Wang Hong, Yang Dan, Wu Zhenru, Luo Yan, Ling Wenwu
Department of Ultrasound, West China Hospital of Sichuan University, Chengdu, China.
Key Laboratory of Transplantation Engineering and Transplantation Immune, The Ministry of Health, West China Hospital of Sichuan University, Chengdu, China.
Front Med (Lausanne). 2021 Aug 16;8:602346. doi: 10.3389/fmed.2021.602346. eCollection 2021.
Hepatocellular carcinoma (HCC) with the concurrent occurrence of primary hepatic neuroendocrine carcinoma (NEC) of the liver is extremely rare. Preoperative diagnosis of HCC combined with NEC is very difficult. Here, we presented a case report of HCC combined with NEC. A 33-year-old male was admitted to our hospital due to focal liver lesion. To further the diagnosis, he received laboratory tests, conventional ultrasound, contrast-enhanced ultrasound (CEUS), and magnetic resonance imaging (MRI). Grayscale ultrasound showed a hypoechoic nodule with peripheral hypoechoic halo and central small patches of anechoic area in the hepatic segment VI, and the liver background was cirrhosis. In the CEUS, the solid component of the nodule was rapidly homogeneous hyper-enhancement in the arterial phase. Then, the enhancement of the nodule was washed out slowly and gradually; the nodule presented heterogeneously mild enhancement in the portal phase, and slight hypo-enhancement was showed in the late phase. The hypo-enhanced area was mainly located in the surrounding space. Meanwhile, there was a small piece of non-enhanced area within the lesion center in the whole three-phase imaging. MRI showed a lobular contoured mass in segment VI. The patient underwent middle liver resection, splenectomy, and cholecystectomy. The pathological diagnosis was a HCC with NEC. At the time of the preparation of this manuscript, the patient has been alive without recurrence or distant metastases for 6 months since the surgery. We mainly focus on the ultrasound imaging characteristics, especially its enhancement manifestations on CEUS. In this report, since this article is a case report, which is based on the clinical information of the patient and does not involve the patient's privacy, informed consent is not necessary. In addition, the patient agreed to publish the case. To the best of our knowledge, this report is the first to describe the CEUS patterns of the HCC combined with NEC. Herein, we report a case that provides novel insights that will improve clinicians' awareness of the clinical and ultrasound manifestations of this mixed tumor, resulting in improved diagnosis, treatment, and outcomes.
肝细胞癌（HCC）合并原发性肝神经内分泌癌（NEC）极为罕见。术前诊断HCC合并NEC非常困难。在此，我们报告一例HCC合并NEC的病例。一名33岁男性因肝脏局灶性病变入院。为进一步明确诊断，他接受了实验室检查、常规超声、超声造影（CEUS）及磁共振成像（MRI）检查。灰阶超声显示肝VI段有一个低回声结节，周边有低回声晕，中央有小片无回声区，肝脏背景为肝硬化。在CEUS检查中，结节的实性成分在动脉期迅速均匀高增强。然后，结节的增强逐渐缓慢消退；在门静脉期结节呈不均匀轻度增强，延迟期呈轻度低增强。低增强区主要位于周边。同时，在整个三期成像中病变中心有一小片无增强区。MRI显示VI段有一个分叶状肿块。患者接受了肝中叶切除、脾切除及胆囊切除术。病理诊断为HCC合并NEC。在撰写本稿件时，患者术后已存活6个月，无复发及远处转移。我们主要关注超声成像特征，尤其是其在CEUS上的增强表现。在本报告中，由于本文是一篇病例报告，基于患者的临床信息且不涉及患者隐私，无需知情同意。此外，患者同意发表该病例。据我们所知，本报告首次描述了HCC合并NEC的CEUS表现模式。在此，我们报告一例病例，提供了新的见解，将提高临床医生对这种混合肿瘤的临床及超声表现的认识，从而改善诊断、治疗及预后。
