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Ghattas S, Al Bitar J, Chahine G, Kamar F, Haddad M, Wakim R. Primary Hepatic Neuroendocrine Tumor: A Case Report and Literature Review. Case Reports Hepatol 2024; 2024:9181560. [PMID: 38440188 PMCID: PMC10911880 DOI: 10.1155/2024/9181560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 02/03/2024] [Accepted: 02/16/2024] [Indexed: 03/06/2024] Open
Abstract
Primary hepatic neuroendocrine tumors (PHNETs) are extremely rare and account for about 0.3% of all neuroendocrine tumor cases. Resection is usually difficult because they are usually diagnosed in the late stages. We report the case of a patient diagnosed with PHNETs, initially classified as unresectable but then underwent a successful left hepatectomy. PHNETs are rare malignant tumors, and a high index of suspicion is warranted for the diagnosis after excluding the presence of a primary extrahepatic lesion. Radical hepatectomy can be curative when feasible along with a combination of multiple treatments that improve the prognosis.
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Affiliation(s)
- Souad Ghattas
- Department of General Surgery, Mount Lebanon Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Jad Al Bitar
- Department of General Surgery, Mount Lebanon Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Georges Chahine
- Department of General Surgery, Mount Lebanon Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Francois Kamar
- Department of Oncology, Mount Lebanon Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Marwan Haddad
- Departement of Radiology, Mount Lebanon Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Raja Wakim
- Department of General Surgery, Mount Lebanon Hospital University Medical Center, University of Balamand, Beirut, Lebanon
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Kushwaha NK, Jaiswal P, Gupta P, Mishra N, Kulkarni SV. Primary hepatic functional neuroendocrine tumor in an elderly female: Case report. Clin Case Rep 2024; 12:e8382. [PMID: 38161645 PMCID: PMC10753622 DOI: 10.1002/ccr3.8382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 01/03/2024] Open
Abstract
Key Clinical Message Primary hepatic neuroendocrine tumor, an exceptionally rare subtype, poses a diagnostic challenge. Oncological resections should be considered, even in elderly patients after following protocolized pre-operative optimizations. Abstract Neuroendocrine tumors (NETs) are rare tumors that primarily develop in the gastrointestinal and respiratory tracts. While the liver is commonly affected by NET metastases, primary hepatic neuroendocrine tumors (PHNETs) are an exceptionally rare subtype. The characteristic slow growth and nonfunctional nature of PHNETs pose challenges in their diagnosis. Furthermore, PHNETs often exhibit a lack of unique radiological characteristics that differentiate them from other liver tumors, leading to frequent misdiagnosis as hepatocellular carcinoma. We performed left hepatectomy for PHNET in an elderly lady with prolonged stormy postoperative course. This case report of a PHNET highlights the importance of histopathology and immunohistochemistry in the diagnosis and emphasizes that oncological resection, if feasible, is the preferred treatment even in the elderly population.
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Affiliation(s)
| | | | - Prashant Gupta
- Army Hospital Research and Referral New DelhiNew DelhiIndia
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Harrelson A, Wang R, Stewart A, Ingram C, Gillis A, Rose JB, El-Rayes B, Azmi A, Chen H. Management of neuroendocrine tumor liver metastases. Am J Surg 2023; 226:623-630. [PMID: 37657968 DOI: 10.1016/j.amjsurg.2023.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 07/15/2023] [Accepted: 08/14/2023] [Indexed: 09/03/2023]
Abstract
BACKGROUND Neuroendocrine Tumors (NETs) are a group of tumors that arise from neuroendocrine cells, and are increasing in incidence worldwide. These tumors often metastasize to the liver, and management of these neuroendocrine tumor liver metastases (NELMs) requires a multi-disciplinary approach. We aim to provide a comprehensive update for treatment of NELMs. METHODS We completed a comprehensive systemic review of papers involving the diagnosis, treatment, and outcomes of NELMs. We identified 1612 records via Scopus database literature search. Two independent authors reviewed these records, with 318 meeting criteria for inclusion in the final systemic review. RESULTS Primary tumor resection with resection of liver metastases is the treatment of choice for patients with NELMs. Liver-directed therapies and liver transplantation can be considered for patients with unresectable liver metastases. Systemic medical therapy is used for managing tumor burden and symptoms caused by NELMs. CONCLUSIONS Advancement in liver-directed and targeted systemic therapies provide improved options for patients with unresectable tumors. Given the complexity of NELMs, management of NELMs necessitates multidisciplinary teams at comprehensive health centers.
