A Case of Primary Hepatic Neuroendocrine Tumor and Literature Review

Primary hepatic neuroendocrine tumor with repeated diarrhea and flushing face: A case report and literature review

Introduction and importance

Primary hepatic neuroendocrine tumors (PHNET) are neuroendocrine tumors (NETs) originate from liver, they are rare kind of NETs, and only account for about 0.3 % of all NETs. The main symptom of PHNET is abdominal pain, diarrhea and flushing only account for about 7.2 % and 4.3 %, respectively. We report a PHNET patient with diarrhea and flushing face and review cases in the literature.

Case presentation

A 50-year-old male patient came to our hospital for repeated diarrhea and flushing face for more than 2 years. The patient was hepatitis B virus carrier. Contrast-enhanced computed tomographic scan of the abdomen showed multiple tumors in both right and left hepatic lobes. An ultrasound-guided percutaneous needle biopsy was performed. Pathological examination of the biopsy showed the neoplasm were consisted of cells having an eosinophilic cytoplasm and round to oval hyperchromatic nuclei, indicating adenocarcinoma. To further identify the nature of the masses, immunohistochemical examination was performed, the result was positive for β-catenin, Ber-EP4, CgA, CK19, Syn, Ki-67 (3 %). Finally, the patient accepted transcatheter arterial chemoembolization treatment, and his symptoms did not occur ever after.

Clinical discussion

PHNET is neuroendocrine tumor which originates from liver, it is a rare disease. The main clinical manifestation of PHNET is abdominal pain, in comparison, abdominal mass, weight loss, nausea, vomiting, diarrhea and flushing are relatively rare,In our case, the patient had repeated diarrhea, and his face turned blushing each time when diarrhea occurred. Fine needle aspiration biopsy guided by ultrasound was made, after immunohistochemical examinations, the patient was diagnosed PHNET. Treatments of PHNET include surgical resection, chemotherapy, TACE, percutaneous ethanol injection treatment (PEIT) and transplantation. The patient accepted TACE treatment, his diarrhea and blushing face were controlled.

Conclusion

We reported a PHNET patient who had symptoms of repeated diarrhea and flushing face, and accepted transcatheter arterial chemoembolization treatment. Transcatheter arterial chemoembolization is an effective treatment for PHNET patient with diarrhea.

Case Report: Primary hepatic neuroendocrine tumor: two cases report with literature review

Background & Aims

Primary hepatic neuroendocrine tumors (PHNETs) are rare malignant liver tumors that present diagnostic challenges owing to their rarity and absence of specific clinical features. This study aimed to investigate the characteristics of this rare liver tumor to enhance our understanding of the disease, improve diagnostic accuracy, and explore standardized diagnostic and treatment approaches.

Case description

During physical examination, two elderly women, aged 64 and 74 years, were found to have liver masses. 18F-FDG Positron Emission Tomography-Computed Tomography (18F-FDG PET-CT) and Ga68-DOTATATE PET-CT scans of both individuals revealed multiple liver masses that were initially suspected to be hepatic neuroendocrine tumors. Subsequent puncture pathology confirmed the diagnosis of neuroendocrine tumors. Furthermore, in Case 1, the tumor was also detected by 18F-FDG PET-CT in the lung, suggesting a metastatic tumor, in conjunction with liver immunohistochemistry and imaging findings. Laboratory tests revealed no significant abnormalities in liver function or autoimmune liver disease indicators, and there was no evidence of viral hepatitis infection. However, partial hepatectomy was not indicated for cases with distant metastasis or multiple space-occupying lesions. Individualized treatment approaches have been developed for such situations. A large portion of the tumor underwent Transarterial Embolization (TAE), and targeted combination chemotherapy or endocrine therapy was administered based on the pathological results. During regular follow-ups a 13 and 12 months, the tumor remained stable. The patients' quality of life was good, and their psychological well-being was healthy. They led active lifestyles, demonstrated a thorough understanding of their disease and its progression, and actively cooperated during the follow-up process.

Conclusion

Our findings suggest that a combination of serological, radiological, and immunohistochemical examinations can aid in the diagnosis of PHNET. In addition, we determined that TAE combined with drug therapy could be an effective method for controlling PHNET progression. Regular postoperative follow-ups are important for monitoring the prognosis and tumor progression status of patients with PHNET.

Cystic Primary Hepatic Neuroendocrine Tumor

Neuroendocrine tumors (NETs) can arise throughout the body. Most NETs in the liver are metastatic tumors; primary hepatic NET (PHNET) is extremely rare. A diagnosis of PHNET is very difficult. No single modality can diagnose PHNET by itself, and it often resembles other hypervascular masses of the liver. This paper reports the case of a 51-year old female with a large hepatic mass. Unlike most of PHNETs reported previously, it was composed of a solid mass with mainly multiple cystic lesions, which led to an erroneous diagnosis of hepatic mucinous cystadenoma or cystadenocarcinoma. PHNET with cystic lesions is extremely rare, and the features are not well studied. This case may help physicians suspect PHNET in a differential diagnosis of an atypical hepatic mass.

Primary hepatic neuroendocrine tumour with multiple liver metastases: A case report with literature review

INTRODUCTION AND IMPORTANCE

To describe an unusual case with a primary hepatic neuroendocrine tumour (PHNET) with multiple liver metastases.

CASE PRESENTATION

We reported a 65-year-old woman with PHNET with multiple liver metastases. She was highly suspected of having primary liver cancer with multiple intrahepatic metastases before liver biopsy, but was diagnosed with PHNET with multiple liver metastases after histopathology and immunohistochemistry (IHC) examinations. The patient successfully underwent three times of transcatheter arterial chemoembolization (TACE), and is currently living in a good state without related complications.

CLINICAL DISCUSSION

Neuroendocrine tumors (NETs), also known as carcinoids or argyrophilic tumors, are very rare malignant tumors. The liver is the main metastasis site of NETs, but primary hepatic neuroendocrine tumors (PHNETs) are extremely rare. Histopathology and immunohistochemistry (IHC) examinations are still the main methods used for diagnosing NETs. There are no treatment guidelines for PHNETs, and surgical resection is generally the preferred treatment. For PHNET patients who are not suitable for surgery, TACE has been proven to be an effective alternative treatment that can effectively reduce the tumour burden and relieve symptoms, but the current evidence is still limited.

CONCLUSION

The clinical diagnosis of PHNET still faces great challenges, imaging examinations often lead to misdiagnosis, and its diagnosis mainly depends on histopathology and immunohistochemical examinations. For PHNET patients who are not suitable for surgery, TACE may be an effective alternative therapy.