Department of Surgery, Inha University College of Medicine, Incheon 400-711, Republic of Korea.
Medicina (Kaunas). 2023 Feb 20;59(2):418. doi: 10.3390/medicina59020418.
Mixed hepatocellular carcinoma with neuroendocrine carcinoma (HCC-NEC) is extremely rare, comprising about 0.46% of primary hepatic tumors. A 63-year-old man who was a chronic alcoholic presented with a nine-centimeter-sized hepatic mass. His serum alpha-fetoprotein and protein induced by vitamin K antagonist-II levels were 22,815 ng/mL and 183 mAU/mL, respectively. The patient underwent a right hemihepatectomy, including the middle hepatic vein. The tumor consisted of poorly differentiated HCC (20%) and large- and small-cell-type NEC (80%) components as per the pathological examination. Immunohistochemically chromogranin and synaptophysin were positive in the areas of NEC and negative in the areas of HCC. Adjuvant chemotherapy with a combination of cisplatin and etoposide was administered after surgery. At postoperative 5 months, the patient complained of right flank pain, and CT showed a new mass measuring 7.3 cm in the right adrenal gland. Postoperatively, after 6.5 months, more recurred masses were noted on the posterior aspect of the right kidney and both lungs. Although the regimen was changed from etoposide to irinotecan, additional recurred masses were developed in the liver, lung, and brain. He passed away 12 months after the surgery. After reviewing and analyzing previous literature, the 1 and 2 year overall survival rates are 57.3 and 43.6%, respectively, and the 1 and 2 year disease-free survival rates are 36.2 and 29.0%, respectively. Mixed HCC-NEC is a very rare tumor, and the surgical outcome is poor.
混合性肝细胞癌伴神经内分泌癌（HCC-NEC）非常罕见，约占原发性肝肿瘤的 0.46%。一位 63 岁的慢性酒精中毒患者，肝内有一个 9 厘米大的肿块。他的血清甲胎蛋白和维生素 K 拮抗剂-II 诱导蛋白水平分别为 22815ng/ml 和 183mAU/ml。患者接受了右半肝切除术，包括中肝静脉。病理检查发现肿瘤由分化差的 HCC（20%）和大、小细胞型 NEC（80%）组成。免疫组化显示 NEC 区 chromogranin 和 synaptophysin 阳性，HCC 区阴性。术后给予顺铂和依托泊苷联合辅助化疗。术后 5 个月，患者出现右侧腰痛，CT 显示右侧肾上腺有一个新的 7.3 厘米大的肿块。术后 6.5 个月，右肾后和双肺均发现更多复发肿块。虽然将方案从依托泊苷改为伊立替康，但肝、肺和脑内又出现更多复发肿块。术后 12 个月患者死亡。回顾和分析既往文献后发现，1 年和 2 年总生存率分别为 57.3%和 43.6%，1 年和 2 年无病生存率分别为 36.2%和 29.0%。混合性 HCC-NEC 是一种非常罕见的肿瘤，手术结果较差。
