Tumor of the liver (hepatocellular and high grade neuroendocrine carcinoma): A case report and review of the literature
We describe a rare hepatic collision tumor composed of a hepatocellular carcinoma and a high-grade neuroendocrine carcinoma. The patient, a 50-year-old man, underwent a partial hepatectomy because of a 5.0-cm mass. The tumor had two distinctive patterns. The majority of the tumor was a high-grade neuroendocrine carcinoma with features of a small cell carcinoma that was positive for chromogranin, synaptophysin, and cytokeratin 19 and negative for hepatocellular antigen and alpha-fetoprotein (AFP). The second component was a moderately differentiated hepatocellular carcinoma that was positive for hepatocellular antigen and AFP and negative for neuroendocrine markers. The two tumors were separated by fibrous bands. In areas where they collided, there was no transition or intermingling of cells between the two components, thus, it is different from the combined type of tumors. After removal of the tumor, the patient had intrahepatic and mesenteric recurrences within a follow-up period of 16 months.
[Show abstract] [Hide abstract] ABSTRACT: The wide application of immunohistochemistry to the study of tumors has led to the recognition that epithelial neoplasms composed of both a neuroendocrine and nonneuroendocrine component are not as rare as traditionally believed. It has been recommended that mixed neuroendocrine-nonneuroendocrine epithelial neoplasms are classified as only those in which either component represents at least 30 % of the lesion but this cutoff has not been universally accepted. Moreover, since their pathogenetic and clinical features are still unclear, mixed neuroendocrine-nonneuroendocrine epithelial neoplasms are not included as a separate clinicopathological entity in most WHO classifications, although they have been observed in virtually all organs. In the WHO classification of digestive tumors, mixed neuroendocrine-nonneuroendocrine neoplasm is considered a specific type and is defined as mixed adenoneuroendocrine carcinoma, a definition that has not been accepted for other organs. In fact, this term does not adequately convey the morphological and biological heterogeneity of digestive mixed neoplasms and has created some misunderstanding among both pathologists and clinicians. In the present study, we have reviewed the literature on mixed neuroendocrine-nonneuroendocrine epithelial neoplasms reported in the pituitary, thyroid, nasal cavity, larynx, lung, digestive system, urinary system, male and female genital organs, and skin to give the reader an overview of the most important clinicopathological features and morphological criteria for diagnosing each entity. We also propose to use the term “mixed neuroendocrine-nonneuroendocrine neoplasm (MiNEN)” to define and to unify the concept of this heterogeneous group of neoplasms, which show different characteristics mainly depending on the type of neuroendocrine and nonneuroendocrine components.0Comments 0Citations
- "Very rare cases of hepatocellular carcinoma (HCC) showing neuroendocrine differentiation have been reported (Table 7), but MiNEN was not included as a specific entity of hepatic neoplasm in the last WHO classification of digestive neoplasms. In one of the reported cases, the HCC component was completely separate from a small cell neuroendocrine carcinoma in the same tumor mass, and the two components likely represented a collision tumor rather than a true MiNEN . In other four cases, the neuroendocrine and nonneuroendocrine components were intermingled with some areas of transition between the HCC and neuroendocrine component , suggesting a divergent differentiation of the same neoplastic proliferation . "
- [Show abstract] [Hide abstract] ABSTRACT: Résumé Nous rapportons une observation d’un carcinome hépatocellulaire (CHC) avec contingent cellulaire de type neuroendocrine. Il s’agit d’un patient âgé de 56 ans, ayant consulté pour une distension abdominale. L’examen physique a mis en évidence une ascite. Le bilan biologique était normal à l’exception de l’alphafoetoprotéine élevée à 70 ng/ml. Les sérologies virales des hépatites B et C étaient négatives. Les examens échographique et tomodensitométrique montraient de multiples nodules hépatiques du segment postérieur associés à des ganglions des chaînes hépatiques communes et coeliomésentériques. Une biopsie hépatique chirurgicale a été effectuée. Elle a montré à l’examen anatomopathologique une prolifération tumorale répondant à un CHC moyennement différencié, au sein duquel on notait un contingent cellulaire représentant environ 10 % du prélèvement tumoral et répondant à un carcinome de type neuroendocrine. Le patient n’a pas eu de traitement et décède un mois après le diagnostic.0Comments 0Citations
- [Show abstract] [Hide abstract] ABSTRACT: The diagnosis of hepatocellular carcinoma (HCC) is based on classic histologic findings. However, some cases may need additional studies to clarify the origin of the neoplasm or confirm its malignant nature. Immunohistochemistry is useful not only in determining the hepatic origin but also in ruling out potential metastatic malignancies, and can also aid in distinguishing benign and malignant hepatic neoplasms The aim of this study is to review the utilities and potential pitfalls of the most commonly used markers. We reviewed the English literature published from 1986 to 2008 and considered pattern of staining, cross reaction with tissues other than hepatocytes, sensitivity, and specificity for each potentially useful antibody. In the last 20 years, innumerable immunomarkers have been studied in HCC but only a few of them are helpful on a daily basis. Among all the markers hepatocyte paraffin 1, polyclonal CEA antibody (canalicular pattern), and glypican-3 are the most sensitive and specific markers of HCC. MOC-31, Ber-ep4, epithelial membrane antigen, CD15, and mCEA are usually not expressed in the tumoral cells. Vascular markers stain sinusoidal lining cells and can aid in the distinction between benign and malignant hepatic lesions.0Comments 1Citation