title: Right hepatectomy for combined primary neuroendocrine and hepatocellular carcinoma. A case report.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  To the best of our knowledge, this is the first case of combined neuroendocrine carcinoma and hepatocellular carcinoma in Egypt.
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Aboelenen
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Egypt.
authors.forename: Amira Kamal
authors.initials: AK
authors.lastname: El-Hawary
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Egypt.
authors.forename: Nirmeen
authors.initials: N
authors.lastname: Megahed
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Egypt.
authors.forename: Khaled Refaat
authors.initials: KR
authors.lastname: Zalata
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Egypt.
authors.forename: Eman M
authors.initials: EM
authors.lastname: El-Salk
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Egypt.
authors.forename: Marwa Abdel
authors.initials: MA
authors.lastname: Fattah
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Egypt. Electronic address: sorogy@gmail.com.
authors.forename: Mohamed El
authors.initials: ME
authors.lastname: Sorogy
authors.affiliation: Gastroenterology Surgical Center, Mansoura University, Egypt.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Shehta
keywords: Hepatocellular carcinoma; Neuroendocrine tumor; Right hepatectomy