Abstract
A 72-year-old man was admitted to our hospital with obstructive jaundice. Abdominal imaging showed a tumor located in the anterior segment and hilum of the liver. The tumor invaded the main portal trunk and the horizontal portion of the left portal vein. Bile cytology obtained from a biliary drainage tube showed nuclear molding, suggesting neuroendocrine carcinoma (NEC). After right portal vein embolization, resection of the right and caudate lobes was performed with portal reconstruction of the anastomosis between the main portal trunk and the horizontal portion of the left portal vein. On histological examination, the resected hepatic tumor, measuring 29 × 22 mm2, showed rosette formation, and immunostaining was positive for neuroendocrine markers including chromogranin A, confirming the diagnosis of primary hepatic NEC. In addition, the Ki-67 positive rate was 47% (>20%), and staining was positive for p53, consistent with poorly differentiated NEC. Therefore, postoperative chemotherapy with cisplatin and etoposide or irinotecan was given. He showed a partial response to chemotherapy, but the tumor recurred, and the patient died 395 days after the operation. In this case, bile cytology was useful for preoperative diagnosis, and the intensive surgical procedure combined with postoperative chemotherapy provided some survival benefit.
