Image of the Month| Volume 53, ISSUE 6, P792-793, June 2021

Simultaneous primary hepatocellular carcinoma and neuroendocrine carcinoma

      An 80-year-old woman with diabetes and nonalcoholic steatohepatitis -related cirrhosis was admitted for anorexia and epigastralgia. Although AFP, CA125, interleukin-2 receptor, and ferritin were elevated, PIVKA-II, CEA, CA19-9 were normal. CT revealed multiple tumors in the liver (S8), continuous one in the liver (S1) and pancreas, and lymphnodes (Fig. 1), which were absent one year before. She did not want further examination and died on the 17th day. Although her family did not give consent for autopsy, they agreed for needle necropsy of S8, hepato-pancreatic, and axillary tumors. The S8 tumor was diagnosed as hepatocellular carcinoma (HCC). The others showed undifferentiated tumor cells. Immunohistochemical examination showed these cells were positive for synaptophysin and CD56, but negative for low-molecular-weight keratin, high-molecular-weight keratin, CD45 and p63. Ki67 index was >80%. Thus, small cell neuroendocrine carcinoma (NEC) was diagnosed.
      Fig. 1
      Fig. 1(A) and (B) Computed tomography (CT) showed multiple tumors. (A) Plain CT showed a tumor in liver (S8, arrow heads), a continuous tumor in the liver (S1) and pancreas (arrow heads), and suspected lymphnode metastases of the left axilla, mediastinum, and para-aorta (arrows). (B) Enhanced CT showed that the S8 tumor was different from the others. Needle necropsy was done for tumors in the S8 liver (#1), hepato-pancreatic (#2), and left axillary tumors (#3). (C) and (D) Histological examination revealed two different tumors. (C) Tumors in the S8 (#1 in (B)) was diagnosed as moderately differentiated hepatocellular carcinoma with cirrhosis. (D) The hepato-pancreatic tumor (#2 in (B)) and left axillary tumors (#3 in (B)) showed same histology and the undifferentiated tumor cells distributed non-cohesively with an increased nuclear-cytoplasmic ratio.


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        • Lin F.
        • Chen Z.E.
        • Wang H.L
        Utility of immunohistochemistry in the pancreatobiliary tract.
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