Medullary-like hepatocellular carcinoma

Abstract

Hepatocellular carcinoma (HCC) is the most frequent primary hepatic cancer. Pathological features can define the biological behavior and prognosis. Medullary-like HCC is a very rare variant that has been described only twice in literature. In the present study, we report the case of a non-cirrhotic 72-year-old man, who presented two HCC lesions on routine screening for hepatitis C virus liver disease. Radiological imaging and biopsy showed two different subtypes: one classic HCC, which was treated with chemoembolization, and a second PET/CT-positive carcinoma with a PET/CT-positive metastatic coeliac lymph node, which was resected laparoscopically with a left lateral sectionectomy and extended lymphadenectomy. Histopathology revealed a medullary-like HCC; lymph node analysis confirmed the metastatic nature of the PET/CT-positive coeliac node and showed an incidental B-cell lymphoma in the hepatic pedicle lymph nodes. To the best of our knowledge this is the third case of medullary-like HCC described in the literature, and the first associated to a concomitant typical HCC.

Figure 1:

(A) Venus phase of dynamic CT-scan showing two hepatic nodules (classical HCC in S8 and medullary-like HCC in S2) and (B) large lymph node in the coeliac region.

Figure 2:

Segment 8 nodule treated with transarterial chemoembolization.

Figure 3:

Treatment of Segment 2 nodule: (A) laparoscopic lateral left sectionectomy; (B) left hepatic vein stapling; (C) complete lymphadenectomy with excision of the lymph nodes in the coeliac region; and (D) specimen extraction through a minilaparotomy.

Figure 4:

Macroscopic photograph of the operative specimen.

Figure 5:

H&E-stained slide, ×50. Large anaplastic cells with enlarged vesicular nuclei, prominent nucleoli and numerous mitoses.

Figure 6:

H&E-stained slide, ×50. Periphery of the tumor with dense lymphoplasmacytic infiltrate.

Figure 7:

Immunohistochemistry for β-catenin, ×50. The tumor cells showed membranous staining for β-catenin.

Figure 8:

Immunohistochemistry for HEP, ×50. The tumor cells showed negativity for HepPar.

Figure 9:

Immunohistochemistry for CK 7, ×50. The tumor cells showed negativity for cytocheratin 7.