Diagnosis and therapy of primary hepatic neuroendocrine carcinoma: clinical analysis of 10 cases

Role of advanced imaging in primary hepatic neuroendocrine tumor with borderline raised AFP and negative chromogranin staining: A case report

BACKGROUND

Primary hepatic neuroendocrine tumors (PHNETs) are rare, accounting for approximately 0.3 % of all neuroendocrine tumors (NETs) and are often difficult to diagnose due to their nonspecific symptoms and imaging features. Standard diagnostic and treatment protocols are lacking due to their rarity, but imaging and immunohistochemistry (IHC) remain key tools for diagnosis.

CASE REPORT

A 68-year-old male presented with abdominal discomfort and loss of appetite. Imaging revealed a large exophytic mass in the left lobe of the liver. After ruling out extrahepatic primary sources, a left lobe hepatectomy was performed. Histopathology confirmed the diagnosis of PHNET, with positive IHC staining for synaptophysin and CK-7. Postoperative PET-CT ruled out any distant metastases. The patient had an uneventful recovery.

DISCUSSION

PHNETs are believed to originate from ectopic neuroendocrine cells in the liver, though several theories exist. Imaging alone cannot conclusively diagnose PHNETs, as they mimic other hepatic tumors like hepatocellular carcinoma. Histopathological examination, along with IHC markers like chromogranin and synaptophysin, is essential for diagnosis. Surgical resection remains the treatment of choice, with good outcomes despite the risk of recurrence. Non-surgical therapies, such as chemotherapy or ablation, are under investigation but lack consensus.

CONCLUSION

PHNETs are rare and challenging to diagnose, requiring imaging and IHC for confirmation. Surgery offers the best prognosis, making personalized, surgery-centered treatment plans essential for management. Comprehensive follow-up, including functional imaging, is necessary to monitor recurrence or metastasis.

Primary hepatic neuroendocrine carcinoma with subsequent cerebral and spinal metastases

A 72-year-old man was referred to us for evaluation of asymptomatic masses in the liver that had been detected on ultrasonography performed during a physical screening. The level of neuron-specific enolase was elevated (56.97 ng/mL; normal level, 15.7-17.0 ng/mL). Other tumor markers were normal, including alpha fetoprotein, carcinoembryonic antigen and cancer antigen 199. No tumor was found through chest CT scan, gastroscopy and colonoscopy. Abdominal MR demonstrated multiple masses with irregular central necrosis, which appeared as marked hyperintensity on T2WI. Most lesions showed rim-like enhancement at portal venous phase. Pathological examination of tissue obtained by means of percutaneous biopsy indicated that the tumor was composed of small cells which were arranged in nests and trabeculae, the nuclei were round with little cytoplasm, and nuclear division was present (hematoxylin-eosin stain.

"A Tale of 2 Demons"-Concomitant Presence of Hepatocellular Carcinoma and Primary Neuroendocrine Tumor of Liver: A Case Report and Review of Literatures

Neuroendocrine tumors usually originate from the neuroendocrine cells of gastrointestinal tract and their presence in the liver is mostly in the form of metastases. A primary neuroendocrine tumor in the liver concomitantly with hepatocellular carcinoma is an infrequent phenomenon. We present a 66-year-old woman with a remote history of breast cancer coming with postprandial fullness, later found to have multiple liver masses. After a thorough investigation, she was found to have a combined type of hepatocellular and primary neuroendocrine tumor of liver with pulmonary metastases. She was not a surgical candidate due to distant metastases. She was treated with chemotherapy, immunotherapy, and targeted therapies but continued to deteriorate clinically, and finally succumbed to her illness. The presence of this combined type of tumor in our patient is unique in many different ways: It is extremely rare, she did not have any risk factors for liver cancer, no genetic mutation till date could tie all these cancers (breast cancer, neuroendocrine tumor, and hepatocellular carcinoma) together, and not a lot of literatures/studies performed on this illness.

