Abstract
Background: Hepatocellular carcinoma (HCC) can grow in a mosaic pattern, often combined with various non-hepatocellular cells. However, HCC combined with a neuroendocrine carcinoma (NEC) component is very rarely reported, and its clinical features, origin, diagnosis and behavior have not been established. In the literature, mixed HCC–NEC tumors are categorized as either collision type or combined type, depending on their microscopic features. Here we report a patient with a combined-type HCC–NEC tumor.Case presentation: An asymptomatic 84-year-old woman was found to have a solid mass in the right lobe of her liver. Laboratory and radiologic examinations showed findings typical of HCC, including arterial-phase enhancement, and portal- and delay-phase washout. She was preoperatively diagnosed with HCC, and treated with partial laparoscopic hepatectomy of her S5 segment. The tumor was 5.0 × 6.0 cm in diameter, and was predominantly HCC, partly admixed with a NEC component. A transitional zone between the HCC and NEC tissues was also observed. The tumor was finally diagnosed as a combined-type primary mixed NEC–HCC tumor. After the diagnosis, the patient underwent somatostatin receptor scintigraphy to look for the primary NEC lesion, but no accumulations were found in any other part of her body. She has been free of recurrence for 6 months since the surgery.Conclusion: Mixed HCC–NEC tumors are very rare. Correct diagnosis requires multidisciplinary collaboration. Accumulating cases is needed to help understand their exact pathology, diagnosis and treatment.