Conversion Hepatectomy After New FP Therapy for Malignant Hepatocellular Neoplasm, Not Otherwise Specified: A Case Report

BACKGROUND: Malignant hepatocellular neoplasm, not otherwise specified (HCN, NOS), is a rare primary liver tumor showing overlapping features of hepatoblastoma and hepatocellular carcinoma. Because of its rarity and histopathologic heterogeneity, the optimal treatment strategy for HCN, NOS remains undefined. AIM AND METHODS: We report a case of a 20-year-old woman with initially unresectable HCN, NOS, who was treated with hepatic arterial infusion chemotherapy using a fine-powder formulation of cisplatin suspended in Lipiodol combined with continuous 5-fluorouracil administration (New FP). The therapeutic response was assessed radiologically and serologically after each treatment cycle, and the patient subsequently underwent surgical resection after adequate tumor regression. RESULTS: After eight cycles of New FP, marked tumor shrinkage and a significant decline in tumor markers were achieved, enabling subsequent systemic chemotherapy according to the SIOPEL-4 regimen. Thereafter, conversion hepatectomy was performed, and histological examination of the resected specimen demonstrated approximately 90% tumor necrosis. The patient has remained disease-free for 20 months after surgery. CONCLUSION: This case demonstrates the potential of New FP as an effective hepatic arterial infusion regimen capable of achieving conversion therapy in rare liver malignancies such as HCN, NOS.