Published online Oct 16, 2022. doi: 10.12998/wjcc.v10.i29.10575
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
Processing time: 274 Days and 23.8 Hours
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.
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.