Primary hepatic neuroendocrine carcinoma diagnosed by needle biopsy: a case report

Abstract

Background Primary hepatic neuroendocrine carcinomas (NECs) are extremely rare. The rate of recurrence after resection is extremely high, and the prognosis is poor. It is debatable whether chemotherapy or surgical resection is the optimal initial treatment for primary hepatic NECs. Therefore, selecting an appropriate therapeutic approach for patients with primary hepatic NECs remains clinically challenging. We present a case of primary hepatic NEC in a patient who developed recurrence after undergoing surgical resection. Case presentation A 78-year-old man with bone metastases of prostate cancer was referred to our department because of a solitary 66-mm tumor in the left lateral segment of the liver, which was detected on annual follow-up by computed tomography after prostate resection. A biopsy and preoperative diagnostic workup identified the lesion as a primary hepatic neuroendocrine carcinoma; therefore, left lateral segmentectomy was performed. Immunohistochemically, the tumor was positive for chromogranin A, synaptophysin, and CD 56, and the Ki-67 index was 40%. This neuroendocrine carcinoma was classified as a large cell type. Adjuvant chemotherapy with carboplatin + etoposide was initially administered a month after surgery. However, lymph node recurrence occurred 4 months after surgery, and the patient died of systemic metastases 15 months after surgical resection. Conclusions Due to the lack of availability of abundant quantities of relevant, high-quality data, there is no standard therapy for primary hepatic NECs. Selecting the most appropriate treatment for patients depending on several factors, such as the stage and differentiation of a tumor and a patient’s performance status and clinical course, is consequently preferred. More cases need to be studied to establish the best treatment strategy for primary hepatic NEC.

Primary Hepatic Neuroendocrine Carcinoma with Metastasis to the Mesentery: A Case Report

“…Based on the abovementioned clinical-imaging findings, it is difficult to distinguish hepatic NECs from other hepatic carcinomas, such as HCC and cholangiocarcinoma. Consequently, pathological examination through the performance of a preoperative liver tumor biopsy is essential for diagnosis [9‒52]. In our case, the patient underwent a biopsy of the liver lesion for histological diagnosis, since the characteristics in the imaging studies were not sufficient to make the diagnosis conclusively.…”

“…Presentation: there is no staging for NENs of the liver, so they are classified according to the location of the disease; localized (located within the primary organ, in this case the liver), locally advanced or regional (nodal disease), and advanced or metastatic (disease in distant nodes and organs) [9, 11‒52]. The size of the tumor is 1.5–27 cm, presenting as single (76.3%) and multiple in 23.7% of cases, located mainly in the right lobe in 48.4% of cases, and as bilobular in 18.5%.…”

“…The size of the tumor is 1.5–27 cm, presenting as single (76.3%) and multiple in 23.7% of cases, located mainly in the right lobe in 48.4% of cases, and as bilobular in 18.5%. Knox et al [54] reported extrahepatic involvement in 18.6% of cases, such as bone (60%), lymph node (60%), and lung (40%) [9‒55]. The form of tumor presentation was two liver tumors that occupied both lobes of approximately 20 cm with metastasis to the mesentery.…”

Primary Hepatic Neuroendocrine Carcinoma with Thrombocytopenia Due to Diffuse Bone Marrow and Splenic Infiltration: An Autopsy Case

“…Park et al reported the median overall survival in 12 reported PHNEC cases to be 16.5 months ( 29 ). Recently, a literature review of case studies showed the 5-year survival rate of 33 PHNEC cases to be poor (9.1%) ( 30 ). Chen et al reported that a high expression of Ki-67 was an independent prognostic factor for primary hepatic NENs ( 14 ).…”

Relation between WHO Classification and Location- and Functionality-Based Classifications of Neuroendocrine Neoplasms of the Digestive Tract

“…Primary hepatic-NENs (H-NENs) develop sporadically and are extremely rare, accounting for only 0.3% of all NENs [78] and less than 1% of all primary neoplasms of the liver [79][80][81][82][83]. As the liver is the most frequently affected site of metastases from other (GEP-/GI-)NENs [84,85], the distinction between primary H-NENs and metastases from other locations is important to establish correct treatment and prognosis of patients [74].…”