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Rare Case of Liver Cancer With Neuroendocrine Differentiation: Focus on Use of Tumor Organoids

By: Joshua D. Madera, MS
Posted: Tuesday, October 25, 2022

The use of patient-derived tumor organoids may improve the quality of patient management through personalized medicine for patients with hepatocellular carcinoma with neuroendocrine differentiation (HCC-NED), according to a study published in Communications Medicine. However, additional efforts dedicated to determining the extent of their use are warranted, explained Markus H. Heim, MD, of the University Hospital and University of Basel, Switzerland, and colleagues.

A 74-year-old man presented with isolated one-sided vision loss diagnosed as giant cell arteritis. He was treated with aspirin and high-dose steroids prior to receiving an additional diagnostic workup. Imaging showed a mass in the gastric corpus and an intrahepatic mass suspicious of malignancy. Biopsy revealed poorly differentiated hepatocellular carcinoma and a gastrointestinal stromal tumor of the stomach. Surgical resection was decided as the best course of management, and the patient underwent left-lateral liver resection and partial gastrectomy with complete resection of both tumors. Immunophenotypic characterization of the intrahepatic tumor revealed poorly differentiated hepatocellular carcinoma with neuroendocrine differentiation.

The patient was subsequently enrolled in a hepatocellular carcinoma surveillance program. At 3 months postoperatively, he was found to have multifocal intrahepatic disease recurrence with portal vein invasion and pulmonary metastasis. The rarity of this condition in combination with the limited published evidence of appropriate treatment challenged the treating physicians to look further for the most appropriate treatment.

Organoids from the patient’s HCC-NED tissue were generated, with similar characteristics to the patient’s tumor. Whole-genome sequencing was performed and showed mutations in CTNNB1, TP53, and NTRK1. Furthermore, organoids were subjected to treatment with various antineoplastics to determine which were most efficacious. This study revealed that the HCC-NED organoids responded best to treatment with cisplatin, etoposide, and carboplatin. These findings prompted the clinicians to begin treating the patient with a palliative chemotherapy regimen consisting of etoposide and carboplatin. Unfortunately, this patient’s condition progressively deteriorated because of the extent of his disease.

Disclosure: For full disclosures of the study authors, visit ncbi.nlm.nih.gov.


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