Case Report
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 21, 2009; 15(19): 2418-2422
Published online May 21, 2009. doi: 10.3748/wjg.15.2418
Primary hepatic carcinoid: A case report and literature review
Luigi Maria Fenoglio, Sara Severini, Domenico Ferrigno, Giovanni Gollè, Cristina Serraino, Christian Bracco, Elisabetta Castagna, Chiara Brignone, Fulvio Pomero, Elena Migliore, Ezio David, Mauro Salizzoni
Luigi Maria Fenoglio, Sara Severini, Domenico Ferrigno, Giovanni Gollè, Cristina Serraino, Christian Bracco, Elisabetta Castagna, Chiara Brignone, Fulvio Pomero, Elena Migliore, Department of Internal Medicine, Santa Croce and Carle Hospital, 12100 Cuneo, Italy
Ezio David, Department of Pathology, San Giovanni Battista Hospital, 10126 Turin, Italy
Mauro Salizzoni, Liver Transplantation Center, San Giovanni Battista Hospital, 10126 Turin, Italy
Author contributions: Fenoglio LM and Severini S contributed equally to this work; Fenoglio LM, Severini S, Ferrigno D, Gollè G, Serraino C, Bracco C and Migliore E designed the research; Fenoglio LM, Severini S, Castagna E and Pomero F performed the research; Fenoglio LM, Severini S, David E and Salizzoni M analyzed the data; Fenoglio LM, Severini S and Ferrigno D wrote the paper.
Correspondence to: Dr. Luigi Maria Fenoglio, Department of Internal Medicine, Santa Croce Hospital, Via Michele Coppino 26, 12100 Cuneo, Italy. fenoglio.l@ospedale.cuneo.it
Telephone: +39-338-5064398
Fax: +39-171-641614
Received: January 15, 2009
Revised: April 10, 2009
Accepted: April 17, 2009
Published online: May 21, 2009
Abstract

Carcinoids are tumors derived from neuroendocrine cells and often produce functional peptide hormones. Approximately 54.5% arise in the gastrointestinal tract and frequently metastasize to the liver. Primary hepatic carcinoid tumors (PHCT) are extremely rare; only 95 cases have been reported. A 65-year-old man came to our attention due to occasional ultrasound findings in absence of clinical manifestations. His previous medical history, since 2003, included an echotomography of the dishomogeneous parenchymal area but no focal lesions. A computed tomography scan performed in 2005 showed an enhanced pseudonodular-like lesion of about 2 cm. Cholangio-magnetic resonance imaging identified the lesion as a possible cholangiocarcinoma. No positive findings were obtained with positron emission tomography. Histology suggested a secondary localization in the liver caused by a low-grade malignant neuroendocrine tumor. Immunohistochemistry was positive for anti chromogranin antibodies, Ki67 antibodies and synaptophysin. Octreoscan scintigraphy indicated intense activity in the lesion. Endoscopic investigations were performed to exclude the presence of extrahepatic neoplasms. Diagnosis of PHCT was established. The patient underwent left hepatectomy, followed by hormone therapy with sandostatine LAR. Two months after surgery he had a lymph nodal relapse along the celiac trunk and caudate lobe, which was histologically confirmed. The postoperative clinical course was uneventful, with a negative follow-up for hematochemical, clinical and radiological investigations at 18 mo post-surgery. Diagnosis of PHCT is based principally on the histopathological confirmation of a carcinoid tumor and the exclusion of a non-hepatic primary tumor. Surgical resection is the recommended primary treatment for PHCT. Recurrence rate and survival rate in patients treated with resection were 18% and 74%, respectively.

Keywords: Carcinoid, Primary hepatic carcinoid, Neuroendocrine neoplasm, Therapy, Surgical treatment, Prognosis