Coexistence of Hepatocellular Carcinoma and Primary Hepatic Neuroendocrine Tumor: Case Series and Literature Review

1. Abstract
Coexistence of hepatocellular carcinoma (HCC) and primary hepatic neuroendocrine tumor (PHNET) is rare. No consensus has been reached on the diagnosis and treatment plan for this condition. We herein describe two different cases of coexistent HCC and PHNET. Both patients had a history of chronic hepatitis B virus infection and presented with hepatic lesions and without any specific symptoms. In one case, the tumor was singular and originally diagnosed as PHNET by pathology. Then the tumor presented progressive enlargement. In another case, two hepatic lesions were located in different liver segments, and the patient was misdiagnosed as HCC with intrahepatic metastasis. Both patients were confirmed to be coexistent HCC and PHNET according to the postoperative pathological result. Although one case was metachronous, and another was synchronous. We used the combination of lenvatinib and
somatostatin long-acting release as adjuvant therapy after surgical resection of hepatic lesions. Both patients acquired favorable outcomes.
This report suggests that PHNET should be included inthe differential diagnosis of HCC, even when sufficient evidence of typical presentation exists to support the clinical diagnosis of
HCC. It is better to perform a needle biopsy when conditions permit in cases of hepatic lesions. The combined lenvatinib and somatostatin long-acting release may be a potential therapy to prolong