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Jiang S, Wu H, Fu R, Mai J, Yao J, Hua X, Chen H, Liu J, Lu M, Li N. The Outcome of Primary Hepatic Carcinoid Tumor: A Retrospective Study Based on Propensity Score Matched Survival Analysis. Front Oncol 2021; 11:609397. [PMID: 33718162 PMCID: PMC7945031 DOI: 10.3389/fonc.2021.609397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/11/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Primary hepatic carcinoid tumor (PHCT) is rare and has unclear clinical characteristics and prognosis. METHODS A retrospective study using data from the SEER database for patients diagnosed with PHCT used univariate and multivariate Cox models to screen for independent prognostic factors. The outcomes of patients in the surgical and nonsurgical groups were compared, and Propensity Score Matching (PSM) analysis was used to reduce confounder bias. RESULTS A total of 186 PHCT patients were identified and the median survival was 65 (95% CI [43.287, 86.713]) months. Tumor size(HR = 2.493, 95% CI[1.222,5.083], p = 0.012), male(HR = 1.690, 95% CI[1.144,2.497], p = 0.008), age(HR = 2.583, 95% CI[1.697,3.930], p < 0.001), SEER stage(HR = 1.555, 95% CI[1.184,2.044], p = 0.002) and surgery(HR = 0.292, 95% CI[0.135,0.634], p = 0.002) were significantly correlated with patient prognosis. In multivariate analysis, sex(HR = 3.206, 95% CI[1.311,7.834], p = 0.011) and surgery(HR = 0.204, 95% CI[0.043,0.966], p = 0.0045) were independent predictors of patient prognosis. Females are potentially susceptible to PHCT but have a better prognosis. With consistent baseline data, surgical patients have a better prognosis. CONCLUSIONS PHCT is uncommon and survival time is longer than that of other primary liver cancers. We found that none-surgery was potentially independent risk factors for poor prognosis.
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Affiliation(s)
- Shaotao Jiang
- Department of HBP SURGERY II, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Huijie Wu
- Department of Gynecology, The First People’s Hospital of Foshan, Foshan, China
| | - Rongdang Fu
- Department of Hepatic Surgery, The First People’s Hospital of Foshan, Affiliated Foshan Hospital of Sun Yat-sen University, Foshan, China
| | - Jialuo Mai
- Department of HBP SURGERY II, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jiyou Yao
- Department of HBP SURGERY II, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Xuefeng Hua
- Department of HBP SURGERY II, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Huan Chen
- Department of HBP SURGERY II, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Jie Liu
- Department of HBP SURGERY II, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Minqiang Lu
- Department of HBP SURGERY II, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Ning Li
- Department of HBP SURGERY II, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
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Parray A, Patkar S, Goel M. Primary hepatic neuroendocrine tumours of liver- a rarity: Single centre analysis of 13 patients. Ann Hepatobiliary Pancreat Surg 2020; 24:17-23. [PMID: 32181424 PMCID: PMC7061040 DOI: 10.14701/ahbps.2020.24.1.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 12/14/2019] [Accepted: 01/19/2020] [Indexed: 11/25/2022] Open
Abstract
Backgrounds/Aims Primary hepatic neuroendocrine tumours (PHNETs) are a rarity and this rarity imparts management complexities. Methods A retrospective analysis of prospectively maintained liver database from 2009 to 2018 was performed and patients with PHNETs were identified and studied for clinical, imaging and pathological features, surgical outcomes, disease free and overall survival. Results Thirteen patients of PHNET were identified following rigorous investigational protocols, which constituted 0.6% of all liver tumours (2095) in our series. The median age of patients was 50 years (14–65), with male to female ratio of 9:4. Eight patients (62%) underwent hepatic resections as primary treatment, while 5 (38%) patients received peptide receptor radiotherapy, trans-arterial chemotherapy, trans-arterial radiotherapy or a combination of these. In the surgical group at a median follow up of 36 months (range 5–114 months), 4 (50%) patients were alive without disease and disease free survival was 20 months. Median OS in surgical group was 47 months (40–53, 95% confidence interval) that was better but not statistically significant from that of non-surgical treatment group (36 months). Conclusions PHNETs are rare tumours that require multidisciplinary treatment approach. Liver directed surgery centred management leads to better clinical outcomes in these selected patients.
