How would you approach metastatic hepatocellular cancer with neuroendocrine features?

I would consider having both specimens reviewed by an expert GI pathologist to determine the histology and apply additional IHC stains as indicated. Misdiagnosis of NETs is not all that uncommon and I have seen both HCC and cholangiocarcinoma called NETs and the other way around too. For a tumor that is predominantly typical HCC but with NE features such as positivity for synaptophysin or chromogranin, I would treat as HCC with sorafenib, regorafenib and nivolumab.

If there is a prominent compon...

• Most of these patients end up having aggressive HCC or cholangio rather than real high grade G3 NET or NEC. So definitely agree with path review, preferably with a NET pathologist is the first most important step given that imaging and therapy will be completely different.
• If the pathologist's concern for higher grade NENs: TP53, Rb1, and PETFDG can be helpful for NEC or PET-Ga68 for NET include G3 but at this point, we need to look for the primary.
• For treatment, if we established NEC, I will...