Dimopoulos YP, Winslow ER, He AR, Ozdemirli M. Hepatocellular carcinoma with biliary and neuroendocrine differentiation: A case report. World J Clin Oncol 2021; 12(4): 262-271 [PMID: 33959479 DOI: 10.5306/wjco.v12.i4.262]
Corresponding Author of This Article
Yiannis Petros Dimopoulos, MD, Doctor, Department of Pathology and Laboratory Medicine, Medstar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007, United States. yiannispetros.dimopoulos@medstar.net
Research Domain of This Article
Pathology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yiannis Petros Dimopoulos, Metin Ozdemirli, 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
Author contributions: Dimopoulos YP, Ozdemirli M, He AR, and Winslow ER reviewed the literature, wrote the manuscript, and revised the manuscript; Dimopoulos YP and Ozdemirli M were involved in the pathology side of managing the patient; Winslow ER performed the patient’s surgery and was involved in the patient’s pre- and post-surgical care and follow-up; He AR was the oncologist and was involved in the patient’s care; all authors issued final approval for the version to be submitted.
Informed consent statement: At the time of preparation of this case report, the patient had passed away. Thus, informed consent was not able to be obtained. However, utmost care was shown during the preparation of the case report to not reveal any personally identifiable protected health information. Also, per the MedStar Office of Research integrity, case reports including 3 or fewer individuals do not meet the U.S. Department of Health and Human Services (DHHS) definition of research and therefore do not require Institutional Review Board (IRB) review but are still subject to Health Insurance Portability and Accountability Act of 1996 (HIPAA) requirements. No Protected Health Information (PHI) was disclosed during the preparation of the case report.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yiannis Petros Dimopoulos, MD, Doctor, Department of Pathology and Laboratory Medicine, Medstar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007, United States. yiannispetros.dimopoulos@medstar.net
Received: December 3, 2020 Peer-review started: December 3, 2020 First decision: December 24, 2020 Revised: January 7, 2021 Accepted: March 22, 2021 Article in press: March 22, 2021 Published online: April 24, 2021 Processing time: 137 Days and 17.5 Hours
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.
Core Tip: Hepatocellular carcinoma (HCC) exhibiting additional biliary and neuroendocrine differentiation are exceedingly rare, with only three previous case reports in the literature. We present a case of HCC with this triple differentiation, which developed in a patient with a history of previously excised rectal neuroendocrine tumor. This case highlights the diagnostic difficulties encountered during the evaluation of these patients, especially in cases where patients have a previous history of neuroendocrine tumors elsewhere in the body. The aggressive nature of these tumors is demonstrated in addition.