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Affiliation(s)
- Amir Parray
- Gastrointestinal & HPB Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, INDIA
| | - Shraddha Patkar
- Gastrointestinal & HPB Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, INDIA
| | - Mahesh Goel
- Gastrointestinal & HPB Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Parel, Mumbai, INDIA
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Quartey B. Primary Hepatic Neuroendocrine Tumor: What Do We Know Now? World J Oncol 2011; 2:209-216. [PMID: 29147250 PMCID: PMC5649681 DOI: 10.4021/wjon341w] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2011] [Indexed: 12/17/2022] Open
Abstract
Primary hepatic neuroendocrine tumors (PHNETs) are rear neoplasm. Diagnosis is an evolution, and requires a systematic clinical exclusion with histological confirmation. Treatment is surgical with excellent prognosis, and a long-term follow-up is required due to high tumor recurring rate. Knowledge from this species of tumor remains limited due to paucity of cases. This article elaborates the key features, diagnosis algorithm, current management, other treatment options and extensive review of literature on this rear tumor.
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Affiliation(s)
- Benjamin Quartey
- National Capital Consortium, National Naval Medical Center, Department of Surgery, 8901 Wisconsin Ave, Bethesda, MD 20889, USA
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Balta Z, Sauerbruch T, Hirner A, Büttner R, Fischer HP. [Primary neuroendocrine carcinoma of the liver. From carcinoid tumor to small-cell hepatic carcinoma: case reports and review of the literature]. DER PATHOLOGE 2009; 29:53-60. [PMID: 18210116 DOI: 10.1007/s00292-007-0957-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Primary hepatic neuroendocrine tumors are rare neoplasms. While primary hepatic carcinoid tumors (PHCT) are well-differentiated tumors, primary hepatic small-cell carcinomas (PHSCC) represent the poorly differentiated end of the spectrum of neuroendocrine carcinomas. The first patient, suffering from PHCT, has had a follow-up for 32 years and is still alive. Within this time, the tumor relapsed 4 times with unchanged histology and immunohistochemistry features. The second patient suffered from small-cell carcinoma of the liver. There were no risk factors for a hepatocellular carcinoma. An extensive preoperative and postoperative diagnostic investigation could rule out an extrahepatic primary site. Immunohistochemically the tumor was negative for Hepar-1, AFP, TTF1 and CDX2 but reacted positively with CD56 and sporadically with the keratins 8, 18 and 20. A neuroendocrine PHSCC was diagnosed. After neoadjuvant cytostatic treatment the carcinoma was completely extirpated and 18 months after treatment the patient is healthy.PHCT and PHSCC have to be clearly separated from hepatocellular and cholangiocellular carcinomas. Exclusion of an extrahepatic primary site requires an accurate and synoptic analysis of clinical, radiologic and pathologic findings. Surgical resection is the treatment of choice.
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Affiliation(s)
- Z Balta
- Institut für Pathologie, Universitätsklinik Bonn.
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Primary hepatic carcinoid tumor: a case report and review of the literature. CASES JOURNAL 2009; 2:90. [PMID: 19173727 PMCID: PMC2654436 DOI: 10.1186/1757-1626-2-90] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Accepted: 01/27/2009] [Indexed: 12/18/2022]
Abstract
BACKGROUND Primary hepatic carcinoid tumor (PHCT) is very rare and difficult to diagnose before biopsy or operation. We report a patient with a small PHCT and review cases in the literature. CASE PRESENTATION A 48-year-old Chinese female with underlying hepatitis B virus (HBV) infection was found to have a low echoic hepatic nodule by abdominal ultrasound. Tumor markers were negative. Dynamic liver computed tomography scans showed enhancement of the nodule in the arterial phase and early washout in the portal phase. Hepatocellular carcinoma (HCC) was considered based on the image findings and underlying HBV infection. However, the tumor biopsy revealed a malignant neoplasm that originating from neuroendocrine cells. Pre-operative and intra-operative investigations for the possible other origin of carcinoid tumor were negative, so PHCT was confirmed. CONCLUSION A small and asymptomatic PHCT is extremely rare. PHCT should be one of the differential diagnoses in patients with small hepatic tumor, even in regions with high prevalence of HBV infection and HCC. Pre-operative biopsy is necessary to avoid misdiagnosis even when HCC is highly suspected clinically.
