Jeng Kuo-Shyang, Huang Chun-Chieh, Chung Chen-Shuan, Chang Chiung-Fang
Department of General Surgery, Far Eastern Memorial Hospital, New Taipei 220, Taiwan.
Department of Radiology, Far Eastern Memorial Hospital, New Taipei 220, Taiwan.
World J Clin Cases. 2022 Dec 16;10(35):13129-13137. doi: 10.12998/wjcc.v10.i35.13129.
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.
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 25 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.
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.
肝细胞癌（HCC）偶尔会与其他非HCC细胞类型一起出现，呈联合型或碰撞型。碰撞瘤被定义为同一器官内两个组织病理学上不同的肿瘤，且缺乏明确的过渡区。肝碰撞瘤很罕见。其中，“肝细胞癌-肝神经内分泌癌”（HCC-NEC）碰撞瘤尤为罕见，关于它们的信息很少发表。
一名有典型HCC表现的48岁男性在切除术前接受了包括射频消融和栓塞在内的一系列治疗。手术切除后确诊为右肝HCC-NEC碰撞瘤和左肝另一HCC。患者术后出现NEC转移，在又进行两轮化疗后死于败血症。据我们所知，这是第25例报道的混合性HCC-NEC肿瘤病例。HCC-NEC碰撞瘤的罕见性以及缺乏诊断标准使得难以将这种情况与单纯肝肿瘤区分开来，尤其是在慢性肝病患者中。
我们的病例突出了在缺乏组织学证据的情况下准确诊断HCC-NEC的困难。这种情况预后较差，尽管超声引导下肝活检有助于迅速做出诊断。进一步积累此类病例可能有助于更早地做出准确诊断。早期发现NEC可能会带来更好的治疗策略和更好的预后。
