Presence of Cytokeratin 19-Expressing Cholangiocarcinoma-Like Tumour in a Liver Metastatic Lesion of Rectal Neuroendocrine Tumour

Abstract

Introduction: Tumours with adenocarcinoma and neuroendocrine components have often been reported, although the reason underlying the dual components remains unclear. Case Presentation: A 43-year-old woman with multiple liver metastatic lesions of rectal neuroendocrine tumour underwent primary tumour resection and subsequent liver transplantation. Pathological examination indicated a cholangiocarcinoma-like tumour with gland formation, adjacent to a liver metastatic lesion of the neuroendocrine tumour. This tumour comprised atypical columnar epithelium, and stained positively for neuroendocrine markers and the ductal marker cytokeratin 19, indicating amphicrine properties and a partial cholangiocarcinoma phenotype – features not observed in the primary and metastatic neuroendocrine tumours. Conclusion: The presence of adenocarcinoma only at the metastatic site indicated that neuroendocrine tumour cells acquired stemness and differentiated into adenocarcinoma through metastasis, or that the adenocarcinoma newly arose from the adjacent epithelium influenced by the neuroendocrine tumour. We propose a novel mechanism for the pathogenesis of mixed tumours in neuroendocrine tumours.

The Revolution in Indication for Liver Transplantation: Will Liver Metastatic Disease Overcome the End-Stage Liver Disease in the Next Future?

“…This is an important point that must be taken into account when evaluating these results, as a longer waiting time could have a major impact in dropping out from the LT list due to the progression of the disease. In countries with a long LT waiting time, such as the UK where the median time is 152 days [40], it could be difficult to add a new transplantable disease, as this, would inherently cause longer waiting time or even drop-out for other patients. In addition, the severe dearth of organs and mortality in the waiting list represent further problems.…”

“…In addition, the severe dearth of organs and mortality in the waiting list represent further problems. In the UK, the burden of waiting list mortality raises major ethical considerations, since it has been reported that the number of patients who die on the waiting list relative to the total number of LT is about 16% [40]. In this regard, recipients with metastatic liver disease usually have normal liver function.…”