Primary hepatic neuroendocrine tumor with multiple liver metastases: A case report with review of the literature

Abstract

We herein present a case involving a 41-year-old woman in whom ultrasound examination revealed multiple liver hemangiomas more than 3 years ago. Follow-up ultrasound examination revealed that the masses had significantly increased; the largest was located in the right lobe (about 8.2 cm × 7.4 cm × 6.0 cm). Abdominal multidetector computed tomography revealed multiple well-circumscribed, heterogeneous, hypodense masses (largest, 6.4 cm × 6.3 cm × 5.0 cm) with significant contrast enhancement during the arterial and portal phases and with contrast wash-out and peripheral enhancement during the delayed phases. Magnetic resonance images demonstrated multiple well-circumscribed, heterogeneous, hypointense hepatic masses with significant contrast enhancement (largest, 6.4 cm × 6.5 cm × 5.1 cm); multiple enlarged porta lymph nodes; and multiple slightly enlarged retroperitoneal lymph nodes. Histological and immunohistochemical examination of the right mass biopsy specimen suggested a malignant neoplasm that had originated from a neuroendocrine cell type (grade 2 well-differentiated neuroendocrine carcinoma). After performing a systemic examination to exclude metastasis from an extrahepatic primary site, we considered that the masses had arisen from a primary hepatic neuroendocrine tumor with multiple liver metastases. The patient underwent transcatheter arterial chemoembolization using a combination of oxaliplatin (150 mg) mixed with one bottle of gelatin sponge particles (560-710 μm) and lipiodol (6 mL). Primary neuroendocrine tumors of the liver are extremely rare. This case is interesting because of the rarity of this neoplasm and previous misdiagnosis as multiple liver hemangiomas. Previously reported cases in the literature are also reviewed.

Keywords: Liver, Neoplasms - primary, Neuroendocrine tumor, Metastatic, Immunohistochemical, Imaging, Transcatheter arterial chemoembolization

Core tip: Whereas more than 80% of the neuroendocrine tumors (NETs) found in the liver are metastatic, primary hepatic neuroendocrine tumors (PHNETs) are very rare, when a NET is found in the liver, it must be treated with great care to exclude metastasis from extrahepatic primary site, as that is a much more common occurrence. Only fewer than 100 cases of PHNETs have been reported in the English literatures and most was a case report. we report a case of PHNET with multiple liver metastases have focused on multiple imaging modalities, including computed tomography, magnetic resonance imaging, and digital subtraction angiography.