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Obi N, Katabami T, Obi R, Odanaka M, Sasano K, Tanaka Y. Primary malignant hepatic glucagonoma: an autopsy case. Endocr J 2009; 56:715-9. [PMID: 19367016 DOI: 10.1507/endocrj.k09e-058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A 73-year-old woman was admitted to our department for treatment of diabetes (plasma glucose 289 mg/dl, HbA(1C) 7.1%, and glycated albumin 34.9%). She displayed the signs and symptoms of glucagonoma syndrome, including necrolytic migratory erythema (NME), low aminoacidemia, and a marked increase of the serum glucagon level (4,940 pg/ ml). Thus, we suspected a glucagonoma causing secondary diabetes. However, we could not detect any mass in the pancreas or the gastrointestinal tract, and only found a liver lesion resembling a hemangioma. Her NME improved markedly after intravenous infusion of amino acids, and her plasma glucose was controlled reasonably well by intensive insulin therapy. However, her general condition deteriorated and she died on day 57 after hospitalization. At autopsy, the only tumor detected was the liver mass. This was a large solid tumor (8 x 6 x 5 cm) with a pattern of white and dark brown stripes located in the left lobe, while two white nodules were also found in the right lobe. Based on the histopathological and immunohistochemical findings, the liver lesion was shown to be a malignant glucagonoma with intrahepatic metastases. Since primary malignant hepatic glucagonoma has not been reported before, we present this extremely rare case of primary malignant glucagonoma of the liver.
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Affiliation(s)
- Naoko Obi
- Division of Metabolism and Endocrinology, St. Marianna University School of Medicine, Kanagawa, Japan
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Nishimori H, Tsuji K, Miyamoto N, Sakurai Y, Mitsui S, Kang JH, Yoshida M, Nomura M, Fuminori I, Ishiwatari H, Matsunaga T, Osanai M, Katanuma A, Takahashi K, Anbo Y, Masuda T, Kashimura N, Shinohara T, Maguchi H. Recurrence of primary hepatic carcinoid tumor in the remnant liver 13 yr after resection. ACTA ACUST UNITED AC 2005; 35:147-51. [PMID: 15879630 DOI: 10.1385/ijgc:35:2:147] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We report here a case of primary hepatic carcinoid tumor (PHCT) recurring in the remnant liver 13 yr and 10 mo after first resection. A 70-yr-old man developed four hypervascular tumors in the liver in December 2003. He had undergone curative left-lobe hepatectomy for PHCT in February 1990. Histopathological examination of the tumor biopsy specimen showed that the tumor was composed of uniform round-to-oval cells with solid arrangement and the tumor cells stained positive for chromogranin A, synaptophysin, and neuron-specific enolase. We diagnosed this case as an intrahepatic metastasis of PHCT with a long latency period, based on the fact that no primary site of carcinoid tumor could be found despite intensive examination and the immunohistochemical findings of the resected tumors were essentially same as those of PHCT in 1990. Although PHCT is reported to have a more favorable prognosis than other hepatic cancer or metastatic carcinoid tumor in the liver, long-term observation is recommended.
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Affiliation(s)
- Hiroyuki Nishimori
- Center for Gastroenterology, Teine Keijinkai Hospital, 1-12-1-40 Maeda, Teine-ku, Sapporo, 006-8555, Japan.
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Fenwick SW, Wyatt JI, Toogood GJ, Lodge JPA. Hepatic resection and transplantation for primary carcinoid tumors of the liver. Ann Surg 2004; 239:210-9. [PMID: 14745329 PMCID: PMC1356214 DOI: 10.1097/01.sla.0000109155.89514.42] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To discuss the diagnosis and management of primary carcinoid tumors of the liver in light of our experience and a literature review. SUMMARY BACKGROUND DATA Carcinoid tumors of the liver are rare and pose a diagnostic and management dilemma. This series is the largest reported and the only one to include liver transplantation as a treatment option. METHODS Between March 1994 and May 2002, we treated 8 patients (4 male, 4 female) with primary hepatic carcinoid tumors. Carcinoid syndrome complicated only 1 of the cases. Treatment was by liver resection in 6 patients and orthotopic liver transplantation in 2. RESULTS The diagnosis was confirmed histologically with light microscopy and immunohistochemistry in the absence of an alternative primary site. Six patients remain alive and disease free after follow-up of more than 3 years: 39, 43, 45, 50, 50, and 95 months. Two patients are recently postoperative. CONCLUSIONS Active exclusion of an extrahepatic primary site is essential for the diagnosis of primary carcinoid of the liver. The mainstay of treatment should be liver resection, although liver transplantation may be considered in patients with widespread hepatic involvement. A radical surgical approach is warranted as this disease carries a better prognosis than for other primary hepatic tumors and for secondary hepatic carcinoids.
