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Int J Surg Case Rep. 2014;5(1):26-9. doi: 10.1016/j.ijscr.2013.10.018. Epub 2013 Nov 11.

Right hepatectomy for combined primary neuroendocrine and hepatocellular carcinoma. A case report.

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  • 1Gastroenterology Surgical Center, Mansoura University, Egypt.
  • 2Gastroenterology Surgical Center, Mansoura University, Egypt. Electronic address:



Cases of primary neuroendocrine tumors in the liver combined with hepatocellular carcinoma are scarce. Such cases could present either as combined-type tumor or collision type.


A 51-year-old man presented with a mass in the right hemiliver. Serum level of alpha-fetoprotein was slightly elevated (2.3ng/ml), with normal CA19-9 and CA125. The patient underwent right hepatectomy. The resected specimen showed a well-defined and heterogeneous gray-white to brown friable tumor, 20cm in diameter. Microscopically, the tumor consisted predominantly of monotonous small- to medium-sized neoplastic cells arranged in trabeculea separated by sinusoidal spaces. Immunohistochemically, the tumor cells were strongly positive for synaptophysin and focally positive for chromogranin-A. Interestingly, the tumor cells showed patchy positive coarse granular staining of HerPar-1 involving about 1% of the tumor cells. Glypican-3 staining was negative. These immunohistochemical findings supported the diagnosis of combined high grade neuroendocrine carcinoma and hepatocellular carcinoma.


Cases of primary neuroendocrine tumors in the liver combined 82 with hepatocellular carcinoma are scarce. The uniqueness of this case lies in the fact that the neuroendocrine carcinoma component comprised more than 99% of the tumor area, and the minor hepatocellular carcinoma component was detected only by the immunohistochemical staining for HepPar-1.


To the best of our knowledge, this is the first case of combined neuroendocrine carcinoma and hepatocellular carcinoma in Egypt.

Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.


Hepatocellular carcinoma; Neuroendocrine tumor; Right hepatectomy

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