Collision tumor of hepatocellular carcinoma and neuroendocrine carcinoma involving the liver: Case report and review of the literature

Abstract

Primary hepatic neuroendocrine carcinoma (NEC) with concurrent occurrence of hepatocellular carcinoma (HCC) of the liver is very rare. Only 8 cases have been reported in the literature. Concurrent occurrence of HCC and NEC in the liver is classified as combined type or collision type by histological distributional patterns; only 2 cases have been reported. Herein, we report a case of collision type concurrent occurrence of HCC and NEC, in which primary hepatic NEC was in only a small portion of the nodule, which is different from the 2 previously reported cases. A 72-year-old male with chronic hepatitis C was admitted to our hospital for a hepatic mass detected by liver computed tomography (CT) at another clinic. Because the nodule was in hepatic segment 3 and had proper radiologic findings for diagnosis of HCC, including enhancement in the arterial phase and wash-out in the portal and delay phases, the patient was treated with laparoscopic left lateral sectionectomy. The pathology demonstrated that the nodule was 2.5 cm and was moderately differentiated HCC. However, a 3 mm-sized focal neuroendocrine carcinoma was also detected on the capsule of the nodule. The tumor was concluded to be a collision type with HCC and primary hepatic NEC. After the surgery, for follow-up, the patient underwent a liver CT every 3 mo. Five multiple nodules were found in the right hepatic lobe on the follow-up liver CT 6 mo post-operatively. As the features of the nodules in the liver CT and MRI were different from that of HCC, a liver biopsy was performed. Intrahepatic recurrent NEC was proven after the liver biopsy, which showed the same pathologic features with the specimen obtained 6 mo ago. Palliative chemotherapy with a combination of etoposide and cisplatin has been administered for 4 months, showing partial response.

Contrast-Enhanced Ultrasound Findings of Hepatocellular Carcinoma with Neuroendocrine Carcinoma: Case Report and Review of the Literature

“…We present a case of a liver tumor with features of both classical HCC and NEC. In this case, the patient is young, male, and has a history of hepatitis B, which is consistent with the previous literature [5,6,7], which all featured male patients with underlying liver disease, involving chronic hepatitis or cirrhosis of unknown cause, sometime a fat component [8].…”

Incidental Collision Tumor of Hepatocellular Carcinoma and Neuroendocrine Carcinoma

“…Although multiple HCC-NEC of the liver has been described in some reports, 6 , 9 , 14 they are solitary lesions and frequently do not metastasize at the time of diagnosis, as seen in our case. Rarely, metastases to lymph nodes and omentum have been described ( Table 2 ).…”

“… 7 , 8 , 14 – 16 , 19 This observation suggested that NEC components strongly affect the aggressive behavior of the tumor and it is proposed that the NEC component may be responsible for the poor prognosis in these patients. 16 , 19 Recently, Choi et al 9 proposed adjuvant chemotherapy to increase life expectancy when the grade of NEC is high. Because the awareness of an NEC component might influence the treatment strategy and eventually the outcome of the patient, 9 , 16 , 19 the possibility of NEC should be considered in HCCs with nodal metastasis.…”

What is New in the 2019 World Health Organization (WHO) Classification of Tumors of the Digestive System: Review of Selected Updates on Neuroendocrine Neoplasms, Appendiceal Tumors, and Molecular Testing

“…Most hepatic MiNENs contain a component of hepatocellular carcinoma, which may be the dominant component. 5,32,33 Neuroendocrine Neoplasms of the Bile Ducts and Gallbladder…”