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Affiliation(s)
- Alex Harrelson
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rongzhi Wang
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Addison Stewart
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Clark Ingram
- Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Andrea Gillis
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - J Bart Rose
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Bassel El-Rayes
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Asfar Azmi
- Department of Oncology, Karmanos Cancer Institute, Detroit, MI, USA
| | - Herbert Chen
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA.
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Torbenson M, Venkatesh SK, Halfdanarson TR, Navin PJ, Kamath P, Erickson LA. Primary neuroendocrine tumors and primary neuroendocrine carcinomas of the liver: a proposal for a multidiscipline definition. Hum Pathol 2023; 132:77-88. [PMID: 35809684 DOI: 10.1016/j.humpath.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 02/07/2023]
Abstract
Primary hepatic neuroendocrine tumors and primary hepatic neuroendocrine carcinomas are rare and pose challenges for both diagnosis and for determining whether the tumor is primary to the liver versus metastatic disease. The lack of a uniform definition for primary hepatic neuroendocrine neoplasms is also a limitation to understanding and treating these rare tumors. Recently, there have been significant histological advances in the diagnosis and classification of neuroendocrine tumors in general, as well as significant advances in imaging for neuroendocrine neoplasms, all of which are important for their treatment. This article presents a multiple disciplinary definition and proposed guidelines for diagnosing a neuroendocrine tumor/neuroendocrine carcinomas as being primary to the liver.
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Affiliation(s)
- Michael Torbenson
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, 55906, USA.
| | | | | | - Patrick J Navin
- Department of Nuclear Medicine, Mayo Clinic Rochester, MN, 55906, USA
| | - Patrick Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN, 55906, USA
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, 55906, USA
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Lin J, Li X, Ding X, Chen Z, Wu Y, Zhao K. Developing a competing risk nomogram that predicts the survival of patients with a primary hepatic neuroendocrine tumor. Front Med (Lausanne) 2022; 9:960235. [DOI: 10.3389/fmed.2022.960235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 10/17/2022] [Indexed: 11/10/2022] Open
Abstract
Primary hepatic neuroendocrine tumor (PHNET) is rare liver cancer and related prognostic factors are unclear. The aim of this study was to analyze the prognostic risk factors of patients with PHNETs and establish an assessment model for prognosis. The clinical information of 539 patients with PHNETs who met the criteria for inclusion was extracted from the Surveillance, Epidemiology, and End Results (SEER) database. These patients were randomly assigned to the training (269 cases) and validation sets (270 cases). Prognostic factors in patients with PHNETs were screened using the Cox proportional regression model and Fine–Gray competing risk model. Based on the training set analysis using the Fine–Gray competing risk model, a nomogram was constructed to predict cumulative probabilities for PHNET-specific death. The performance of the nomogram was measured by using receiver operating characteristic curves, the concordance index (C-index), calibration curves, and decision curve analysis (DCA). No differences in clinical baseline characteristics between the training and validation sets were observed, and the Fine–Gray analysis showed that surgery and more than one primary malignancy were associated with a low cumulative probability of PHNET-specific death. The training set nomograms were well-calibrated and had good discriminative ability, and good agreement between predicted and observed survival was observed. Patients with PHNETs with a high-risk score had a significantly increased risk of PHNET-specific death and non-PHNET death. Surgical treatment and the number of primary malignancies were found to be independent protective factors for PHNETs. The competing risk nomogram has high accuracy in predicting disease-specific survival (DSS) for patients with PHNETs, which may help clinicians to develop individualized treatment strategies.
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Gudiño-González JC, Rodríguez-Salinas CA, Purón-González E, Coronado-Alejandro EU, Garcia-Aguilar J. Carcinoid Heart Disease From a Primary Liver Carcinoid Tumor. JACC Case Rep 2022; 4:1360-1362. [PMID: 36299646 PMCID: PMC9588570 DOI: 10.1016/j.jaccas.2022.08.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/18/2022] [Accepted: 08/29/2022] [Indexed: 06/16/2023]
Abstract
Carcinoid heart disease (CaHD) is part of the carcinoid syndrome. Cardiac involvement is present in 20% to 60% of patients with carcinoid syndrome and is normally from liver metastasis. We report the case of a patient who presented with CaHD disease with an undiagnosed primary tumor or a possible primary liver carcinoid tumor. (Level of Difficulty: Advanced.).
