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Zolotov E, Sigal A, Hazaveh S, Patel V, Zhu H. Unusual Presentation of a Hepatic Neuroendocrine Tumor With Elevated CEA and CA 19-9: A Case Report. Cureus 2024; 16:e52858. [PMID: 38406105 PMCID: PMC10885841 DOI: 10.7759/cureus.52858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Abstract
Neuroendocrine tumors (NETs) of the gastrointestinal tract (GIT) are rare malignancies, which may have unique presentations. The diagnostic process predominantly relies on immunohistochemical analysis. While tumor markers are extensively utilized in diagnosing and monitoring GI malignancies, their specific role in NETs has not been fully explored. This case describes an 83-year-old male presenting with jaundice and general weakness. Diagnostic imaging through MRI and CT angiography (CTA) revealed a nodular texture on the liver's surface suggesting cirrhosis. The presence of elevated tumor markers, specifically carcinoembryonic antigen (CEA) and cancer antigen 19-9 (CA 19-9), raised suspicions of malignancy. A subsequent liver biopsy confirmed the diagnosis of small-cell high-grade neuroendocrine carcinoma accompanied by reactive fibrosis. As per our knowledge, this case is the first recorded instance of a liver neuroendocrine tumor (NET) exhibiting elevated levels of both CEA and CA 19-9, with no abnormalities detected in the gallbladder, biliary tree, and bowel in the MRI with magnetic resonance cholangiopancreatography (MRCP) and CTA. This is an atypical presentation of a liver NET, mimicking cirrhotic liver morphology, and underscores the potential diagnostic relevance of tumor markers CEA and CA 19-9 in such cases.
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Affiliation(s)
- Eli Zolotov
- Internal Medicine, Hackensack University Medical Center, Hackensack, USA
| | - Anat Sigal
- Pediatrics, Hackensack University Medical Center, Hackensack, USA
| | - Sara Hazaveh
- Internal Medicine, Hackensack University Medical Center, Hackensack, USA
| | - Vanisha Patel
- Internal Medicine, Hackensack University Medical Center, Hackensack, USA
| | - Hongfa Zhu
- Department of Pathology, Hackensack Pathology Associates, Hackensack, USA
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2
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Alghamdi HM. A rare primary hepatic neuroendocrine tumour with laparoscopic resection: a case report. J Med Case Rep 2023; 17:296. [PMID: 37386646 DOI: 10.1186/s13256-023-03993-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 05/21/2023] [Indexed: 07/01/2023] Open
Abstract
INTRODUCTION Primary hepatic neuroendocrine tumours (PHNETs) are a rare form of hepatic neoplasms, and it is difficult to differentiate them from common hepatic malignancies in routine imaging studies. PRESENTATION OF THE CASE We describe the case of a 60-year-old Indian male patient with a tentative preoperative diagnosis of hepatocellular carcinoma (HCC). Nevertheless, the definitive post-operative diagnosis was made by Histopathological and immunohistochemical assessment, which revealed a grade II neuroendocrine tumour (NET) of moderate differentiation. Surgical resection was performed through a minimally invasive approach with a favourable postoperative course and a short hospital stay. One-month Post-operative Octreotide scan showed no extrahepatic primary origin of the tumour. DISCUSSION PHNET is a rare entity, and multi modalities investigations, including imaging, serology, endoscopy series, and histopathology findings, aside from long-term follow-up to rule out another primary origin, are essential for the final diagnosis of PHNET. Surgical resection stands as the mainstay of treatment of PHNETs. CONCLUSION The absence of primary liver diseases should expand our possible differential diagnosis. Laparoscopic surgical resection of PHNETs carries a favourable outcome.
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Affiliation(s)
- Hanan M Alghamdi
- Department of Surgery, College of Medicine, Imam Abdulrahman Bin Faisal University, Al Khobar, Saudi Arabia.
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3
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Fernández-Ferreira R, Romero-López U, Robles-Aviña JA, Rivas-Mendoza UN, González-Camacho C, Valero-Gómez A, Barquet-Mata OA, Reyes-Gabiño A, Tovar-Figueroa KA, Ramírez-Villagrán V. Primary Hepatic Neuroendocrine Carcinoma with Metastasis to the Mesentery: A Case Report. Case Rep Oncol 2023; 16:681-697. [PMID: 37933308 PMCID: PMC10625823 DOI: 10.1159/000533199] [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: 06/08/2023] [Accepted: 07/10/2023] [Indexed: 11/08/2023] Open
Abstract
Primary hepatic neuroendocrine carcinomas (PHNECs) are extremely rare, with only about 90 cases having been reported in the English-language literature. Among all neuroendocrine neoplasms, primary hepatic neuroendocrine tumors (NETs) and neuroendocrine carcinomas (NECs) are extremely rare, accounting for 0.3% of NETs and 0.28-0.46% of malignant liver tumors. Additionally, primary hepatic NECs occur infrequently. The clinical diagnosis of primary hepatic NEC remains challenging because of its rarity and the lack of information about its characteristic appearance on images. Consequently, pathological examination through the performance of a preoperative liver tumor biopsy is essential for diagnosis. Due to the lack of availability of substantial high-quality data, there is no standard therapy for primary hepatic NEC. We present the first case of PHNEC metastasized to the mesentery reported in the English-language literature.