Effects of tumor origins and therapeutic options on the prognosis of hepatic neuroendocrine tumors: A retrospective study

Hepatic neuroendocrine tumors (HNETs) are uncommon neoplasms that can be subdivided into 2 types: primary and metastatic HNETs. Due to its rarity, heterogeneity and complexity, the diagnosis, treatment modalities and prognosis are still controversial.This retrospective study reviewed the effects of tumor origins and therapeutic options on the prognosis of gastroenteropancreatic neuroendocrine tumors with liver metastasis (GEP-NETLM) and primary hepatic neuroendocrine tumors (PHNETs), providing additional evidence for clinicians evaluating patients.HNETs consisted of PHNETs and GEP-NETLM. GEP-NETLM (76.2%, 112/147) was more common, which was mainly manifested as multiple lesions in both lobes of the liver. PHNETs were relatively rare (23.8%, 35/147) and were mainly single lesion located in the right lobe of the liver. In patients with GEP-NETLM, primary tumor resection could prolong survival (P = .044). As the most widely used treatment method, systematic therapy alone could not achieve a satisfactory survival. However, the combination with hepatectomy or liver-directed therapy improved the prognosis (P = .023). As the main treatment, patients with PHNETs treated with local therapy could achieve a better prognosis (P = .049). Compared with PHNETs patients, GEP-NETLM patients with higher ki-67 index showed higher mortality and poorer prognosis (P = .006).Therefore, patients with PHNETs can be distinguished from GEP-NETLM by comprehensive imaging examinations and long-term follow-ups. The choice of appropriate treatment strategies can improve the prognosis of HNETs patients.

Primary hepatic neuroendocrine tumours of liver- a rarity: Single centre analysis of 13 patients

Backgrounds/Aims

Primary hepatic neuroendocrine tumours (PHNETs) are a rarity and this rarity imparts management complexities.

Methods

A retrospective analysis of prospectively maintained liver database from 2009 to 2018 was performed and patients with PHNETs were identified and studied for clinical, imaging and pathological features, surgical outcomes, disease free and overall survival.

Results

Thirteen patients of PHNET were identified following rigorous investigational protocols, which constituted 0.6% of all liver tumours (2095) in our series. The median age of patients was 50 years (14–65), with male to female ratio of 9:4. Eight patients (62%) underwent hepatic resections as primary treatment, while 5 (38%) patients received peptide receptor radiotherapy, trans-arterial chemotherapy, trans-arterial radiotherapy or a combination of these. In the surgical group at a median follow up of 36 months (range 5–114 months), 4 (50%) patients were alive without disease and disease free survival was 20 months. Median OS in surgical group was 47 months (40–53, 95% confidence interval) that was better but not statistically significant from that of non-surgical treatment group (36 months).

Conclusions

PHNETs are rare tumours that require multidisciplinary treatment approach. Liver directed surgery centred management leads to better clinical outcomes in these selected patients.

Analysis of B-ultrasound and contrast-enhanced ultrasound characteristics of different hepatic neuroendocrine neoplasm

BACKGROUND

Hepatic neuroendocrine neoplasm (hNEN) is a highly heterogeneous tumor. The exact identification of the source and malignant degree of hNEN is important. However, there is a lack of information regarding diagnosis of hNEN with imaging. In addition, no studies have compared the imaging between hNEN and hepatocellular carcinoma (HCC) and among different sources and malignant degrees of hNEN.

AIM

To compare the ultrasound characteristics between hNEN and HCC and among different sources and malignant degrees of hNEN.

METHODS

A total of 55 patients with hNEN were recruited and defined as the hNEN group. Among them, 35 cases of hNET were defined as the hNET group. Twenty cases of hepatic neuroendocrine carcinoma (hNEC) were defined as the hNEC group. Among the 55 lesions, 29 were transferred from the pancreas, 20 were from the gastrointestinal tract, and six were from other sites. In total, 55 patients with HCC were recruited and defined as the HCC group. The characteristic differences of B-mode ultrasound and contrast-enhanced ultrasound (CEUS) between hNEN and HCC and among different sources and malignant degrees of hNEN were compared.

RESULTS

In the hNEN group, the proportions of multiple liver lesions, unclear borders, and high echo lesions were higher than those in the HCC group. The proportions of non-uniform echo and peripheral acoustic halo were lower than those in the HCC group (P < 0.05). The washout to iso-enhancement time and washout to hypo-enhancement time were lower than those in the HCC group (P < 0.05). The characteristics of B-ultrasound and CEUS among different sources of hNEN were similar, and the differences were not statistically significant (P > 0.05). B-mode ultrasound characteristics of hNET and hNEC were similar. The proportions of low enhancement at portal venous phase, non-uniform enhancement forms, and combined tumor vasculature in the hNEC group were larger than those in the hNEN group (P < 0.05).

CONCLUSION

Compared with HCC, hNEN showed multiple intrahepatic lesions, uniform high echo, uniform high enhancement at arterial phase, and rapid washout. Low enhancement at portal venous phase, overall non-uniform enhancement form, and the proportion of combined tumor vasculature in hNEC were larger than those in hNET.