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Affiliation(s)
- Juan Carlos Gudiño-González
- Department of Cardiology, Christus Muguerza Hospital Alta Especialidad, University of Monterrey, Monterrey, México
| | | | - Emma Purón-González
- Department of Internal Medicine, Christus Muguerza Hospital Alta Especialidad, University of Monterrey, Monterrey, México
| | | | - Jorge Garcia-Aguilar
- Department of Cardiology, Christus Muguerza Hospital Alta Especialidad, University of Monterrey, Monterrey, México
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Wang Q, Zhang J, Xu L, Li X, Lu Y, Chen S, Jin Q. Primary hepatic neuroendocrine carcinoma with colon adenoma: A case report with literature review. Int J Surg Case Rep 2022; 95:107176. [PMID: 35636210 PMCID: PMC9157444 DOI: 10.1016/j.ijscr.2022.107176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/05/2022] [Accepted: 05/07/2022] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Primary hepatic neuroendocrine tumors (PHNETs) are extremely rare, and the clinical symptoms, test results, and imaging characteristics are nonspecific in most patients; thus, it is difficult to differentiate from other liver masses before surgery. Histopathology and immunohistochemistry are the main basis for the diagnosis. PHNETs and colon tumors co-occur in a patient and are non-homologous, as reported in the English-language literature for the first time. CASE PRESENTATION We present a case of a 60-year-old woman with right hepatic lobe mass accidentally discovered on abdominal ultrasonography during a routine examination. Preoperative liver contrast-enhanced computed tomography suggested hepatocellular carcinoma; then, surgery were performed. Pathological results revealed a Grade 2 neuroendocrine tumor of the liver. In search of the primary tumor, upper and lower endoscopy of the GI tract was performed and revealed a mass in the ascending colon. Ascending colon cancer was considered; then, laparoscopic right hemicolectomy was performed. Pathological results suggested tubular villous adenoma of the ascending colon. The final diagnosis was not colon cancer with liver metastases but was PHNETs with colon adenoma. CLINICAL DISCUSSION PHNETs are rare cancers that are difficult to diagnose, requiring not only differentiation from other liver masses but also exclusion of metastases from extrahepatic sources. The pathological results play an important in making an accurate diagnosis. CONCLUSION Pathology, postoperative follow-up, and comprehensive imaging examinations are powerful tools in the diagnosis of PHNETs. Currently, surgery is the best treatment to achieve a potential cure and prolong the patient's survival.
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Affiliation(s)
- Qingqing Wang
- Department of General Surgery, The First Hospital of Jiaxing (The First Affiliated Hospital of Jiaxing University), Jiaxing, Zhejiang 314001, PR China
| | - Jie Zhang
- Department of General Surgery, The First Hospital of Jiaxing (The First Affiliated Hospital of Jiaxing University), Jiaxing, Zhejiang 314001, PR China.
| | - Liu Xu
- Department of General Surgery, The First Hospital of Jiaxing (The First Affiliated Hospital of Jiaxing University), Jiaxing, Zhejiang 314001, PR China
| | - Xiaohuan Li
- Department of General Surgery, The First Hospital of Jiaxing (The First Affiliated Hospital of Jiaxing University), Jiaxing, Zhejiang 314001, PR China
| | - Yifan Lu
- Department of General Surgery, The First Hospital of Jiaxing (The First Affiliated Hospital of Jiaxing University), Jiaxing, Zhejiang 314001, PR China
| | - Songhai Chen
- Department of General Surgery, The First Hospital of Jiaxing (The First Affiliated Hospital of Jiaxing University), Jiaxing, Zhejiang 314001, PR China
| | - Qianhui Jin
- Department of General Surgery, The First Hospital of Jiaxing (The First Affiliated Hospital of Jiaxing University), Jiaxing, Zhejiang 314001, PR China
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Elayan A, Batah H, Badawi M, Saadeh A, Abdel Hafez S. Primary Hepatic Neuroendocrine Tumor: A Case Report and Literature Review. Cureus 2022; 14:e22370. [PMID: 35371747 PMCID: PMC8938252 DOI: 10.7759/cureus.22370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2022] [Indexed: 11/05/2022] Open
Abstract
Primary hepatic neuroendocrine tumors (PHNETs) are an utterly rare subtype of neuroendocrine tumors (NETs) that arise from cells of the neuroendocrine system. Due to the rarity and lack of distinctive radiological features, diagnosis and management of this tumor are challenging. Herein, we report a case of PHNET in a 19-year-old previously healthy female patient whose diagnosis was confirmed by histopathology and immunohistochemistry. This case emphasizes the importance of considering PHNETs in the differential diagnosis of a hepatic mass, management of patients with this disease, and post-operative follow-up.
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