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Affiliation(s)
- Ricardo Fernández-Ferreira
- Oncology Medicine and Surgical Oncology Department. Central South High Specialty Hospital PEMEX, Mexico City, Mexico
- Oncology Medicine and Surgical Oncology Department. Tlahuac General Hospital Dr. Matilde Petra Montoya Lafragua, Mexico City, Mexico
| | - Ulises Romero-López
- Faculty of Medicine. University of Veracruz. Minatitlan Campus. Heroica Veracruz, Mexico
| | - Jorge Alberto Robles-Aviña
- Oncology Medicine and Surgical Oncology Department. Central South High Specialty Hospital PEMEX, Mexico City, Mexico
| | - Uriel Norberto Rivas-Mendoza
- Oncology Medicine and Surgical Oncology Department. Tlahuac General Hospital Dr. Matilde Petra Montoya Lafragua, Mexico City, Mexico
| | - Casandra González-Camacho
- Imagenology Department, Tlahuac General Hospital Dr. Matilde Petra Montoya Lafragua, Mexico City, Mexico
| | - Alfredo Valero-Gómez
- Patology Department, Tlahuac General Hospital Dr. Matilde Petra Montoya Lafragua, Mexico City, Mexico
| | - Omar Armando Barquet-Mata
- Oncology Medicine and Surgical Oncology Department. Tlahuac General Hospital Dr. Matilde Petra Montoya Lafragua, Mexico City, Mexico
| | - Almira Reyes-Gabiño
- Oncology Medicine and Surgical Oncology Department. Tlahuac General Hospital Dr. Matilde Petra Montoya Lafragua, Mexico City, Mexico
| | - Karen Analí Tovar-Figueroa
- Oncology Medicine and Surgical Oncology Department. Tlahuac General Hospital Dr. Matilde Petra Montoya Lafragua, Mexico City, Mexico
| | - Viridiana Ramírez-Villagrán
- Oncology Medicine and Surgical Oncology Department. Tlahuac General Hospital Dr. Matilde Petra Montoya Lafragua, Mexico City, Mexico
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Huang K, Lan Z, Chen W, Zhang J, Wang J, Zhu H, Xu B, Zhang L, Lu T, Guo Y, Wen Z. Hepatectomy and pneumectomy combined with targeted therapy for primary hepatic neuroendocrine carcinoma: Case report and review of the literature. Front Surg 2022; 9:920276. [PMID: 35910478 PMCID: PMC9334775 DOI: 10.3389/fsurg.2022.920276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
Primary hepatic neuroendocrine carcinoma (PHNEC) manifests as a rare type of liver tumor. PHNEC is not specifically clinical or radiographical and is often misdiagnosed and mistreated. Here, we present a case report of PHNEC in a 50-year-old woman who was admitted to our department with concealed pain in the right upper abdomen. The initial diagnosis was a probable hepatic space-occupying lesion with tumor bleeding. The patient was subjected to a partial right hemihepatectomy, cholecystectomy, partial resection of the lower lobe of the right lung, partial resection of the diaphragm, and resection of the right perirenal fat sac to alleviate her symptoms. After surgery, gene sequencing was performed to determine the possible cause of the condition. However, five months after discharge, the patient was hospitalized again because of retroperitoneal and peritoneal multiple metastases. Nine months after surgery, the patient died. This case is likely to aid in furthering our understanding of PHNEC to improve the future diagnosis and treatment of this disease.
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Affiliation(s)
- Keyu Huang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhujing Lan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Weitao Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jianyong Zhang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jilong Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hai Zhu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Banghao Xu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ling Zhang
- Department of Radiology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Tingting Lu
- Department of Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Ya Guo
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhang Wen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Correspondence: Zhang Wen
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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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Song S, Koh Y. Primary Hepatic Neuroendocrine Tumor Arising at a Young Age: Rare Case Report and Literature Review. THE KOREAN JOURNAL OF GASTROENTEROLOGY = TAEHAN SOHWAGI HAKHOE CHI 2022; 79:35-40. [PMID: 35086971 DOI: 10.4166/kjg.2021.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 02/05/2023]
Abstract
Neuroendocrine tumors (NETs) are low-grade malignancies arising from neuroendocrine cells. Primary hepatic neuroendocrine tumors (PHNETs) are extremely rare and difficult to differentiate from other liver tumors, such as hepatocellular carcinoma (HCC) or cholangiocarcinoma. A 22-year-old male presented with intermittent abdominal pain. A preoperative imaging study revealed a 5.1cm-sized heterogeneously enhancing mass in S6 of the liver, suggesting HCC. Laparoscopic right hepatectomy was performed, and a well-demarcated brown solid mass was found. The pathology report revealed a neuroendocrine tumor of the liver. 18F-fluorodeoxyglucose-positron emission tomography/computed tomography was performed postoperatively to exclude extrahepatic lesions, and no lesions were found. This is a rare case of PHNET that developed at a young age and was misdiagnosed as HCC preoperatively. This suggests that PHNET should be considered one of the differential diagnoses when a non-specific enhanced hepatic tumor is found, even when the patient is young.
