Hepatocellular carcinoma with biliary and neuroendocrine differentiation: A case report.
Hepatocellular carcinoma with biliary and neuroendocrine differentiation: A case report.
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DOI：
10.5306/wjco.v12.i4.262
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发表时间：
2021-04-24
影响因子：
2.8
通讯作者：
Ozdemirli M
中科院分区：
文献类型：
--
作者：
Dimopoulos YP;Winslow ER;He AR;Ozdemirli M
具有双重分化的肝肿瘤[合并肝细胞癌和胆管细胞癌]是常见的。然而，表现出肝细胞、胆管和神经内分泌分化的肝肿瘤是极其罕见的，文献中只有三例报道。1例65岁女性，既往有丙型肝炎病史，远期有低度分化的直肠神经内分泌肿瘤病史，在影像上发现4节段和7节段有两个肝脏病变。血清甲胎蛋白和嗜铬粒蛋白A升高。4节段较大的病变活检显示为高级别肿瘤，具有神经内分泌肿瘤的形态和免疫组织化学特征。考虑到直肠神经内分泌肿瘤的既往病史、影像检查、血清标志物和活检结果，转移性神经内分泌肿瘤被考虑。随后对这些肝脏病变进行区域切除，发现第4段病变是伴有胆道和神经内分泌分化的肝癌，而第7段病变是具有神经内分泌分化的胆管细胞癌。对患者的随访发现，疾病复发于肝顶，转移于胰腺后淋巴结。由于化疗的并发症，患者最终去世。伴有额外胆道和神经内分泌分化的肝细胞癌病例极为罕见，这对临床医生和病理学家的诊断提出了挑战。
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. 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. HCC cases with additional biliary and neuroendocrine differentiation are exceedingly rare, posing a diagnostic challenge for clinicians and pathologists.