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Primary hepatic carcinoid tumor: a case report and review of the literature.

Lin CW, Lai CH, Hsu CC, Hsu CT, Hsieh PM, Hung KC, Chen YS - Cases J (2009)

Bottom Line: Tumor markers were negative.Dynamic liver computed tomography scans showed enhancement of the nodule in the arterial phase and early washout in the portal phase.A small and asymptomatic PHCT is extremely rare.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery and Organ Transplantation Center, E-Da Hospital/I-Shou University, 1, E-Da Road, Jiau-shu Tsuen, Yan-chau Shiang, Kaohsiung county 82445, Taiwan. yawsen.chen@msa.hinet.net.

ABSTRACT

Background: Primary hepatic carcinoid tumor (PHCT) is very rare and difficult to diagnose before biopsy or operation. We report a patient with a small PHCT and review cases in the literature.

Case presentation: A 48-year-old Chinese female with underlying hepatitis B virus (HBV) infection was found to have a low echoic hepatic nodule by abdominal ultrasound. Tumor markers were negative. Dynamic liver computed tomography scans showed enhancement of the nodule in the arterial phase and early washout in the portal phase. Hepatocellular carcinoma (HCC) was considered based on the image findings and underlying HBV infection. However, the tumor biopsy revealed a malignant neoplasm that originating from neuroendocrine cells. Pre-operative and intra-operative investigations for the possible other origin of carcinoid tumor were negative, so PHCT was confirmed.

Conclusion: A small and asymptomatic PHCT is extremely rare. PHCT should be one of the differential diagnoses in patients with small hepatic tumor, even in regions with high prevalence of HBV infection and HCC. Pre-operative biopsy is necessary to avoid misdiagnosis even when HCC is highly suspected clinically.

No MeSH data available.


Related in: MedlinePlus

(A) The tumor was composed of round or ovoid cells arranged in insular pattern with a rosette formation (hematoxylin and eosin). (B) The tumor cells were positive for chromogranin A.
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Figure 2: (A) The tumor was composed of round or ovoid cells arranged in insular pattern with a rosette formation (hematoxylin and eosin). (B) The tumor cells were positive for chromogranin A.

Mentions: A 48-year-old Chinese female with HBV infection for 15 years was regularly followed up at gastroenterology outpatient department by abdominal ultrasound (US) and serum alpha-fetoprotein (AFP) screening every six months. In May 2005, abdominal US demonstrated a low echoic nodule, 1.6 × 1.6 cm in size in the sixth segment of the liver and mild parenchymal liver disease (Fig. 1A). She was asymptomatic and no abnormality was disclosed by physical examination. Noncontrast liver computed tomography (CT) showed a 1.6 × 1.6 cm well-circumscribed and low density nodule in the same liver segment (Fig. 1B). Dynamic CT scans showed enhancement of the nodule in the arterial phase and early washout in the portal phase (Figs. 1C and 1D). Serum was positive for hepatitis B surface antigen (HBsAg), but negative for HBeAg. The serum anti-HCV was also negative. AFP and CEA were within normal range. Based on the imaging findings and underlying HBV infection, small HCC was highly suspected and a US-guided liver biopsy was performed for definite diagnosis. However, the pathological finding suggested a malignant neoplasm originating form neuroendocrine cells (Fig. 2A). The result of immunohistochemical (IHC) stain was positive for neuron-specific enolase (NSE), synaptophysin, and chromogranin A (Fig. 2B). The pre-operative 24-hour urine 5-hydroxyindoleacetic acid (5-HIAA) value was within normal limits. We undertook a more thorough investigation to rule out the possibility that the liver tumor was a metastatic carcinoid. This workup included upper and low GI endoscopy, a small bowel series, abdominal US, and chest and abdominal CT scans. All imaging findings were unremarkable. Partial hepatectomy was performed. Small bowel, appendix and large bowel were checked during operation and no tumor was found. No cirrhotic liver was noted. The surgery was performed successfully and the patient recovered well. The resected liver tissue contained a 1.6 × 1.6 × 1.5 cm circumscribed tumor (Fig. 3). Histological examination revealed the round or ovoid neoplastic cells arranged in insular pattern with a rosette formation. There was no tumor embolus in the vessels and the resection line was free from tumor invasion. The IHC stains were positive for chromogranin A, cytokeratin, NSE, and synaptophysin. The final diagnosis was PHCT. She was followed up regularly at our hospital and remained disease-free 3 years after operation.