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Affiliation(s)
- Sanghwa Song
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
| | - Yangseok Koh
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, Korea
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Feng J, Zhu R, Yin Y, Wang S, Zhou L, Lv F, Zhao D. Re-Recognizing the Cellular Origin of the Primary Epithelial Tumors of the Liver. J Hepatocell Carcinoma 2021; 8:1537-1563. [PMID: 34917552 PMCID: PMC8668194 DOI: 10.2147/jhc.s334935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/25/2021] [Indexed: 11/29/2022] Open
Abstract
The primary epithelial tumors of the liver (PETL) are composed of a series of heterogeneous tumors. Although the classification of PETLs has been updated several times by the World Health Organization, the cellular origins of some tumors in this family remain to be precisely depicted. In addition, certain tumors in different categories have similar histology, molecular phenotypes and biological characteristics, suggesting that they may have the same cellular origin. In this work, a narrative review method was adopted to review the relevant papers. By comparing the expression profiles of biomarkers of liver epithelium at different lineages and stages of differentiation, the cells-of-origin of some major members of the PETL family were reassessed. We propose that 1) hepatic adenomas, hepatocellular carcinomas (HCCs) and pure fetal hepatoblastomas (HBs) share the same spectrum in their cellular origin including the hepatocytic-committed progenitors (HCP) and their differentiated descendants. 2) Bile duct adenomas, peribiliary cysts and intrahepatic cholangiocellular carcinomas (ICCs) can share the same spectrum in their cellular origin including the cholangiocytic-committed progenitors (CCP) and their differentiated descendants. 3) The cells-of-origin of embryonal HBs include liver stem cells (LSCs), hepatoblasts, and transitional cells between them. Embryonal HB with small cell element, small cell undifferentiated HB and small cell neuroendocrine carcinoma of the liver can have the same or similar cells-of-origin from LSC. Embryonal HB lacking the small cell component of the LSC phenotype and presenting both hepatocytic and bile duct/ductule components may originate from actual hepatoblasts/hepatic progenitor cells (HPCs) as the combined HCC-ICC does. 4) Teratoid hepatoblastoma and mixed epithelial/mesenchymal HBs can be derived from the LSCs or even less committed extrahepatic pluripotent stem cell. 5) Many members of the PETLs family, including those derived from LSCs, hepatoblasts/HPCs, early HCPs and CCPs, have neuroendocrine potentiality. Except for those primary hepatic neuroendocrine tumor (PHNET) exhibit hepatocytic and/or cholangiocytic phenotypes, other PHNETs subtype may be derived from the descendants of LSC that differentiate towards the upper digestive tract, pancreas or other lineages.
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Affiliation(s)
- Jiliang Feng
- Clinical-Pathology Center, Beijing You-An Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
- Correspondence: Jiliang Feng Clinical-Pathology Center, Beijing You-An Hospital, Capital Medical University, No. 8, Xitoutiao, Youanmenwai Street, FengTai District, Beijing, 100069, People’s Republic of ChinaTel +86-10-83997342Fax +86-10-83997343 Email
| | - Ruidong Zhu
- General Surgical Center, Beijing You-An Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Yu Yin
- Department of Pathology, Anhui Medical University, Hefei, 230032, People’s Republic of China
| | - Shanshan Wang
- Clinical-Pathology Center, Beijing You-An Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Lei Zhou
- Department of Pathology, First Affiliated Hospital of Bengbu Medical College/Bengbu Medical College, Bengbu, 233004, People’s Republic of China
| | - Fudong Lv
- Clinical-Pathology Center, Beijing You-An Hospital, Capital Medical University, Beijing, 100069, People’s Republic of China
| | - Dawei Zhao
- Department of Medical Imaging, Capital Medical University, Beijing, 100069, People’s Republic of China
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Seki Y, Sakata H, Uekusa T, Momose H, Yoneyama S, Hidemura A, Tajima Y, Suzuki H, Ishimaru M. Primary hepatic neuroendocrine carcinoma diagnosed by needle biopsy: a case report. Surg Case Rep 2021; 7:236. [PMID: 34727269 PMCID: PMC8563892 DOI: 10.1186/s40792-021-01315-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 10/19/2021] [Indexed: 12/18/2022] Open
Abstract
Background Primary hepatic neuroendocrine carcinomas (NECs) are extremely rare. The rate of recurrence after resection is extremely high, and the prognosis is poor. It is debatable whether chemotherapy or surgical resection is the optimal initial treatment for primary hepatic NECs. Therefore, selecting an appropriate therapeutic approach for patients with primary hepatic NECs remains clinically challenging. We present a case of primary hepatic NEC in a patient who developed recurrence after undergoing surgical resection. Case presentation A 78-year-old man with bone metastases of prostate cancer was referred to our department because of a solitary 66-mm tumor in the left lateral segment of the liver, which was detected on annual follow-up by computed tomography after prostate resection. A biopsy and preoperative diagnostic workup identified the lesion as a primary hepatic neuroendocrine carcinoma; therefore, left lateral segmentectomy was performed. Immunohistochemically, the tumor was positive for chromogranin A, synaptophysin, and CD 56, and the Ki-67 index was 40%. This neuroendocrine carcinoma was classified as a large cell type. Adjuvant chemotherapy with carboplatin + etoposide was initially administered a month after surgery. However, lymph node recurrence occurred 4 months after surgery, and the patient died of systemic metastases 15 months after surgical resection. Conclusions Due to the lack of availability of abundant quantities of relevant, high-quality data, there is no standard therapy for primary hepatic NECs. Selecting the most appropriate treatment for patients depending on several factors, such as the stage and differentiation of a tumor and a patient’s performance status and clinical course, is consequently preferred. More cases need to be studied to establish the best treatment strategy for primary hepatic NEC.
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Affiliation(s)
- Yusuke Seki
- Department of Surgery, Kanto Rosai Hospital, 1-1 Kizukisumiyoshicho, Nakahara-ku, Kanagawa, 211-8510, Japan.
