Primary hepatic neuroendocrine tumor: A case report

Abstract

We herein present a case of an 87-year-old patient with multiple liver tumors identified on abdominal ultrasound. The assessment performed on admission included physical examination, computed tomography (CT) during hepatic angiography and CT during arterial portography. The examination revealed contrast enhancement of a proportion of the liver tumors (20 mm maximum diameter) during the arterial phase and mild contrast washout of those tumors during the delayed phase. On contrast-enhanced magnetic resonance imaging using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid, certain liver tumors exhibited contrast enhancement during the early phase and contrast washout during the hepatocyte phase in both lobes. By contrast, no lesions were identified during positron emission tomography imaging of the liver. A liver biopsy was performed and immunohistochemical staining revealed enhanced expression of cytokeratin AE1/AE3, synaptophysin, chromogranin A and CD56 and no expression of hepatocyte antigen or CΚ7. The mindbomb E3 ubiquitin protein ligase-1 index was ~2% in most of the tumor. The liver tumors were finally diagnosed as multiple intrahepatic metastases from a primary hepatic neuroendocrine tumor (PHNET). The patient underwent transarterial chemoembolisation with a combination of miriplatin (84 mg) mixed with gelatin sponge particles and lipiodol. To the best of our knowledge, this is the first report of PHNET in an patient aged >85 years.

Keywords: CD56; chromogranin A; cytokeratin AE1/AE3; miriplatin; multiple liver tumors; primary hepatic neuroendocrine tumor; synaptophysin; transarterial chemoembolisation.

Figure 1.

(A) Computed tomography (CT) images during hepatic angiography (CTHA) and arterial portography (CTAP). (B) contrast-enhanced magnetic resonance imaging using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid during the arterial phase (left two panels) and the hepatocyte phase (right two panels). The tumors are indicated by the arrows.

Figure 2.

Immunohistochemistry was positive for the neuroendocrine tumor (NET) markers cytokeratin (ck) AE1/AE3, synaptophysin, chromogranin A and CD56 and negative for hepatocyte antigen and CK7 in primary hepatic NET tissues.