A case of primary mesenteric embryonal carcinoma

We describe a case of primary mesenteric embryonal carcinoma. The patient was a 73-year-old man who presented with a huge mass palpable at the right upper side of the abdomen. Laboratory evaluations showed very high alpha-fetoprotein and PIVKA-II levels, and an abdominal computed tomographic scan demonstrated a mass contiguous with the liver. These findings suggested hepatic cell carcinoma extending beyond the liver. However, angiography showed the mass to be supplied mainly by the middle colic artery and greater omentum artery, suggesting a mesenteric tumor. Gastroscopy demonstrated a IIc lesion in the anterior wall of the antrum. This lesion was histologically diagnosed to be moderately differentiated adenocarcinoma. The large tumor adjacent to the liver was diagnosed to be a primary mesenteric tumor or a metastatic mesenteric tumor from arising gastric cancer. At laparotomy, a huge tumor was found in the gastrocolic ligament. The tumor adhered to the distal part of stomach, the transverse colon, and the gallbladder. En-bloc resection of the tumor was performed, including the distal part of stomach, Part of the transverse colon, and the gall-bladder. The tumor mass measured 26.0 x 21.0 x 9.0 cm, weighted 2750 g, and showed central necrosis and hemorrhage. The histopathological diagnosis was a primary embryonal carcinoma originating in the mesentery. Primary mesenteric embryonal carcinoma is extremely rare. To our knowledge, no other cases have been reported. We describe this case and briefly discuss the related literature.     

肝脏原发高级别神经内分泌癌1例报告

1病例资料患者男性,61岁,因“腹痛、乏力7 d”于2019年4月30日入本院,无恶心、呕吐,既往体健。入院查体:皮肤巩膜轻度黄染,右上腹部压痛明显,无其他阳性体征。入院血生化检查:TBil 31.8μmol/L,DBil 9.3μmol/L,IBil 22.5μmol/L,ALT 135.9 U/L,AST 163.3 U/L,GGT 115.1 U/L,余未见异常。肿瘤标志物:AFP 3.12 ng/ml,细胞角蛋白19片段20.47 ng/ml,神经元特异性烯醇化酶(neuron-specific enolase,NSE)176.25 ng/ml。实验室指标:各项肝炎指标正常。腹部平扫+增强CT:肝内多发占位性病变,考虑恶性,肝门区/腹主动脉周围多发淋巴结肿大,考虑转移可能。为明确诊断行经皮肝穿刺活组织检查术,病理结果提示:高级别神经内分泌癌(neuroendocrine carcinoma,NEC),免疫组化结果提示:CD56(+),CK7(灶状+),Ki-67(+70%),CK-pan(灶状+),Syn(灶状+)(图1)。结合影像学检查未发现其他组织来源NEC的证据,故诊断为原发性肝脏NEC伴肝内多发转移及肝外淋巴结转移。本病例因存在多发病灶无法手术切除,选择依托泊苷和顺铂方案(EP方案)行全身化疗,现已完成4疗程。复查肿瘤标志物:AFP 4.49 ng/ml,细胞角蛋白19片段2.89 ng/ml,NSE 7.66 ng/ml,恢复至正常。腹部平扫+增强CT:肝内多发占位性病变与前相比明显变少变小,肝门区、门腔间隙见多发淋巴结显示,部分肿大,较前片体积略减小(图2、3)。     

原发性肝癌并右肩部软组织转移1例

原发性肝癌常见的转移途径为肝内转移、血行转移、淋巴转移、种植转移，我科收治1例原发性肝癌并右肩部转移患者，较为少见，特总结报道。     

A case of primary small cell neuroendocrine carcinoma of the liver]

Small cell neuroendocrine carcinoma is a type of undifferentiated, malignant neuroendocrine tumor. Most of neuroendocrine tumors exhibit well-differentiated features and are classified as carcinoid tumors. However, carcinomas of the liver with anaplastic characters, which are classified as small-cell carcinomas are extremely rare and only few cases have been reported in the literature. We report an unusual case of primary small cell neuroendocrine carcinoma of the liver in a 67-year-old man. The patient was found to have a palpable mass on right upper quadrant of abdomen on physical examination. The diagnosis was made by immunohistochemical stains of biopsied specimen from the liver. Other possible primary site was excluded by radiologic and endoscopic evaluations. The tumor was composed of small monotonous and hyperchromatic poorly differentiated cells with higher nuclear to cytoplasmic ratio, and were positive for neuroendocrine tissue markers such as synaptophysin, c-kit, and CD56.     

直肠腺瘤合并原发性肝脏神经内分泌癌一例

原发性肝脏神经内分泌癌(PHNEC)较罕见,临床症状、体征、超声及影像学检查均不具特异性,病理表现和免疫表型是确诊的主要依据.本例患者因直肠和肝脏特殊的影像学表现,入院初考虑直肠癌伴肝转移,后经病理和免疫组化确诊PHNEC.该病例提示我们临床工作中应警惕因经验主义引起的误诊,应重视病理学诊断结果.     

