for both). Age, gender, presenting symptoms, serum AFP level, and T stage were not associated with DSS. On multivariate analysis, none of these parameters was significantly associated with DSS.
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Affiliation(s)
- Chen Yang
- 1 Washington University School of Medicine, St Louis, MO, USA
| | - Li Sun
- 2 Peking University Cancer Hospital and Institute, Beijing, China
| | - Jenny Z Lai
- 3 Washington University in St Louis, MO, USA
| | - Lixin Zhou
- 2 Peking University Cancer Hospital and Institute, Beijing, China
| | - Zhen Liu
- 2 Peking University Cancer Hospital and Institute, Beijing, China
| | - Yanfeng Xi
- 4 Shanxi Medical University, Taiyuan, China
| | - Yu Tao
- 1 Washington University School of Medicine, St Louis, MO, USA
| | | | - Dengfeng Cao
- 1 Washington University School of Medicine, St Louis, MO, USA
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Chuah KL, Pang B, Lim D, Lee CK, Chau CYP. Combined hepatocellular carcinoma and high grade neuroendocrine carcinoma with EWSR1 gene rearrangement. Pathology 2018; 50:779-782. [DOI: 10.1016/j.pathol.2018.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/02/2018] [Accepted: 07/05/2018] [Indexed: 12/17/2022]
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Abstract
Many advances have developed in the pathology of liver tumors in the recent decade. Examples of these advances include the use of glutamine synthetase in the diagnosis of focal nodular hyperplasia, subtyping of hepatocellular adenomas using molecular and immunohistochemical methods, the unraveling of the fusion transcript between the DNAJB1 gene and the PRKACA gene in fibrolamellar carcinoma, and the more unified classification and terminology in intrahepatic bile duct tumors and their precursor lesions. Nevertheless, challenges still remain, e.g., the differential diagnosis between well-differentiated hepatocellular carcinoma and hepatocellular adenoma; distinction among poorly differentiated hepatocellular carcinoma, cholangiocarcinoma and metastatic neoplasm; terminology of the combined hepatocellular carcinoma-cholangiocarcinoma, etc. This review aims to address updates in the pathologic diagnosis and clinical relevance of tumors of the liver and intrahepatic bile ducts in adults and their differential diagnosis and diagnostic pitfalls.
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25
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Yılmaz DB, Bayramoğlu Z, Ünay G, Ayık E, Başsorgun Cİ, Elpek GÖ. Incidental Collision Tumor of Hepatocellular Carcinoma and Neuroendocrine Carcinoma. J Clin Transl Hepatol 2018; 6:339-344. [PMID: 30271748 PMCID: PMC6160311 DOI: 10.14218/jcth.2017.00076] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/03/2018] [Accepted: 04/06/2018] [Indexed: 02/05/2023] Open
Abstract
The composite tumors of the liver are very rare, including the coexistence of HCC (hepatocellular carcinoma) with NEC (neuroendocrine carcinoma). The rare occurrence of these tumors necessitates more reported cases in order to fully understand their clinical characteristics, behaviors and treatments. Herein is described an incidental collision tumor of HCC-NEC, along with a review of the literature focusing on their clinicopathological findings and prognosis. The tumor presented here was found incidentally in the hepatectomy specimen of a 56-year-old man who had undergone liver transplantation for rapidly progressive liver failure because of alcoholic hepatitis and cirrhosis. Imaging and laboratory examinations did not demonstrate tumor-related findings. During macroscopic examination, two sharply defined and distinctive areas (1.7 cm and 0.6 cm dimension respectively) were detected among the cirrhotic nodules. The characteristic histopathological features and immunohistochemical findings allowed a diagnosis of HCC-NEC to be made. There was no evidence of recurrence and metastasis after 10 months following surgery. The present case and review revealed that these tumors are frequently found in older ages and males. Although serum markers are valuable in the discrimination of malignant tumors, their absence cannot completely rule out composite HCC-NEC. Diagnosis requires a comprehensive histopathological evaluation together with immunohistochemistry. The NEC component might influence the treatment strategy and eventually the outcome of the patient. In conclusion, the rare occurrence of HCC-NEC and the lack of diagnostic clinical signs and symptoms do not exclude their consideration in the differential diagnosis of liver tumors, especially in patients with the chronic liver disease.
