A Case of Composite Hepatocellular Carcinoma and Neuroendocrine Carcinoma in a Patient with Liver Cirrhosis Caused by Chronic Hepatitis B

Eun Young Yun; Tae Hyo Kim; Sang Soo Lee; Hong Jun Kim; Hyun Jin Kim; Woon Tae Jung; Ok Jae Lee; Dae Hyun Song

doi:10.4166/kjg.2016.68.2.109

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Yun, Kim, Lee, Kim, Kim, Jung, Lee, and Song: A Case of Composite Hepatocellular Carcinoma and Neuroendocrine Carcinoma in a Patient with Liver Cirrhosis Caused by Chronic Hepatitis B

Case Report

Korean J Gastroenterol 2016;68(2):109-113.

Published online: 4 October 2016

DOI: https://doi.org/10.4166/kjg.2016.68.2.109

A Case of Composite Hepatocellular Carcinoma and Neuroendocrine Carcinoma in a Patient with Liver Cirrhosis Caused by Chronic Hepatitis B

Eun Young Yun¹, Tae Hyo Kim^1,³, Sang Soo Lee¹, Hong Jun Kim¹, Hyun Jin Kim^1,³, Woon Tae Jung^1,³, Ok Jae Lee^1,³, Dae Hyun Song²

¹Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, Korea

²Department of Pathology, Gyeongsang National University School of Medicine, Jinju, Korea

³Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea

Correspondence to: Tae Hyo Kim, Department of Internal Medicine, Gyeongsang National University School of Medicine, 15 Jinju-daero 816beon-gil, Jinju 52727, Korea. Tel: +82-55-750-8726, Fax: +82-55-755-9078, E-mail: kimthy@gnu.ac.kr

Received 29 April 2016 Revised 5 July 2016 Accepted 8 July 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Primary hepatic neuroendocrine carcinoma (PHNEC) is rare and its origin is not clearly understood. The coexistence of PHNEC and hepaotcellular carcinoma has been reported in only a few cases. We report a rare case of combined PHNEC and hepaotcellular carcinoma in a patient with liver cirrhosis caused by chronic hepatitis B that resulted in aggressive behavior and poor prognosis.

Keywords: Neuroendocrine carcinoma, Hepatocellular carcinoma, Hepatitis B, Liver cirrhosis

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Fig. 1.

Abdominal CT scan showing tumor of S3 with a high density area in the peripheral part of the mass. (A) Arterial phase showed about 2.4 cm hypervascular nodule in S3 of liver. (B) Portal phase showed heterogeneous enhancing mass. (C) Delayed phase showed pseudo washout sign underlying liver cirrhosis.

Fig. 2.

(A) MRI showed peripheral hypervascular mass with pseudo washout appearance and heterogeneous T2 signal. (B) MRI showed restricted diffusion.

Fig. 3.

Cut section of the specimen showed 2.5 cm light gray mass with clear distinction underlying liver cirrhosis.

Fig. 4.

(A) The neoplastic cells of the neuroendocrine carcinoma (NEC) are separated from hepatocellular carcinoma (HCC) (H&E, ×40). (B) The transition between HCC (left) and NEC (right) (H&E, ×100). (C) Immunostain for CD56 are strongly positive in small round cells (×200). (D) Immunostain for hepatocyte specific antigen showed positive for HCC (×200).

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