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Affiliation(s)
- Stephen W Fenwick
- Hepatobiliary and Transplant Unit, St James's University Hospital, Leeds, UK
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Miura Y, Kuroda H, Kasai K, Kondo K, Yoshida T, Suzuki K, Sato S, Masuda T, Ueda S, Sakashita N, Abe T. Primary carcinoid tumor of the liver: A case report. J Med Ultrason (2001) 2002; 29:71-7. [PMID: 27277743 DOI: 10.1007/bf02481442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
A53-year-old woman was hospitalized with a hepatic tumor that had been detected on health-screening ultrasonography. Laboratory data showed no marked findings: HBs-Ag and HCV-Ab were negative, and levels of serum AFP, PIVKA-II, CEA, and CA 19-0 were within their normal ranges. Ultrasonogram showed a hyperechoic circle concentric with and inside of a hypoechoic mass in the right hepatic lobe. The tumor appeared isodense with the surrounding liver in unenhanced CT, but enhanced CT showed a low density mass. A celiac arteriogram revealed a hypervascular tumor. The resected tumor measured 20×15 mm. Microscopic findings showed a carcinoid tumor that was positive for Grimelius stain. Further examination of the lung, gastrointestinal tract, and other organs found no primary carcinoid tumor. The patient has been well and free from tumor of the liver or elsewhere for the 7 years since her operation. We therefore considered this lesion to have been a primary carcinoid tumor of the liver. Only 14 cases of this disease have ever been reported in Japan. This report includes a review of the literature on the imaging of this rare tumor.
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Affiliation(s)
- Yoshiaki Miura
- First Department of Internal Medicine, Iwate Medical University School of Medicine, 19-1 Uchimaru, 020-8505, Morioka, Japan
| | - Hidekatsu Kuroda
- First Department of Internal Medicine, Iwate Medical University School of Medicine, 19-1 Uchimaru, 020-8505, Morioka, Japan
| | - Kazuhiro Kasai
- First Department of Internal Medicine, Iwate Medical University School of Medicine, 19-1 Uchimaru, 020-8505, Morioka, Japan
| | - Koryo Kondo
- First Department of Internal Medicine, Iwate Medical University School of Medicine, 19-1 Uchimaru, 020-8505, Morioka, Japan
| | - Toshimi Yoshida
- First Department of Internal Medicine, Iwate Medical University School of Medicine, 19-1 Uchimaru, 020-8505, Morioka, Japan
| | - Kazuyuki Suzuki
- First Department of Internal Medicine, Iwate Medical University School of Medicine, 19-1 Uchimaru, 020-8505, Morioka, Japan
| | - Shunichi Sato
- First Department of Internal Medicine, Iwate Medical University School of Medicine, 19-1 Uchimaru, 020-8505, Morioka, Japan
| | - Tomoyuki Masuda
- Second Department of Pathology, Iwate Medical University School of Medicine, 19-1 Uchimaru, 020-8505, Morioka, Japan
| | - Shu Ueda
- First Department of Internal Medicine, Iwate Prefectural Fukuoka Hospital, 7-2 Ohata Horino, 028-6105, Ninohe, Japan
| | - Nobuo Sakashita
- Department of Surgery, Iwate Prefectural Ichinohe Hospital, 55 Mukai, 028-5300, ichinohe, Japan
| | - Tadashi Abe
- Department of Surgery, Iwate Prefectural Kuji Hospital, 10-1 Asahi, 028-8040, kuji, Japan
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Nemes B, Podder H, Járay J, Dabasi G, Lázár L, Schaff Z, Sótonyi P, Perner F. Primary hepatic carcinoid in a renal transplant patient. Pathol Oncol Res 2001; 5:67-9. [PMID: 10079384 DOI: 10.1053/paor.1999.0067] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
There seems to be a world-wide increase in the incidence of tumors among immunosuppressed patients. Of 1350 renal allografts transplanted in the past 23 years at the Department of Transplantation and Surgery, 56 cases were malignant tumors. The case of a 58-year-old female patient is reported, with disseminated primary carcinoid in the liver detected 86 days after renal transplantation. According to the literature only 39 patients with primary liver carcinoids have been reported until 1997, but this is the first where the carcinoid developed in an immunosuppressed patient. The rapid progression of the carcinoid could be associated with the immunosuppression.
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Affiliation(s)
- B Nemes
- Semmelweis University of Medicine, Department of Transplantation and Surgery, Budapest, Hungary.
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