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Affiliation(s)
| | | | | | | | | | - Gülsüm Özlem Elpek
- *Correspondence to: Gülsüm Özlem Elpek, Department of Pathology, Akdeniz University Medical School Hospital, Dumlupinar Street, Pinarbasi District, Konyaalti/Antalya-07070, Turkey. Tel: +90-242-249-6389, E-mail:
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Kwon HJ, Kim JW, Kim H, Choi Y, Ahn S. Combined Hepatocellular Carcinoma and Neuroendocrine Carcinoma with Ectopic Secretion of Parathyroid Hormone: A Case Report and Review of the Literature. J Pathol Transl Med 2018; 52:232-237. [PMID: 29794961 PMCID: PMC6056365 DOI: 10.4132/jptm.2018.05.17] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/15/2018] [Indexed: 12/19/2022] Open
Abstract
Primary combined hepatocellular carcinoma (HCC) and neuroendocrine carcinoma is a rare entity, and so is hypercalcemia due to ectopic parathyroid hormone (PTH) secretion by tumor. A 44-year old man with hepatitis B virus associated chronic liver disease presented with a hepatic mass. Hemihepatectomy discovered the mass as combined HCC and poorly differentiated cholangiocarcinoma. During adjuvant chemoradiation therapy, he presented with nausea, and multiple systemic metastases were found. Laboratory tests revealed hypercalcemia with markedly elevated PTH and neuron specific enolase. Parathyroid scan showed normal uptake in parathyroid glands, suggestive of ectopic PTH secretion. Subsequently, immunohistochemistry of neuroendocrine marker was performed on the primary lesion, and confirmed the neuroendocrine differentiation in non-HCC component. The patient died 71 days after surgery. This report may suggest the possibility of ectopic PTH secretion by neuroendocrine carcinoma of hepatic origin causing hypercalcemia. Caution for neuroendocrine differentiation should be exercised when diagnosing poorly differentiated HCC.
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Affiliation(s)
- Hyun Jung Kwon
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji-Won Kim
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Haeryoung Kim
- Department of Pathology, Seoul National University Hospital, Seoul, Korea
| | - YoungRok Choi
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soomin Ahn
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
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Liu YJ, Ng KF, Huang SC, Wu RC, Chen TC. Composite hepatocellular carcinoma and small cell carcinoma with early nodal metastasis: A case report. Medicine (Baltimore) 2017; 96:e7868. [PMID: 28834900 PMCID: PMC5572022 DOI: 10.1097/md.0000000000007868] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
RATIONALE Hepatocellular carcinoma (HCC) is known to grow in a mosaic pattern, and it can sometimes be combined with non-hepatocellular cells. Despites the variety of combination, HCC with a significant neuroendocrine carcinoma (NEC) component remains very rare. Most of the reported cases were treated as conventional HCC with a relatively poor prognosis. Early diagnosis may lead to a better treatment modality. Here, we report a case of composite HCC and small cell carcinoma (SCC) with nodal metastasis of the SCC component alone. PATIENT CONCERNS A 65-year-old man with chronic viral hepatitis C presented with abdominal discomfort for 2 months. Computed tomography and angiography of the liver showed a 4.3 cm hypervascular tumor in segment 4 and enlargement of the perihilar and paracaval lymph nodes. INTERVENTIONS Extended left lobectomy and regional lymph node dissection were performed. DIAGNOSIS The hepatic tumor was heterogeneous with two distinct gross components. The green part showed a grade III hepatocellular carcinoma with an immunoreaction to Hep Par 1, glypican 3 and α-fetoprotein, whereas the white part exhibited a small cell carcinoma, as evidenced by expressions of chromogranin A and synaptophysin. The lymph node was metastasized by the SCC component. The SCC part was also positive for vimentin with perivascular accentuation. ß-catenin immunostain showed reduced membranous expression in the SCC component, as compared to HCC. OUTCOMES The patient expired 39 days after the surgical intervention. LESSONS Clinicians should be highly alert to a composite hepatic tumor, especially in dealing with a small heterogeneous tumor (< 5 cm) with early lymph node metastasis.
