Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 16, 2022; 10(29): 10575-10582
Published online Oct 16, 2022. doi: 10.12998/wjcc.v10.i29.10575
Three-in-one incidence of hepatocellular carcinoma, cholangiocellular carcinoma, and neuroendocrine carcinoma: A case report
Yang Wu, Chao-Bang Xie, Yi-Huai He, Di Ke, Qiong Huang, Kai-Fei Zhao, Rong-Shu Shi
Yang Wu, Chao-Bang Xie, Di Ke, Kai-Fei Zhao, Rong-Shu Shi, 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
Qiong Huang, Department of Pathology, The Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
Author contributions: Wu Y, Xie CB, He YH, and Zhao KF reviewed the literature and contributed to manuscript drafting; Shi RS analyzed and interpreted the patient data; Huang Q provide pathological pictures; Ke D managed the patient; and all authors read and approved the final manuscript.
Supported by Zunyi City Science and Technology Department HZ (2021), No. 44.
Informed consent statement: The patient provided written informed consent for the publication of this case report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: We 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:
Corresponding author: Kai-Fei Zhao, Doctor, Associate Professor, Deputy Director, Department of Intervention, The Affiliated Hospital of Zunyi Medical University, No. 149 Dalian Road, Zunyi 563000, Guizhou Province, China.
Received: December 28, 2021
Peer-review started: December 28, 2021
First decision: March 13, 2022
Revised: March 26, 2022
Accepted: August 30, 2022
Article in press: August 30, 2022
Published online: October 16, 2022

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.


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.


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.

Keywords: Neuroendocrine carcinoma, Hepatocellular carcinoma, Mixed neuroendocrine neoplasm, Combined hepatocellular-cholangiocarcinoma, Cholangiocarcinoma, Cholangiocellular carcinoma, Case report

Core Tip: Hepatocellular carcinoma (HCC) is the most common subtype of primary liver cancer. However, the combination of HCC, cholangiocarcinoma, and neuroendocrine carcinoma exhibiting three differentiation pathways is extremely rare. This has been described previously only in four patients. We report a case of a similar tumor in a 32-year-old man. It was diagnosed according to the computed tomography and magnetic resonance imaging findings and histopathology. This report aims to raise awareness and improve the treatment of the disease.