Hepatic neuroendocrine tumors: gadoxetic acid-enhanced magnetic resonance imaging findings with an emphasis on differentiation between primary and secondary tumors

PURPOSE

To describe the findings of magnetic resonance (MR) imaging of hepatic neuroendocrine tumors (hNET) and to identify the features that differentiate secondary from primary tumors.

METHODS

This retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. Between August 2008 and December 2014, 50 patients with pathologically proven hNETs who underwent gadoxetic acid-enhanced MR imaging with diffusion-weighted images were included. The patients were divided into two groups according to whether they had primary (n = 17) or secondary (n = 33) hNETs. Qualitative values based on a consensus between two observers [morphologic findings, signal intensity, and enhancement pattern (poor or indeterminate; hepatocellular carcinoma-like or cholangiocarcinoma-like)], and quantitative values (apparent diffusion coefficient) were evaluated as predictors of secondary hNETs using multivariable logistic regression and receiver operating characteristic (ROC) analysis.

RESULTS

In multivariate analysis, the presence of multiple lesions (p = 0.011), a tumor size less than 6.3 cm (p = 0.001), and a hepatocellular carcinoma-like enhancement pattern (p = 0.031) were significant independent factors for differentiating secondary from primary hNETs, and achieved a sensitivity of 91%, a specificity of 82%, and an accuracy of 88%, with a value of the area under the ROC curve of 0.931.

CONCLUSION

Using these specific MR imaging criteria, secondary hNETs could be differentiated from primary hNETs with a high degree of accuracy in patients with histopathologically proven hNETs.

Primary hepatic neuroendocrine neoplasm: Long-time surgical outcome and prognosis

Primary hepatic neuroendocrine neoplasms (PHNENs) represent a kind of rare liver tumor and its clinical features and prognosis remain unclear. This study aims to reveal the long-term therapeutic outcome of PHNEN and to present its prognostic feature.A retrospective designed, single-center study containing 22 patients with PHNENs receiving surgical resections was done. Clinical data were reviewed and long-term follow-up was updated. Survival analysis was tried to find the prognostic factors.Nine patients recurred (recurrence rate = 40.9%) and 6 patients died on the disease. The actual 1-, 3-, and 5-year recurrence-free survival rate were 86.4%, 63.6%, and 52.9%, respectively. The 1-, 3-, and 5-year overall survival rate were 95.5%, 81.8%, and 64.7%, respectively. Median overall survival for group G1, G2, and G3 were 69, 67, and 42 months, respectively.Patients with PHNEN can have a long survival after radical surgical resection, especially when the tumor proliferative grade exhibits lower (G1/2).

Analysis of the clinicopathological features and prognostic factors of primary hepatic neuroendocrine tumors

Neuroendocrine tumors (NETs) of the gastrointestinal tract often spread to the liver, while primary hepatic NETs (PHNETs), first described by Edmondson in 1958, are very rare. The majority of existing reports regarding PHNETs have small sample sizes, and the clinicopathological characteristics and prognostic factors are still unclear. The aim of the present study was to analyze the clinicopathological features and explore the prognostic factors of PHNETs. From March 2012 to March 2017, 28 cases of PHNETs were retrospectively evaluated to analyze the clinicopathological features and explore the prognostic factors of PHNETs. The 28 PHNETs patients were males (n=15) and females (n=13) aged between 32 and 76 years (mean=53 years). Among them, 16 patients had clinical symptoms. The remaining 12 patients had no obvious clinical symptoms, only hepatoncus was observed during physical examination. Single-factor analysis showed that carbohydrate antigen 125 (CA125), alanine aminotransferase (ALT), aspartate aminotransferase (AST), hemoglobin (HB), Ki-67 positive index (PI), surgical treatment and pathological grading were correlated to PHNET prognosis (P<0.05); multifactor analysis revealed that Ki-67 PI was associated with the prognosis (P<0.05). Thus, the prognosis of PHNETs may be effectively predicted using the indexes of CA125, ALT, AST, HB, Ki-67 PI, pathological grading and surgical treatment. Pathological classification of grade 3, high expression of Ki-67 PI, abnormal elevation of CA125, abnormalities of ALT and AST, anemia and lack of radical operation indicated a poor prognosis. High expression of Ki-67 PI was an independent prognostic factor for PHNETs.

Primary hepatic neuroendocrine carcinoma: report of two cases and literature review

Background

Primary hepatic neuroendocrine carcinoma (PHNEC) is extremely rare. The diagnosis of PHNEC remains challenging—partly due to its rarity, and partly due to its lack of unique clinical features. Available treatment options for PHNEC include surgical resection of the liver tumor(s), radiotherapy, liver transplant, transcatheter arterial chemoembolization (TACE), and administration of somatostatin analogues.