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Affiliation(s)
- Yu-Jen Liu
- Department of Pathology, Chang Gung Memorial Hospital, Guishan
| | - Kwai-Fong Ng
- Department of Pathology, Chang Gung Memorial Hospital, Guishan
- Department of Pathology, Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Shih-Chiang Huang
- Department of Pathology, Chang Gung Memorial Hospital, Guishan
- Department of Pathology, Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Ren-Chin Wu
- Department of Pathology, Chang Gung Memorial Hospital, Guishan
- Department of Pathology, Chang Gung University School of Medicine, Taoyuan, Taiwan
| | - Tse-Ching Chen
- Department of Pathology, Chang Gung Memorial Hospital, Guishan
- Department of Pathology, Chang Gung University School of Medicine, Taoyuan, Taiwan
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Nomura Y, Nakashima O, Akiba J, Ogasawara S, Fukutomi S, Yamaguchi R, Kusano H, Kage M, Okuda K, Yano H. Clinicopathological features of neoplasms with neuroendocrine differentiation occurring in the liver. J Clin Pathol 2016; 70:563-570. [PMID: 27881473 DOI: 10.1136/jclinpath-2016-203941] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 10/10/2016] [Accepted: 10/27/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND/AIMS We investigated the clinicopathological features of hepatic neuroendocrine tumours (NET) and neuroendocrine carcinoma (NEC), which remain largely unknown. MATERIAL AND METHODS We examined 1235 tumours from 1048 patients who had undergone curative hepatectomy for liver neoplasms at Kurume University Hospital. Pathological diagnoses were based on the 2010 WHO Classification of Tumours of the Digestive System. We performed immunostaining for hepatocyte markers (eg, hepatocyte paraffin (HepPar)-1), neuroendocrine markers (eg, chromogranin A (CGA)) and the proliferation marker (Ki-67). RESULTS There were four cases of NET G2 (0.38%) and five of hepatic malignant tumours with an NEC component (HNEC) (0.48%). HNEC cases were classified into three types, that is, transitional, intermediate and separate types, according to their histological and immunohistochemical features. In the former two types, the NEC component intermingled with the moderately to poorly differentiated hepatocellular carcinoma (HCC) component or intermediate component consisting of tumour cells showing the colocalisation of CGA and HepPar-1. In the separate type, the NEC and poorly differentiated HCC components were present separately, whereas the sarcomatous HCC component was detected in the vicinity of the NEC component. Ki-67 labelling indices of the NET G2, HCC and NEC components of HNEC were 6.8%, 14.9% and 58.9%, respectively. CONCLUSIONS Primary hepatic NET and NEC are very rare tumours. The NEC component in HNEC showed high proliferative activity and influenced patient prognoses.
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Affiliation(s)
- Yoriko Nomura
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Fukuoka, Japan.,Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan.,Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Osamu Nakashima
- Clinical Laboratory Medicine, Kurume University Hospital, Kurume, Fukuoka, Japan
| | - Jun Akiba
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Sachiko Ogasawara
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Shogo Fukutomi
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Fukuoka, Japan
| | - Rin Yamaguchi
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Hironori Kusano
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Masayoshi Kage
- Department of Diagnostic Pathology, Kurume University Hospital, Kurume, Fukuoka, Japan
| | - Koji Okuda
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Hirohisa Yano
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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