Case Report
Copyright ©2005 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Dec 28, 2005; 11(48): 7676-7683
Published online Dec 28, 2005. doi: 10.3748/wjg.v11.i48.7676
Liver transplantation for metastatic neuroendocrine tumor: A case report and review of the literature
Wojciech C Blonski, K Rajender Reddy, Abraham Shaked, Evan Siegelman, David C Metz
Wojciech C Blonski, Department of Gastroenterology and Hepatology, Wroclaw Medical University, Wroclaw, Poland
Wojciech C Blonski, the Kosciuszko Foundation Awardee in the Division of Gastroenterology at the University of Pennsylvania, Philadelphia, United States
K Rajender Reddy, Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, United States
Abraham Shaked, Department of Surgery, University of Pennsylvania, Philadelphia, PA, United States
Evan Siegelman, Department of Magnetic Resonance Imaging Division, University of Pennsylvania, Philadelphia, PA, United States
David C Metz, Division of Gastroenterology, University of Pennsylvania, Philadelphia, PA, United States
Author contributions: All authors contributed equally to the work.
Correspondence to: Dr. David C. Metz, 3400 Spruce Street, 3 Ravdin Building, Gastroenterology Division, University of Pennsylvania Health System, Philadelphia, PA 19104, United States. david.metz@uphs.upenn.edu
Telephone: +1-215-662-3541 Fax: +1-215-349-5815
Received: April 9, 2005
Revised: April 23, 2005
Accepted: April 30, 2005
Published online: December 28, 2005
Abstract

Neuroendocrine tumors are divided into gastrointestinal carcinoids and pancreatic neuroendocrine tumors. The WHO has updated the classification of these lesions and has abandoned the term ”carcinoid”. Both types of tumors are divided into functional and non-functional tumors. They are characterized by slow growth and frequent metastasis to the liver and may be limited to the liver for long periods. The therapeutic approach to hepatic metastases should consider the number and distribution of the liver metastases as well as the severity of symptoms related to hormone production and tumor bulk. Surgery is generally considered as the first line therapy. In patients with unresectable liver metastases, alternative treatments are dependent on the type and the growth rate. Initial treatments consist of long acting somatostatin analogs and/or interferon. Streptozocin-based chemotherapy is usually reserved for symptomatic patients with rapidly advancing disease, but generally the therapy is poorly tolerated and its effects are short-lived. Locoregional therapy directed such as hepatic-artery embolization and chemoembolization, radiofrequency thermal ablation and cryosurgery, is often used instead of systemic therapy, if the disease is limited to the liver. However, liver transplantation should be considered in patients with neuroendocrine metastases to the liver that are not accessible to curative or cytoreductive surgery and if medical or locoregional treatment has failed and if there are life threatening hormonal symptoms. We report a case of liver transplantation for metastatic neuroendocrine tumor of unknown primary source and provide a detailed review of the world literature on this controversial topic.

Keywords: Liver metastases; Neuroendocrine tumors; Liver transplantation