Case presentation

We report two male PHNEC cases and discuss the diagnosis and treatment options. Both cases presented with abdominal pain; case two also presented with symptoms of jaundice. The initial diagnosis for both cases was poorly differentiated grade 3 small-cell neuroendocrine carcinoma, based on imaging characteristics and the pathology of liver biopsies. Final diagnoses of PHNEC were arrived at by ruling out non-hepatic origins. Case one presented with a large tumor in the right liver lobe, and the patient was treated with TACE. Case two presented with tumors in both liver lobes, invasions into the left branch of hepatic portal vein, and metastasis in the hepatic hilar lymph node. This patient was ineligible for TACE and was allergic to the somatostatin analogue octreotide. This limited treatment options to supportive therapies such as albumin supplementation for liver protection. Patient one and two died at 61 and 109 days, respectively, following initial hospital admission.

Conclusions

We diagnosed both cases with poorly differentiated grade 3 small-cell PHNEC through imaging characteristics, immunohistochemical staining of liver biopsies, and examinations to eliminate non-hepatic origins. Neither TACE nor liver protection appeared to significantly extend survival time of the two patients, suggesting these treatments may be inadequate to improve survival of patients with poorly differentiated grade 3 small-cell PHNEC. The prognosis of poorly differentiated grade 3 small-cell PHNEC is poor due to limited and ineffective treatment options.

Electronic supplementary material

The online version of this article (10.1186/s12907-018-0070-7) contains supplementary material, which is available to authorized users.

Combination therapies for primary hepatic neuroendocrine carcinoma: a case report

Background

Primary hepatic neuroendocrine carcinomas are extremely rare. Because of the rarity of PHNEC, its clinical features and treatment outcomes are not well understood. A proper diagnosis and the correct therapeutic approach therefore remain clinically challenging.

Case presentation

A 67-year-old man was admitted to our department because of a liver tumor. Computed tomography revealed a single liver tumor 50 mm in diameter and located in the S3 region. Biopsy and imaging findings resulted in a diagnosis of primary hepatic neuroendocrine carcinoma. Left lateral segmentectomy was performed. Immunohistochemically, the tumor cells were positive for synaptophysin, chromogranin A, and CD56. Ki-67 was positive in > 90% of the tumor cells. The final diagnosis was primary hepatic neuroendocrine carcinoma. The patient suffered two episodes of lymph node recurrence. Nonetheless, the tumor was excised to prolong survival. Thus, after lymphadenectomy, he received adjuvant chemotherapy for 6 months. Two years after surgery, the patient remains alive and in good general condition.

Conclusions

In most cases, primary hepatic neuroendocrine carcinoma, while extremely rare, has a poor prognosis. At present, surgical resection is a priority for curative treatment, but in patients with recurrence, combined therapies are recommended.

MR imaging of primary hepatic neuroendocrine neoplasm and metastatic hepatic neuroendocrine neoplasm: a comparative study

PURPOSE

To investigate MR characteristics in differentiating primary hepatic neuroendocrine neoplasm (PHNEN) from metastatic hepatic neuroendocrine neoplasm (MHNEN).

MATERIALS AND METHODS

Thirty-nine patients with histopathologically proven liver neuroendocrine neoplasm were retrospectively analyzed. The morphological and MR signal features on T1, T2-weighted, dynamic-enhanced, and diffusion-weighted imaging were evaluated and compared between the PHNEN group (n = 12) and the MHNEN group (n = 27).

RESULTS

The tumor size (P = 0.0084), number (P = 0.017), distribution (P = 0.000), contour (P = 0.041), the presence of capsule-like enhancement (P = 0.034), tumor homogeneity (P = 0.018) and the apparent diffusion coefficient (ADC) values (P = 0.024) were different between PHNENs and MHNENs. Large, solitary or massive-growing nodules with lobulated or irregular contour, capsule-like enhancement, heterogeneous signals or lower ADC values supported the diagnosis of PHNEN compared with MHNEN. ROC analysis demonstrated an area under the curve of 0.746, when the optimal cutoff value of 1.049 × 10(-3) mm(2)/s was used, a sensitivity of 63.0 % (95 % CI, 44.2-79.4 %), a specitivity of 80.0 % (95 % CI, 50.1-96.4 %), a positive predictive value of 89.5 % (95 % CI, 70.9-98.2 %), and a negative predictive value of 44.4 % (95 % CI, 23.4-67.0 %) can be achieved.

CONCLUSIONS

MRI may provide valuable information for the diagnosis and differential diagnosis of PHNENs and MHNENs.