Small cell carcinoma of the liver and biliary tract without jaundice

Abstract

An 80-year-old woman presenting with chest pain was found to have a large, lobulated soft tissue mass in the liver and nearby tissues on abdominal computed tomography (CT). The tumor had invaded the common hepatic artery and main portal vein. Jaundice developed 4 wk later, at which point, a pancreas and biliary CT scan revealed a large mass in the right lobe of the liver and a hilar duct obstruction, which was found to be a small cell carcinoma. Despite its rarity, liver and bile duct small cell carcinoma should be considered in the differential diagnosis of atypical chest pain without jaundice.

Keywords: Bile duct mass; Extrapulmonary small cell carcinoma; Jaundice; Liver mass; Neuroendocrine tumor.

Figure 1

Findings of initial abdominal computed tomography. Computed tomography showed a large mass located in the liver, common hepatic duct, and common bile duct.

Figure 2

Computed tomography scan obtained before biopsy. One month after the first visit, a computed tomography scan of the pancreas and biliary duct revealed that the large mass in the right lobe of the liver had grown and that there was an obstruction of the hilar duct.

Figure 3

Tumor consisted of tightly packed nests and diffuse, irregularly shaped sheets of cells with necrotic areas. A: The tumor cells were of small-to-intermediate size with hyperchromatic, round-to-oval nuclei and scanty, poorly defined cytoplasm (HE, × 100); B: The nuclear chromatin was finely granular, and nucleoli were absent or inconspicuous. Cell borders were rarely seen, and nuclear molding was common (HE, × 400).

Figure 4

Immunohistochemical findings (× 200). The tumor cells were immunoreactive for synaptophysin (A) and negative for hepatocyte-specific antigen (B).