Contrast-Enhanced Ultrasound Findings of Hepatocellular Carcinoma With Neuroendocrine Carcinoma: A Case Report

Primary hepatic neuroendocrine tumor with a suspicious pulmonary nodule: A case report and literature review

BACKGROUND

Primary hepatic neuroendocrine tumors (PHNETs) are extremely rare tumors originating from neuroendocrine cells. Due to lack of neuroendocrine symptoms and specific radiographic characteristics, PHNETs are challenging to differentiate from other liver tumors.

CASE SUMMARY

This case involved a 67-year-old male who was admitted with a discovered hepatic mass and a suspicious lung lesion. Primary hepatic carcinoma was initially speculated based on the characteristic magnetic resonance imaging findings. The patient underwent a laparoscopic right partial hepatectomy, and subsequent immunohistochemical examination revealed a HNET. To exclude other potential origins, a positron emission tomography-computed tomography scan and gastrointestinal endoscopy were performed, leading to a final diagnosis of PHNETs. Then we conducted a literature review using the PubMed database, identifying 99 articles and 317 cases related to PHNETs. The characteristics, diagnostic methods, and treatment of PHNETs have been described. Finally, we elaborate on the presumed origins, pathological grades, clinical features, diagnosed methods, and treatments associated with PHNETs.

CONCLUSION

The diagnosis of PHNETs was primarily an exclusionary process. A definitive diagnosis of PHNETs relied mainly on immunohistochemical markers (chromogranin A, synaptophysin, and cluster of differentiation 56) and exclusion of primary foci in other organs. Radical surgery was the preferred treatment for early-stage tumors.

Combined Neuroendocrine Carcinoma and Hepatocellular Carcinoma of the Liver: Systematic Literature Review Suggests Implementing Biological Characterization to Optimize Therapeutic Strategy

BACKGROUND

Mixed neuroendocrine-non-neuroendocrine tumors (MINEN) of the liver are exceptionally rare, with limited data available regarding their clinical behavior, pathogenesis, and optimal management. The coexistence of hepatocellular carcinoma (HCC) and neuroendocrine carcinoma (NEC) within the liver presents diagnostic and therapeutic challenges.

METHODS

A systematic literature search was conducted on PubMed, identifying cases of primary mixed HCC and NEC in the liver. The search adhered to PRISMA guidelines, and relevant studies were critically analyzed. A total of 45 documented cases were reviewed, focusing on patient demographics, clinical characteristics, treatment strategies, and outcomes.

RESULTS

Most patients (90%) were male, with a median age of 66.5 years. Hepatitis B or C infection was present in 74% of cases, and liver cirrhosis was reported in 38%. The combined type was the most frequently observed histological pattern (65%). Treatment modalities varied, including transarterial chemoembolization (TACE), radiofrequency ablation (RFA), surgery, and systemic therapies. The median overall survival was 10 months, highlighting the aggressive nature of these tumors.

CONCLUSIONS

Given the rarity and poor prognosis of hepatic MINEN tumors, multidisciplinary management is essential. Advanced molecular profiling may offer insights into tumor biology and potential therapeutic targets. Future research should explore novel systemic therapies, including immune checkpoint inhibitors, to improve patient outcomes.

Clinicopathologic and ultrasonographic features of combined hepatocellular-cholangiocarcinoma and its correlation with microvascular invasion: a predictive role of contrast-enhanced ultrasound

Background

This study aims to investigate the clinicopathological and ultrasonography characteristics of combined hepatocellular-cholangiocarcinoma (cHCC-CCA) and its correlation with microvascular invasion (MVI), as well as the predictive value of contrast-enhanced ultrasound (CEUS) imaging.

Methods

A retrospective analysis was conducted on 57 patients diagnosed with cHCC-CCA between November 2017 and May 2023 at Guizhou Provincial People's Hospital. Among them, 27 patients were MVI-positive and 30 patients were MVI-negative, all of whom underwent preoperative CEUS within 2 weeks. Clinical data, ultrasonographic findings, and CEUS features were compared between the two groups to analyze the influencing factors and predictive value of MVI in cHCC-CCA patients.

Results

Compared to the MVI-negative group, the MVI-positive group showed a higher proportion of tumors with a maximum diameter greater than 5 cm, elevated alpha-fetoprotein (AFP) levels, low echo halo around the tumor, non-smooth tumor contour, peripheral irregular rim-like enhancement and early washout (≤60s) with nodular patterns on CEUS (P<0.05). Multivariate logistic regression analysis revealed that low echo halo, peripheral irregular rim-like enhancement, and early washout were independent risk factors for MVI in cHCC-CCA patients. The receiver operating characteristic (ROC) curve analysis demonstrated an area under the curve (AUC) of 0.8056 for these factors.

Conclusions

Ultrasonographic and CEUS features have a certain correlation with MVI in cHCC-CCA patients. Low echo halo, peripheral irregular rim-like enhancement, and early washout are independent risk factors for MVI in patients with cHCC-CCA. These features have a predictive value in determining the presence of MVI in patients with cHCC-CCA.

Mixed Hepatocellular-Neuroendocrine Carcinoma: A Case Report and Literature Review

Mixed hepatocellular-neuroendocrine carcinoma (HCC-NEC) is a rare entity with a poor prognosis. We report a case of a 44-yearold Tunisian man who was admitted for diffuse abdominal pain. Body computed tomography showed multinodular hepatomegaly. Pathologic findings concluded to HCC-NEC. Clinicians should be aware about this entity. Further collection of case reports is needed to standardize the optimal treatment.

Mixed neuroendocrine carcinoma and hepatocellular carcinoma in the liver

BACKGROUND

Mixed neuroendocrine carcinoma (NEC) and hepatocellular carcinoma (HCC) is extremely rare, thus radiological features have not been fully clarified.

CASE

A male patient (age: 70 years) visited our hospital due to a tumor in the liver. Examination using contrast-enhanced computed tomography (CT) revealed a tumor (diameter: 5.0 cm) in hepatic segment 5, with early enhancement of the peripheral area and slight internal heterogeneous enhancement in the arterial and delayed phases, respectively. F-18 fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT revealed intratumoral heterogeneity, characterized by increased uptake (standardized uptake value, 12.10) in the corresponding low-density area detected using enhanced CT relative to the surrounding areas of the tumor. On magnetic resonance imaging, diffusion-weighted imaging also showed high intensity in the corresponding low-density area detected using CT. Preoperatively, the patient was diagnosed with HCC and underwent anterior sectionectomy. Pathological findings revealed both HCC and NEC components, and the patient was diagnosed with mixed NEC and HCC. Comparison of component distribution with FDG-PET/CT revealed an increased uptake area was congruent with the NEC component in the tumor.

CONCLUSION

In this case, the difference in tumor components affected the uptake in FDG-PET/CT. Such heterogeneous uptake with an enhanced spot may be useful for suspecting the presence of mixed NEC and HCC in patients with atypical HCC.