A Case of a Neuroendocrine Tumor in a Liver Transplant Patient: Diagnostic and Management Difficulties

Abstract

Neuroendocrine tumors (NETs) of the liver are a rare entity. NETs are often poorly recognized, with diagnostic difficulties and differential challenges between primary tumors of the liver and metastases from other organs, mainly from the gastrointestinal tract. Multidisciplinary and multi-technical diagnosis is mandatory to properly treat these tumors. This case describes the complex history and the treatment course of a 68-year-old man with a history of NET onset after liver transplantation. Liver transplantation is the treatment of choice for patients with advanced liver disease or acute liver failure, but careful pre- and post-transplant patient monitoring is required. Liver transplant patients receive immunosuppressive therapy, and donor livers should be screened to exclude potential malignancies. This clinical case, in addition to emphasizing the diagnostic and therapeutic difficulty of hepatic NET, underlines the role of post-transplant immunosuppressive therapy and pre-transplant screening, which includes a thorough evaluation of donor and recipient history, physical examination, and laboratory tests. Moreover, post-transplant immunosuppressive therapy is essential to maintain the viability of the transplanted organ, but it is not free from potential risks, including an increased risk of cancer. Therefore, close monitoring of therapy is necessary to optimize long-term results and the patient's quality of life.

Keywords: HCC; NET; holangiocarcinoma; immunosuppressive therapy; liver; liver transplantation.

Figure 1

Ultrasound image of biopsied liver segment VI lesion. The arrow indicates the presence of the VI liver segment.

Figure 2

F1 esophageal varices in gastroscopy: the left image shows the portion of the middle esophagus; the right image shows the distal esophagus.

Figure 3

Normal colonoscopy findings: the left image shows the cecum; the right image shows the descending colon.