Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 16, 2022; 10(35): 13129-13137
Published online Dec 16, 2022. doi: 10.12998/wjcc.v10.i35.13129
Liver collision tumor of primary hepatocellular carcinoma and neuroendocrine carcinoma: A rare case report
Kuo-Shyang Jeng, Chun-Chieh Huang, Chen-Shuan Chung, Chiung-Fang Chang
Kuo-Shyang Jeng, Department of General Surgery, Far Eastern Memorial Hospital, New Taipei 220, Taiwan
Chun-Chieh Huang, Department of Radiology, Far Eastern Memorial Hospital, New Taipei 220, Taiwan
Chen-Shuan Chung, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei 220, Taiwan
Chiung-Fang Chang, Department of Medical Research, Far Eastern Memorial Hospital, New Taipei 220, Taiwan
Author contributions: Jeng KS and Huang CC contributed equally to this work; Jeng KS designed the study; Jeng KS, Huang CC, Chung CS conducted the study; Jeng KS, Huang CC, and Chang CF wrote and edited the manuscript; and all authors read and approved the final manuscript.
Supported by the Far Eastern Memorial Hospital, No. FEMH-2021-C-002, and No. FEMH-2022-C-122; the Ministry of Science and Technology, Taiwan, No. MOST 109-2314-B-418-007, and No. MOST 110-2314-B-418-009; and the National Health Research Institutes, No. NHRI-109BCCO-MF-202020-01, and No. NHRI-111BCCO-EB-222218 for FEMH Human Biobank.
Informed consent statement: Ethical approval for this case report was obtained from Research Ethics Review Committee, Far Eastern Memorial Hospital (APPROVAL Number: 109054-C, 109012-E). Informed consent for patient information was waived because 109054-C only included a single patient, and the 109012-E sample was from the biobank.
Conflict-of-interest statement: All the authors have no conflict to declare.
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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Kuo-Shyang Jeng, MD, Professor, Department of General Surgery, Far Eastern Memorial Hospital, No. 21 Sec. 2, Nanya S. Road, Banciao District, New Taipei 220, Taiwan. kevin.ksjeng@gmail.com
Received: October 20, 2022
Peer-review started: October 20, 2022
First decision: October 28, 2022
Revised: November 8, 2022
Accepted: November 22, 2022
Article in press: November 22, 2022
Published online: December 16, 2022
Processing time: 55 Days and 0.3 Hours
Abstract
BACKGROUND

Hepatocellular carcinoma (HCC) can occasionally develop with other non-HCC cell types, either in a combined type or collision type. A collision tumor is defined as two histopathologically distinct tumors of the same organ lacking a clear transition zone. Hepatic collision tumors are rare. Among them, “hepatocellular carcinoma-hepatic neuroendocrine carcinoma” (HCC-NEC) collision tumors are especially rare and information about them is rarely published.

CASE SUMMARY

A 48-year-old man with typical findings of HCC underwent consecutive therapies, including radiofrequency ablation and embolization prior to resection. Diagnosis of the HCC-NEC collision tumor in the right liver and another HCC in the left liver was established following surgical resection. The patient displayed NEC metastasis following resection and succumbed to septicemia after 2 more rounds of chemotherapy. To our knowledge, this is the 25th reported case of mixed HCC-NEC tumor. The rarity of HCC-NEC collision tumors and the absence of diagnostic criteria make it difficult to differentiate this condition from simple liver tumors, especially in patients with chronic liver disease.

CONCLUSION

Our case highlights the difficulty in accurately diagnosing HCC-NEC in the absence of histological evidence. The prognosis is poor for this condition, although ultrasound-guided liver biopsy can be helpful to establish a prompt diagnosis. Further accumulation of such cases could help establish an accurate diagnosis earlier. Early discovery of NEC may allow for better treatment strategies and better prognoses.

Keywords: Collision tumor, Combined tumor, Hepatocellular carcinoma, Neuroendocrine tumor, Case report

Core Tip: Collision tumors of the liver are not common. Coexisting hepatocellular carcinomas (HCCs) and neuroendocrine carcinomas (NECs) with collision tumor patterns are extremely uncommon. Herein, we report a case of an HCC-NEC collision tumor of the liver. Definite diagnosis is usually difficult until pathological confirmation. The prognosis is poor. Early discovery of NEC may allow better treatment strategies.