| | - Hiroki Sakata
- Department of Surgery, Kanto Rosai Hospital, 1-1 Kizukisumiyoshicho, Nakahara-ku, Kanagawa, 211-8510, Japan
| | - Toshimasa Uekusa
- Department of Pathology, Kanto Rosai Hospital, 1-1 Kizukisumiyoshicho, Nakahara-ku, Kanagawa, 211-8510, Japan
| | - Hirokazu Momose
- Department of Hepato-Biliary-Pancreatic Surgery, Kyorin University Hospital, 6-20-2 Shinkawa, Mitaka City, Tokyo, 181-8611, Japan
| | - Satomi Yoneyama
- Department of Surgery, Kanto Rosai Hospital, 1-1 Kizukisumiyoshicho, Nakahara-ku, Kanagawa, 211-8510, Japan
| | - Akio Hidemura
- Department of Surgery, Kanto Rosai Hospital, 1-1 Kizukisumiyoshicho, Nakahara-ku, Kanagawa, 211-8510, Japan
| | - Yusuke Tajima
- Department of Surgery, Kanto Rosai Hospital, 1-1 Kizukisumiyoshicho, Nakahara-ku, Kanagawa, 211-8510, Japan
| | - Hiroyuki Suzuki
- Department of Surgery, Kanto Rosai Hospital, 1-1 Kizukisumiyoshicho, Nakahara-ku, Kanagawa, 211-8510, Japan
| | - Masahiro Ishimaru
- Department of Surgery, Kanto Rosai Hospital, 1-1 Kizukisumiyoshicho, Nakahara-ku, Kanagawa, 211-8510, Japan
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Khan J, Jingmei L. Primary Neuroendocrine Tumor of the Liver With Papillary Features in a Multivisceral Transplant Patient. Cureus 2021; 13:e17394. [PMID: 34584804 PMCID: PMC8457678 DOI: 10.7759/cureus.17394] [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] [Accepted: 08/23/2021] [Indexed: 11/05/2022] Open
Abstract
Primary neuroendocrine tumors (NETs) of the liver are rare and difficult to distinguish from other liver tumors such as cholangiocarcinoma and hepatocellular carcinoma. The patient was initially diagnosed with a NET of the liver in 2007. However, the origin of the cancer was not clear, that is, whether it was primary or originated from the gastrointestinal tract. Although the patient underwent partial hepatectomy, he suffered hepatic artery injury, resulting in biliary strictures. The patient eventually became untreatable and developed cirrhosis, a frozen abdomen. He received multivisceral transplantation in May 2019 and received the liver, duodenal-pancreatic complex, spleen, small bowel, and right colon. After the transplantation, the patient did well overall. More recently, he presented with food poisoning and underwent evaluation, and was found to have a mass in the liver. The liver mass was biopsied and revealed a poorly differentiated primary NET (grade 2) with ciliated papillary structures.
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Affiliation(s)
- Jaffar Khan
- Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, USA
| | - Lin Jingmei
- Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, USA
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Bansal N, Satapathy B. Primary multifocal cystic signet ring neuroendocrine tumor of liver: a case report. JOURNAL OF LIVER CANCER 2021; 21:187-193. [PMID: 37383080 PMCID: PMC10035681 DOI: 10.17998/jlc.2021.09.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/11/2021] [Accepted: 09/17/2021] [Indexed: 06/30/2023]
Abstract
Primary signet ring neuroendocrine tumors of the liver are extremely rare tumors. Morphologically, they mimic signet ring cell adenocarcinomas; however, the absence of mucin by special stains and the expression of neuroendocrine markers help to diagnose these tumors. We herein report a case of a 47-year-old female who presented with multiple solid and cystic lesions in both liver lobes, which were initially suggested to be biliary cystadenocarcinoma on imaging. Liver biopsy of the lesion revealed the presence of a signet ring neoplasm with diffuse expression of synaptophysin and pan-cytokeratin. The case was subsequently diagnosed as a primary hepatic signet ring neuroendocrine tumor. The patient was offered 3 cycles of chemotherapy and is well preserved after 14 months of diagnosis. Although this is an extremely rare entity, its possibility should be considered in the differential diagnosis of neoplasms characterized by signet ring cell morphology.
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Affiliation(s)
- Nalini Bansal
- Department of Histopathology, SRL Ltd., Fortis Escorts Heart Institute, New Delhi
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Tuan Linh L, Minh Duc N, Tu Minh H, Ngoc Cuong N, Thu Ha V, Luan DT, Tra My TT, Van Lenh B. Primary hepatic neuroendocrine tumor. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM200220. [PMID: 34152286 PMCID: PMC8240714 DOI: 10.1530/edm-20-0220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 05/13/2021] [Indexed: 12/15/2022] Open
Abstract
SUMMARY Primary hepatic neuroendocrine tumor (PHNET) is a rare type of neuroendocrine tumor (NET) that is also a primary hepatic tumor. Patients are present with almost no specific clinical symptoms and typically present with negative test results and atypical imaging characteristics; therefore, the differentiation of PHNET from other types of primary hepatic masses can be very difficult. In this article, we describe a case of PHNET that mimicked a liver helminth infection in a 57-year-old man. The diagnosis of PHNET in this patient was challenging, and the final diagnosis was based on imaging, histopathology features, and long-term follow-up. LEARNING POINTS An uncommon type of neuroendocrine tumor (NET) is a primary hepatic neuroendocrine tumor (PHNET). Primary hepatic neuroendocrine tumors are rare NET lesions found in the liver, characterized by non-specific clinical and imaging results, which can be easily confused with other liver lesions, including HCC and parasitic lesions. To have a conclusive diagnosis and classification, a mixture of many medical assessment techniques, such as imaging, gastrointestinal endoscopy, nuclear medicine, anatomy, including histopathology, and immunohistochemistry, is essential.
