Hepatocellular carcinoma with biliary and neuroendocrine differentiation: A case report

Table 1 Hepatic tumor cases reported to have triple (hepatocellular, cholangiocytic, and neuroendocrine) differentiation

Cases of liver tumor with triple differentiation described in the literature	Ref.
Chinese male patients (n = 2; average age: 57.5 yr). Both were positive for hepatitis B and exhibited hepatic tumors with triple differentiation.	He et al[8], 2013
An otherwise healthy 19-year-old Caucasian male developed a large hepatic tumor showing triple differentiation.	Beard et al[7], 2017
A 65-year-old female with a previous history of hepatitis C and rectal “carcinoid” developed a hepatic tumor with triple differentiation.	Current case report

Table 2 Timeline of patient’s history and medical interventions

Dates	Summary from initial and follow-up visits	Diagnostic testing	Intervention/results
2012 and 2017	Routine colonoscopy	1 cm polypoid lesion in rectum	Removed endoscopically → well-differentiated neuroendocrine tumor
May/June 2019	Presents with abdominal pain	CT, MRI, FDG/PET → two liver lesions	CT-guided biopsy → poorly differentiated carcinoma with neuroendocrine features
September 2019	Presents for surgical intervention	Presents for surgical intervention	Resection of the 2 liver lesions → Final diagnosis of combined liver tumor
October 2019	Post-surgical follow-up	CT and FDG/PET → New liver lesion in dome	Additional imaging was advocated
March 2020	MRI revealed new portocaval lymphadenopathy	Endoscopic ultrasound-guided FNA of lymph nodes	Lymph nodes positive for metastatic adenocarcinoma
May 2020	Final oncology consultation after imaging		Initiation of cisplatin and gemcitabine chemotherapy
October 2020	Presents to hospital with altered mental status	Found to be in shock due to a combination of GI bleed/sepsis	Patient expired, despite medical treatment

CT: Computed tomography; FDG: Fluorodeoxyglucose; FNA: Fine needle aspiration; GI: Gastrointestinal; MRI: Magnetic resonance imaging; PET: Positron emission tomography.