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Composite hepatocellular carcinoma and small cell carcinoma with early nodal metastasis: A case report.

Abstract Hepatocellular carcinoma (HCC) is known to grow in a mosaic pattern, and it can sometimes be combined with non-hepatocellular cells. Despites the variety of combination, HCC with a significant neuroendocrine carcinoma (NEC) component remains very rare. Most of the reported cases were treated as conventional HCC with a relatively poor prognosis. Early diagnosis may lead to a better treatment modality. Here, we report a case of composite HCC and small cell carcinoma (SCC) with nodal metastasis of the SCC component alone.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title medicine
Publication Year Start




PMID- 28834900
OWN - NLM
STAT- In-Process
DA  - 20170823
LR  - 20170823
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 96
IP  - 34
DP  - 2017 Aug
TI  - Composite hepatocellular carcinoma and small cell carcinoma with early nodal
      metastasis: A case report.
PG  - e7868
LID - 10.1097/MD.0000000000007868 [doi]
AB  - RATIONALE: Hepatocellular carcinoma (HCC) is known to grow in a mosaic pattern,
      and it can sometimes be combined with non-hepatocellular cells. Despites the
      variety of combination, HCC with a significant neuroendocrine carcinoma (NEC)
      component remains very rare. Most of the reported cases were treated as
      conventional HCC with a relatively poor prognosis. Early diagnosis may lead to a 
      better treatment modality. Here, we report a case of composite HCC and small cell
      carcinoma (SCC) with nodal metastasis of the SCC component alone. PATIENT
      CONCERNS: A 65-year-old man with chronic viral hepatitis C presented with
      abdominal discomfort for 2 months. Computed tomography and angiography of the
      liver showed a 4.3 cm hypervascular tumor in segment 4 and enlargement of the
      perihilar and paracaval lymph nodes. INTERVENTIONS: Extended left lobectomy and
      regional lymph node dissection were performed. DIAGNOSIS: The hepatic tumor was
      heterogeneous with two distinct gross components. The green part showed a grade
      III hepatocellular carcinoma with an immunoreaction to Hep Par 1, glypican 3 and 
      alpha-fetoprotein, whereas the white part exhibited a small cell carcinoma, as
      evidenced by expressions of chromogranin A and synaptophysin. The lymph node was 
      metastasized by the SCC component. The SCC part was also positive for vimentin
      with perivascular accentuation. ss-catenin immunostain showed reduced membranous 
      expression in the SCC component, as compared to HCC. OUTCOMES: The patient
      expired 39 days after the surgical intervention. LESSONS: Clinicians should be
      highly alert to a composite hepatic tumor, especially in dealing with a small
      heterogeneous tumor (< 5 cm) with early lymph node metastasis.
FAU - Liu, Yu-Jen
AU  - Liu YJ
AD  - aDepartment of Pathology, Chang Gung Memorial Hospital, Guishan bDepartment of
      Pathology, Chang Gung University School of Medicine, Taoyuan, Taiwan.
FAU - Ng, Kwai-Fong
AU  - Ng KF
FAU - Huang, Shih-Chiang
AU  - Huang SC
FAU - Wu, Ren-Chin
AU  - Wu RC
FAU - Chen, Tse-Ching
AU  - Chen TC
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
EDAT- 2017/08/24 06:00
MHDA- 2017/08/24 06:00
CRDT- 2017/08/24 06:00
AID - 10.1097/MD.0000000000007868 [doi]
AID - 00005792-201708250-00037 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2017 Aug;96(34):e7868. doi: 10.1097/MD.0000000000007868.