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Affiliation(s)
- Le Tuan Linh
- Department of Radiology, Hanoi Medical University Hospital, Hanoi, Vietnam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh city, Vietnam
- Department of Radiology, Childrent's Hospital 2, Ho Chi Minh city, Vietnam
| | - Hoang Tu Minh
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Nguyen Ngoc Cuong
- Department of Radiology, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Vuong Thu Ha
- Department of Radiology, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Dao-Thi Luan
- Department of Pathology, Hanoi Medical University Hospital, Hanoi, Vietnam
| | - Thieu-Thi Tra My
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
| | - Bui Van Lenh
- Department of Radiology, Hanoi Medical University Hospital, Hanoi, Vietnam
- Department of Radiology, Hanoi Medical University, Hanoi, Vietnam
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12
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Zhang Z, Zhao X, Li Z, Wu Y, Liu Y, Li Z, Li G. Development of a nomogram model to predict survival outcomes in patients with primary hepatic neuroendocrine tumors based on SEER database. BMC Cancer 2021; 21:567. [PMID: 34006241 PMCID: PMC8130428 DOI: 10.1186/s12885-021-08337-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/30/2021] [Indexed: 12/15/2022] Open
Abstract
Background Primary hepatic neuroendocrine tumors (PH-NETs) are extremely rare and unknown. Because of its rarity, its prognosis features and influencing factors are not well established. Methods Data of 140 patients with PH-NETs diagnosed in the SEER database from 1975 to 2016 were collected. The demographics and clinic-pathological features were described. By using propensity-score matching (PSM) analysis, three associated cohorts were selected to describe the malignancy of PH-NETs and univariate analysis was conducted. Then, multivariate Cox analyses were performed and a predicting nomograph was constructed. C-index, receiver operating characteristic (ROC) curve and calibration curves were used to evaluate the predictive value of nomogram. Results The overall survival outcomes of PH-NETs were superior to hepatocellular carcinoma (HCC) with a mean survival time 30.64 vs 25.11 months (p = 0.052), but inferior to gastrointestinal tract neuroendocrine tumors in situ (GI-NETs in situ) with a mean survival time 30.64 vs 41.62 months (p = 0.017). With reference to gastrointestinal neuroendocrine tumors with liver metastasis (GI-NETs-LM), GI-NETs-LM had better outcomes in short time (1-year survival rate: 64.75% vs 56.43%) but was worse in long time (5-year survival rate: 8. 63% vs 18.57%). Multivariate Cox analyses showed that tumor grade and surgery were two independent factors for prognosis of the patients (p < 0.00). Tumor grade and surgery were used to construct the predicting nomogram. The C-index was 0.79 (95%CI = 0.75–0.83). The area under curve (AUC) values in ROC were 0.868 in 1-year and 0.917 in 3-year survival and the calibration curves showed good consistency. Conclusions The overall prognosis PH-NETs is generally favorable, better than HCC and GI-NETs-LM in long term. Preoperative biopsy and complete pathological diagnosis were recommended. Radical surgical intervention including transplantation was the first choice in PH-NETs therapy. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08337-y.
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Affiliation(s)
- Ziteng Zhang
- Department of Hepato-Biliary Surgery, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Xin Zhao
- Department of Hepato-Biliary Surgery, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Zhiyan Li
- Department of Ultrasonography, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Youchun Wu
- Department of Hepato-Biliary Surgery, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Yao Liu
- Department of Hepatology, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
| | - Zhiwei Li
- Department of Hepato-Biliary Surgery, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518055, China.
| | - Guobao Li
- Department of Lung Disease, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, 518055, China.
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A case of laparoscopic hepatectomy for a primary hepatic neuroendocrine tumor. Clin J Gastroenterol 2021; 14:876-880. [PMID: 33991322 DOI: 10.1007/s12328-021-01403-9] [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: 01/14/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
Neuroendocrine tumors (NETs) account for approximately 1-2% of all gastrointestinal tumors. In particular, primary hepatic NETs (PHNETs) are extremely rare. A 42-year-old female patient was given a diagnosis of liver tumor after a medical check-up with ultrasonography. An enhanced CT scan and MRI were suggestive for a hepatic hemangioma or adenoma, but the possibility of hepatocellular carcinoma could not be denied. Moreover, this tumor grew larger, so we performed a laparoscopic partial hepatectomy for the diagnosis and treatment of the patient. Pathological examination revealed that the tumor cells were spindle-shaped, forming glandular-tubular structures, and had less visible nucleoli and increased mitotic figures on H&E staining. Immunohistochemical findings indicated that CK19, MOC-31, CD56, synaptophysin, and chromogranin A were positive; CK7, AFP, and glypican-3 were negative; and the Ki-67 index was 3.6%, so the final diagnosis was a PHNET G2. PHNETs differ from other NETs, as they do not produce biologically active polypeptides or amines. As a result, there are no manifestations of carcinoid syndrome. In addition, PHNETs grow slowly, and most patients show no symptoms in the early stages. Laparoscopic hepatectomy is a very useful procedure for diagnosis and treatment in such cases and can be performed safely.
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14
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Wong PC, She WH, Khoo US, Cheung TT. A Case of Primary Hepatic Neuroendocrine Tumor and Literature Review. Case Rep Oncol 2021; 14:90-97. [PMID: 33776688 PMCID: PMC7983612 DOI: 10.1159/000510935] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 08/11/2020] [Indexed: 12/03/2022] Open
Abstract
We report an unusual presentation of primary hepatic neuroendocrine tumor which was initially misdiagnosed as intrahepatic cholangiocarcinoma. The diagnosis was only revealed after a major liver resection by histopathology. With adjuvant lanreotide injection, the patient survived for more than 16 months after the operation without tumor recurrence. Diagnosis of this rare tumor has been a major challenge and we emphasize the importance of a preoperative diagnosis. Surgical resection remains the mainstay for curative treatment, while peptide receptor radionuclide therapy is an emerging treatment option which has provided promising results.
