Hepatic Carcinoma With Epithelial-Myoepithelial Differentiation and Metachronous Intrahepatic Recurrence Following Curative Resection: A Rare Case Report.

BACKGROUND AND AIM: Epithelial-myoepithelial carcinoma (EMC), a malignant tumor with biphasic epithelial and myoepithelial differentiation, is typically a salivary gland neoplasm. Contrastingly, myoepithelial carcinoma (MEC) predominantly comprises myoepithelial cells. In salivary gland pathology, biphasic ductal tumors are classified as EMC, even with a predominant myoepithelial component. Primary hepatic tumors showing myoepithelial and epithelial-myoepithelial differentiation are rare, with uncertain definition and clinical behavior owing to limited reported hepatic carcinoma with MEC/EMC spectrum cases. Here, we report a unique case with intrahepatic recurrence that was successfully managed with repeat hepatectomies.

CASE: A 66-year-old woman presented with pain in the right hypochondrium. Imaging revealed a 13 cm tumor in the right hepatic lobe, and biopsy suggested squamous cell carcinoma. After portal vein embolization, right trisectionectomy was performed. Histopathology revealed a biphasic structure with duct-forming epithelial cells surrounded by myoepithelial cells, confirming hepatic carcinoma with epithelial-myoepithelial differentiation. After 2 years, multiple intrahepatic recurrences without extrahepatic disease were detected and repeat hepatectomies were performed. The patient remains recurrence-free 1 year post-reoperation.

CONCLUSIONS

Hepatic carcinoma with epithelial-myoepithelial differentiation is rare, with uncertain definition and clinical behavior. Careful exclusion of extrahepatic primaries, detailed immunophenotyping, and long-term surveillance are essential. Repeat hepatectomies may be a curative option for intrahepatic recurrence in selected patients.