Case Report
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Mar 14, 2015; 21(10): 3132-3138
Published online Mar 14, 2015. doi: 10.3748/wjg.v21.i10.3132
Primary hepatic neuroendocrine tumor with multiple liver metastases: A case report with review of the literature
Kai Yang, Ying-Sheng Cheng, Ji-Jin Yang, Xu Jiang, Ji-Xiang Guo
Kai Yang, Ying-Sheng Cheng, Department of Radiology and Medical Imaging, Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai 201306, China
Ji-Jin Yang, Xu Jiang, Ji-Xiang Guo, Department of Interventional Radiology, Affiliated ChangHai Hospital of Second Military Medical University, Shanghai 200433, China
Author contributions: Yang K analyzed the date and wrote the paper; Cheng YS track the paper; Yang JJ, Jiang X and Guo JX collected the data.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ying-Sheng Cheng, MD, Professor, Chief, Department of Radiology and Medical Imaging, Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, No. 600, Yi Shan Road, Shanghai 200433, China. chengyingsheng@hotmail.com
Telephone: +86-21-38297858 Fax: +86-21-38297706
Received: July 22, 2014
Peer-review started: July 24, 2014
First decision: September 15, 2014
Revised: October 26, 2014
Accepted: November 7, 2014
Article in press: November 11, 2014
Published online: March 14, 2015
Processing time: 236 Days and 21.4 Hours
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.