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Affiliation(s)
- Pak Chiu Wong
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Wong Hoi She
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Ui Soon Khoo
- Department of Pathology, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Tan To Cheung
- Department of Surgery, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
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15
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Li YF, Zhang QQ, Wang WL. Clinicopathological Characteristics and Survival Outcomes of Primary Hepatic Neuroendocrine Tumor: A Surveillance, Epidemiology, and End Results (SEER) Population-Based Study. Med Sci Monit 2020; 26:e923375. [PMID: 32651994 PMCID: PMC7370587 DOI: 10.12659/msm.923375] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary hepatic neuroendocrine tumor (PHNET) is a rare primary liver tumor that remains poorly understood. Here, we explored the clinicopathological characteristics and survival outcomes of PHNET patients. MATERIAL AND METHODS PHNET patients diagnosed between 1988 and 2015 in the Surveillance, Epidemiology, and End Results (SEER) database were enrolled in the cohort. Kaplan-Meier analysis was used to determine the survival outcomes. Multivariable Cox regression models were used to identify the risk factors for overall survival (OS) and disease-specific survival (DSS). RESULTS A total of 291 PHNET patients from the SEER database met the inclusion criteria for analysis. The majority of the patients were female (53.6%), white (77.7%), and married (49.5%). The 1-, 3-, and 5-year OS were 57.1%, 39.4%, and 30.2%, and the 1-, 3-, and 5-year DSS rates were 61.3%, 44.3%, and 36.7%, respectively. Multivariate Cox regression models showed that older age, unmarried status, poor differentiated grade, and no tumor-directed surgery were independent risk factors for poor OS and DSS. CONCLUSIONS Older age, unmarried status, poor differentiated grade, and no tumor-directed surgery were associated with poorer prognosis of PHNET. Surgical resection is an effective and reliable treatment method for patients with PHNET.
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Affiliation(s)
- Yu-Feng Li
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland).,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang, China (mainland)
| | - Qiu-Qiang Zhang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland).,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang, China (mainland)
| | - Wei-Lin Wang
- Department of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China (mainland).,Key Laboratory of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Tumor of Zhejiang Province, Hangzhou, Zhejiang, China (mainland).,Clinical Medicine Innovation Center of Precision Diagnosis and Treatment for Hepatobiliary and Pancreatic Disease of Zhejiang University, Hangzhou, Zhejiang, China (mainland).,Clinical Research Center of Hepatobiliary and Pancreatic Diseases of Zhejiang Province, Hangzhou, Zhejiang, China (mainland)
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16
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Kumar A, Kalonia T, Bharati V, Gupta A. Primary neuroendocrine tumor of liver: An eye opener for a pathologist. J Family Med Prim Care 2020; 9:3151-3153. [PMID: 32984189 PMCID: PMC7491825 DOI: 10.4103/jfmpc.jfmpc_224_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 03/13/2020] [Accepted: 03/26/2020] [Indexed: 12/24/2022] Open
Abstract
Introduction: Neuroendocrine tumors (NETs) are neoplasms that arise from cells of the endocrine (hormonal) and nervous systems. Many are benign, while some are malignant. They most commonly occur in the intestine. While the liver is a common site of metastases. Case Presentation: We describe a 73-year-old female who reported to our center with complains of swelling and pain in the right upper quadrant of stomach. CECT revealed large well-localized multicystic mass in the right lobe of the liver. A suspicion of hydatid cyst was given. However, immunogenic tests results were negative for hydatid cyst. The AFP level was also unremarkable. Conclusion: Histopathological examination with immunohistochemical panel along with other serological and radiological investigations made the diagnosis possible due to its vague clinical presentation.
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Affiliation(s)
- Arvind Kumar
- Department of Pathology, AIIMS, Rishikesh, Uttarakhand, India
| | - Tushar Kalonia
- Department of Pathology, AIIMS, Rishikesh, Uttarakhand, India
| | - Vandna Bharati
- Department of Pathology, AIIMS, Rishikesh, Uttarakhand, India
| | - Amit Gupta
- Department of General Surgery, AIIMS, Rishikesh, Uttarakhand, India
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17
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Houat ADP, von Atzingen AC, Velloni FG, de Oliveira RAS, Torres UDS, D'Ippolito G. Hepatic neuroendocrine neoplasm: imaging patterns. Radiol Bras 2020; 53:195-200. [PMID: 32587429 PMCID: PMC7302895 DOI: 10.1590/0100-3984.2019.0038] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumors with distinct morphological and biological manifestations, the liver being the main organ affected by its metastases. However, primary hepatic involvement is quite rare. Hepatic NENs can have a variety of radiological presentation forms and can therefore mimic other lesions, making their diagnosis challenging. Nonetheless, certain imaging aspects allow NENs to be included among the main differential diagnoses of hepatic lesions and can guide the search for an extrahepatic primary site when the probable diagnosis is metastases.
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Affiliation(s)
- Abdallah de Paula Houat
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | | | | | | | | | - Giuseppe D'Ippolito
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
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18
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Costa AC, Santa-Cruz F, Guimarães H, Paz AR, Costa EAC, Figueiredo JL, Ferraz ÁAB. Primary hepatic neuroendocrine tumor: A case report and literature review. Int J Surg Case Rep 2020; 72:1-4. [PMID: 32506020 PMCID: PMC7276381 DOI: 10.1016/j.ijscr.2020.05.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 12/25/2022] Open
Abstract
Primary hepatic neuroendocrine tumors are rare neoplasms, with less than 200 cases reported. The clinical presentation of PHNETs is non-specific and its radiologic features are intensely diversified. Surgical resection with clear margins is the mainstay treatment for PHNETs, with very positive results. For unresectable tumors, liver transplantation and transcatheter arterial chemoembolization are the main options.