A case of primary mucoepidermoid carcinoma arising from the common bile duct

Mucoepidermoid carcinoma of the bile duct is an extremely rare tumor. Seventeen cases originating from intrahepatic bile duct and 2 cases from common hepatic duct have been reported in the English literature. Mucoepidermoid carcinoma arising from the common bile duct has not been previously reported. A 68 year-old man was admitted due to obstructive jaundice. Computed tomography showed a malignant tumor of the common bile duct located in the intrapancreatic segment. Filling defects of the distal common bile duct was seen on endoscopic retrograde cholangiogram. Under the impression of bile duct cancer, pylorus-preserving pancreatoduodenectomy was performed. Histologic diagnosis of the resected specimen was mucoepidermoid carcinoma of the common bile duct. After surgery, the patient received concurrent chemoradiotherapy, and planned to receive additional chemotherapy. We herein report on a first case of primary mucoepidermoid carcinoma of the common bile duct, and review the literature.     

A case of primary carcinoma of the cystic duct with limy bile]

A 78-year-old man had been admitted to a previous hospital because of epigastralgia and a diagnosis of cholecystolithiasis had been made. He had been transferred to our institution for further examination. CT scan and US revealed chronic cholecystitis and gallstone, however, ERC revealed severe obstruction of the cystic duct and EUS revealed dilation of that duct and a solitary mass there. Carcinoma of the cystic duct was diagnosed, and we performed cholecystectomy and resection of the extrahepatic duct with two-field lymphadenectomy. The pathological specimen showed a round flat elevated mass localized in the cystic duct. Histopathologically, the diagnosis was well differentiated tubular adenocarcinoma of the cystic duct with limy bile and tiny gallstone.     

直肠腺癌合并原发性肝脏神经内分泌癌一例

原发性肝脏神经内分泌癌较为少见,临床表现和影像学不具有特异性,病理诊断为金标准。该病例中患者同时伴有直肠腺癌,在初诊时肝内病灶考虑肠癌转移。在肝脏病灶与直肠病灶评效不一致后,我们行肝脏病灶穿刺病理证实为原发性肝脏神经内分泌癌,但由于患者肝功异常及体力下降未再有治疗机会。该病例提示我们临床工作中需要警惕患者存在多重癌可能,并且获得病理诊断很重要。     

Primary small cell carcinoma of the ureter

Primary small cell carcinoma of the ureter is a rare clinico-pathological entity. We present a report of primary ureteric small cell carcinoma and pathological correlates.     

A case of primary hepatic epithelioid hemangioendothelioma mimicking metastatic carcinoma]

Epithelioid hemangioendothelioma is a rare vascular origin tumor which usually occurs in soft tissues, liver, and lung. It usually affects adult women and presents as multiple hepatic nodules with mainly peripheral distribution. It is difficult to diagnose and treat because of non-specific clinical manifestations and findings on the imaging study. Moreover, pathological misdiagnosis is common. We report a case of this rare tumor that was detected incidentally. Final diagnosis was based on histological evidence. A 52-years old man suffered from right upper quadrant abdominal pain for 3 months, and was initially misdiagnosed as a metastatic carcinoma. Physical examination revealed superior cervical lymphadenopathy with mild hepatomegaly. Finally, hepatic epithelioid hemangioendothelioma was diagnosed on the basis of positive immunohistochemical staining for factor VIII, CD34, and VEGF. Our case highlights the importance of a histological diagnosis to avoid misdiagnosis.     

Double primary mucoepidermoid carcinoma and hepatocellular carcinoma of the liver--a case report

Double primary mucoepidermoid-hepatocellular carcinoma of the liver is extremely rare, and only one case has previously been reported in the literature, although there have been about 14 cases of primary mucoepidermoid carcinoma of the liver. Most of the reported hepatic mucoepidermoid carcinoma showed a poor prognosis. We presently report the second case of a double primary mucoepidermoid carcinoma and hepatocellular carcinoma with a brief review of the published literature. A 52-year-old man was admitted because of epigastric pain that lasted for 2 months. A computed tomography of the abdomen revealed a 7-cm, ill-defined mass with irregular marginal enhancement in the left lobe of liver. Another 2-cm nodular tumor was found in segment 8 of the right lobe. The two separate nodules in the patient's liver demonstrated clearly different histologic and immunohistochemical features. The pathological diagnoses were mucoepidermoid carcinoma and hepatocellular carcinoma for the larger and the smaller tumors, respectively. The patient died of liver failure 6 months after a left lobectomy of the liver.     

原发性肝脏癌肉瘤1例报告

<正>1临床资料患者男性,49岁,因发现肝占位2周入院。既往:乙型肝炎病史10余年。查体:全身皮肤黏膜无黄染,浅表淋巴结未触及肿大。腹软,无压痛及反跳痛。肝脾肋下未触及,肝区叩击痛阳性。辅助检查:入院时肝功能正常。外科综合提示:抗-HBs、抗-HBe、抗-HBc阳性。余化验结果未见明显阳性。肝胆胰多排CT平扫+三期增强(图1)可见:肝右叶见团块状低密度影,大小约6.4 cm×