BACKGROUND Liver tumors with dual differentiations[combined hepatocellular carcinoma(HCC)and cholangiocarcinoma]are common.However,liver tumors that exhibit hepatocellular,biliary,and neuroendocrine differentiation ar...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.展开更多
文摘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.