Introduction Primary hepatic neuroendocrine tumors (PHNETs) are extremely rare, having less than 200 cases reported in the literature. Presentation of case A 51-year-old woman presenting with mild intensity sharp pain in the upper abdomen that started 4 years ago. Preoperative Magnetic Resonance Imaging (MRI) suggested hepatocellular adenoma. Surgical exploration found a tumor occupying the whole segment IV of the liver, therefore a left hepatectomy was performed. Pathology and immunohistochemistry indicated to be a low-grade neuroendocrine tumor of the liver. The patient is enjoying a good quality of life, free of disease, presenting no signs of recurrence nor metastases 12 months after the procedure. Conclusion The clinical presentation of PHNETs is non-specific and its radiologic features are intensely diversified, frequently leading to misdiagnosis of other hepatic neoplasms.
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Affiliation(s)
- Adriano C Costa
- Oncological Surgery Unit, Napoleão Laureano Hospital, João Pessoa, PB, Brazil; Department of Surgery, Federal University of Pernambuco, Recife, PE, Brazil.
| | | | - Henrique Guimarães
- School of Medicine, Federal University of Pernambuco, Recife, PE, Brazil.
| | - Alexandre R Paz
- Department of Pathology, Napoleão Laureano Hospital, João Pessoa, PB, Brazil.
| | - Eduardo A C Costa
- Department of Radiology, Napoleão Laureano Hospital, João Pessoa, PB, Brazil.
| | | | - Álvaro A B Ferraz
- Department of Surgery, Federal University of Pernambuco, Recife, PE, Brazil.
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19
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Li Z, Yong CC, Chen CL. A primary hepatic neuroendocrine tumor disguised as hepatocellular carcinoma. Hepatobiliary Surg Nutr 2020; 9:263-266. [PMID: 32355699 DOI: 10.21037/hbsn.2020.01.02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Zhihao Li
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung
| | - Chee-Chien Yong
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung
| | - Chao-Long Chen
- Liver Transplantation Center, Department of Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung
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20
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Norton JA, Foster DS, Blumgart LH, Poultsides GA, Visser BC, Fraker DL, Alexander HR, Jensen RT. Incidence and Prognosis of Primary Gastrinomas in the Hepatobiliary Tract. JAMA Surg 2019; 153:e175083. [PMID: 29365025 DOI: 10.1001/jamasurg.2017.5083] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Deshka S. Foster
- Department of Surgery, Stanford University, Stanford, California
| | - Leslie H. Blumgart
- Department of Surgery, Memorial Sloan Kettering Cancer Institute, New York, New York
| | | | | | | | | | - Robert T. Jensen
- Digestive Diseases Branch, National Institute of Arthritis, Diabetes, Digestive and Kidney Diseases, Bethesda, Maryland
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21
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Chen N, Slater K. Primary hepatic neuroendocrine tumours-Case series of a rare malignancy. Int J Surg Case Rep 2019; 55:145-148. [PMID: 30731302 PMCID: PMC6365392 DOI: 10.1016/j.ijscr.2019.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/22/2019] [Indexed: 02/07/2023] Open
Abstract
Primary hepatic neuroendocrine tumours are rare. Liver enzymes and tumour markers are often normal. Radiological imaging may mimic other hypervascular liver tumours. Surgical resection is the only curative treatment for localised disease.
Introduction Primary hepatic neuroendocrine tumours (PHNET) were first described by Edmondson et al. in 1958 and are rare, accounting for only 0.3% of all neuroendocrine tumours. Only several hundred cases have been reported. Presentation of case We present two cases. The first is a 65-year-old asymptomatic male referred with a liver lesion on ultrasound performed to investigate a mildly elevated Alanine Aminotransferase (ALT). Hepatitis serology and tumour markers were normal. He had an unremarkable colonoscopy and gastroscopy. CT and MRI revealed a single liver lesion adjacent to the gallbladder suspicious for malignancy. He underwent a segment IVb/V liver resection. Histology was consistent with a 65 mm grade 2 PHNET. Subsequent Dotatate PET/CT scans have been normal at 5 years. The second is an asymptomatic 73-year-old male referred with fluctuating hepatic enzymes and a history of alcohol overuse. Imaging revealed a suspicious lesion in segment III of the liver. He underwent a left lateral liver resection. Histology revealed an 18 mm grade 1 PHNET. A subsequent Dotatate PET/CT was normal with no new disease at six months. Discussion PHNET, albeit rare are in the differential diagnosis for primary hepatic malignancies. Tumour markers are usually normal and radiological imaging can mimic other hypervascular hepatic tumours. Surgery is the only curative treatment for localised disease to date. Conclusion PHNET needs to be considered in asymptomatic patients with hypervascular hepatic lesions. More research is required before other adjunct treatment options can be suggested.
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Affiliation(s)
- Nelson Chen
- Department of Hepatobiliary and Pancreatic Surgery, Princess Alexandra Hospital, 199 Ipswich Road, Woolloongabba, Queensland, 4102, Australia; University of Queensland, Australia.
| | - Kellee Slater
- Department of Hepatobiliary and Pancreatic Surgery, Greenslopes Private Hospital, Newdegate Street, Greenslopes, Queensland, 4102, Australia.
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22
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The Outcome of Primary Hepatic Neuroendocrine Tumors: A Single-Center Experience. J Clin Exp Hepatol 2019; 9:710-715. [PMID: 31889752 PMCID: PMC6926228 DOI: 10.1016/j.jceh.2019.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 08/05/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Primary hepatic neuroendocrine tumor is an extremely rare entity. Only case reports are available in the literature. The aim of the study was to analyze the symptoms, diagnosis, management, and the outcome of patients with primary liver neuroendocrine tumors. METHODS In the study, a total of eight patients were diagnosed with primary liver neuroendocrine tumors between 2001 and 2017 in our center. Data were analyzed from the records available including the presentation, diagnosis, treatment received, and follow-up. RESULTS Of eight patients, five were males and three were females. The age of presentation was between 35 and 70 years. Two patients had pain in the right side of the abdomen, while it was accidentally detected in two patients in routine checkup. One patient presented with carcinoid syndrome, while two had ascites and one patient presented only with loose motions. Of eight patients, two patients with poorly differentiated neuroendocrine tumor died within 1 month of follow-up. Four patients are still being followed up, while 10-12 years of follow-up data are available for the remaining two patients. Four patients underwent surgery, and three patients received Sandostatin LAR for tumor recurrence after procedure. Transarterial chemoembolization (TACE) of the tumor was performed in two patients for whom resection was not possible. CONCLUSIONS Our data suggest that the prognosis of the tumor seems favorable. Surgical resection is the curative treatment. TACE is a favorable option in unresectable tumors.
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Key Words
- CK 7, Cytokeratin 7
- CT, Computed tomography
- CgA, Chromogranin A
- HIAA, Hydroxyindoleacetic acid
- MRI, Magnetic resonance imaging
- NET, Neuroendocrine tumor
- NSE, Neuron-specific enolase
- PHNET, Primary hepatic neuroendocrine tumor
- TACE, Transarterial chemoembolization
- USG, Ultrasonography
- primary hepatic neuroendocrine tumor
- surgical resection
- transarterial chemoembolization (TACE)
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23
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Zhao ZM, Wang J, Ugwuowo UC, Wang L, Townsend JP. Primary hepatic neuroendocrine carcinoma: report of two cases and literature review. BMC Clin Pathol 2018; 18:3. [PMID: 29507528 PMCID: PMC5831736 DOI: 10.1186/s12907-018-0070-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 02/16/2018] [Indexed: 12/16/2022] Open
Abstract
Background Primary hepatic neuroendocrine carcinoma (PHNEC) is extremely rare. The diagnosis of PHNEC remains challenging—partly due to its rarity, and partly due to its lack of unique clinical features. Available treatment options for PHNEC include surgical resection of the liver tumor(s), radiotherapy, liver transplant, transcatheter arterial chemoembolization (TACE), and administration of somatostatin analogues. Case presentation We report two male PHNEC cases and discuss the diagnosis and treatment options. Both cases presented with abdominal pain; case two also presented with symptoms of jaundice. The initial diagnosis for both cases was poorly differentiated grade 3 small-cell neuroendocrine carcinoma, based on imaging characteristics and the pathology of liver biopsies. Final diagnoses of PHNEC were arrived at by ruling out non-hepatic origins. Case one presented with a large tumor in the right liver lobe, and the patient was treated with TACE. Case two presented with tumors in both liver lobes, invasions into the left branch of hepatic portal vein, and metastasis in the hepatic hilar lymph node. This patient was ineligible for TACE and was allergic to the somatostatin analogue octreotide. This limited treatment options to supportive therapies such as albumin supplementation for liver protection. Patient one and two died at 61 and 109 days, respectively, following initial hospital admission. Conclusions We diagnosed both cases with poorly differentiated grade 3 small-cell PHNEC through imaging characteristics, immunohistochemical staining of liver biopsies, and examinations to eliminate non-hepatic origins. Neither TACE nor liver protection appeared to significantly extend survival time of the two patients, suggesting these treatments may be inadequate to improve survival of patients with poorly differentiated grade 3 small-cell PHNEC. The prognosis of poorly differentiated grade 3 small-cell PHNEC is poor due to limited and ineffective treatment options. Electronic supplementary material The online version of this article (10.1186/s12907-018-0070-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zi-Ming Zhao
- 1The Jackson Laboratory for Genomic Medicine, 10 Discovery Drive, Farmington, CT 06032 USA.,2Department of Biostatistics, Yale University, New Haven, CT 06511 USA
| | - Jin Wang
- 3Division of Vascular Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province 116000 China.,4Division of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Dalian Medical University, 467 Zhongshan Road, Dalian, Liaoning Province 116000 China.,5Dalian Medical University, Dalian, Liaoning Province 116000 China
| | - Ugochukwu C Ugwuowo
- 6Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520 USA
| | - Liming Wang
- 4Division of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Dalian Medical University, 467 Zhongshan Road, Dalian, Liaoning Province 116000 China.,8Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, 467 Zhongshan Road, Dalian, Liaoning 116027 China
| | - Jeffrey P Townsend
- 2Department of Biostatistics, Yale University, New Haven, CT 06511 USA.,Suite 200, 135 College St, New Haven, CT 06510 USA
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24
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Song JE, Kim BS, Lee CH. Primary hepatic neuroendocrine tumor: A case report and literature review. World J Clin Cases 2016; 4:243-247. [PMID: 27574614 PMCID: PMC4983697 DOI: 10.12998/wjcc.v4.i8.243] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/24/2016] [Accepted: 05/27/2016] [Indexed: 02/05/2023] Open
Abstract
Primary hepatic neuroendocrine tumors (PHNETs) are extremely rare and difficult to distinguish from other liver tumors, such as hepatocellular carcinoma (HCC) and cholangiocarcinoma, based on medical imaging findings. A 70-year-old man was referred for evaluation of liver mass incidentally discovered on abdominal computed tomography. The characteristic finding from dynamic liver magnetic resonance imaging led to a diagnosis of HCC. The patient underwent right hepatectomy. Histopathological and immunohistochemical examination revealed grade 2 neuroendocrine tumor. The postoperative 24-h urinary excretion of 5-hydroxy-indolacetic acid was within the normal range. Further imaging investigations were performed. No other lesions were found making probable the diagnosis of PHNET. This case shows that the diagnosis of PHNET is a medical challenge, requiring differentiation of PHNETs other hepatic masses and exclusion of occult primary neuroendocrine tumors. The diagnosis of PHNET can be ascertained after long term follow-up to exclude another primary origin.
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