Primary hepatic carcinoid tumor: a case report and review of the literature.

Lin CW, Lai CH, Hsu CC, Hsu CT, Hsieh PM, Hung KC, Chen YS - Cases J (2009)

(A) The tumor was composed of round or ovoid cells arranged in insular pattern with a rosette formation (hematoxylin and eosin). (B) The tumor cells were positive for chromogranin A.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2654436&req=5

Figure 2: (A) The tumor was composed of round or ovoid cells arranged in insular pattern with a rosette formation (hematoxylin and eosin). (B) The tumor cells were positive for chromogranin A.
Mentions: A 48-year-old Chinese female with HBV infection for 15 years was regularly followed up at gastroenterology outpatient department by abdominal ultrasound (US) and serum alpha-fetoprotein (AFP) screening every six months. In May 2005, abdominal US demonstrated a low echoic nodule, 1.6 × 1.6 cm in size in the sixth segment of the liver and mild parenchymal liver disease (Fig. 1A). She was asymptomatic and no abnormality was disclosed by physical examination. Noncontrast liver computed tomography (CT) showed a 1.6 × 1.6 cm well-circumscribed and low density nodule in the same liver segment (Fig. 1B). Dynamic CT scans showed enhancement of the nodule in the arterial phase and early washout in the portal phase (Figs. 1C and 1D). Serum was positive for hepatitis B surface antigen (HBsAg), but negative for HBeAg. The serum anti-HCV was also negative. AFP and CEA were within normal range. Based on the imaging findings and underlying HBV infection, small HCC was highly suspected and a US-guided liver biopsy was performed for definite diagnosis. However, the pathological finding suggested a malignant neoplasm originating form neuroendocrine cells (Fig. 2A). The result of immunohistochemical (IHC) stain was positive for neuron-specific enolase (NSE), synaptophysin, and chromogranin A (Fig. 2B). The pre-operative 24-hour urine 5-hydroxyindoleacetic acid (5-HIAA) value was within normal limits. We undertook a more thorough investigation to rule out the possibility that the liver tumor was a metastatic carcinoid. This workup included upper and low GI endoscopy, a small bowel series, abdominal US, and chest and abdominal CT scans. All imaging findings were unremarkable. Partial hepatectomy was performed. Small bowel, appendix and large bowel were checked during operation and no tumor was found. No cirrhotic liver was noted. The surgery was performed successfully and the patient recovered well. The resected liver tissue contained a 1.6 × 1.6 × 1.5 cm circumscribed tumor (Fig. 3). Histological examination revealed the round or ovoid neoplastic cells arranged in insular pattern with a rosette formation. There was no tumor embolus in the vessels and the resection line was free from tumor invasion. The IHC stains were positive for chromogranin A, cytokeratin, NSE, and synaptophysin. The final diagnosis was PHCT. She was followed up regularly at our hospital and remained disease-free 3 years after operation.

Bottom Line: Tumor markers were negative.Dynamic liver computed tomography scans showed enhancement of the nodule in the arterial phase and early washout in the portal phase.A small and asymptomatic PHCT is extremely rare.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery and Organ Transplantation Center, E-Da Hospital/I-Shou University, 1, E-Da Road, Jiau-shu Tsuen, Yan-chau Shiang, Kaohsiung county 82445, Taiwan. yawsen.chen@msa.hinet.net.

ABSTRACT

Background: Primary hepatic carcinoid tumor (PHCT) is very rare and difficult to diagnose before biopsy or operation. We report a patient with a small PHCT and review cases in the literature.

Case presentation: A 48-year-old Chinese female with underlying hepatitis B virus (HBV) infection was found to have a low echoic hepatic nodule by abdominal ultrasound. Tumor markers were negative. Dynamic liver computed tomography scans showed enhancement of the nodule in the arterial phase and early washout in the portal phase. Hepatocellular carcinoma (HCC) was considered based on the image findings and underlying HBV infection. However, the tumor biopsy revealed a malignant neoplasm that originating from neuroendocrine cells. Pre-operative and intra-operative investigations for the possible other origin of carcinoid tumor were negative, so PHCT was confirmed.

Conclusion: A small and asymptomatic PHCT is extremely rare. PHCT should be one of the differential diagnoses in patients with small hepatic tumor, even in regions with high prevalence of HBV infection and HCC. Pre-operative biopsy is necessary to avoid misdiagnosis even when HCC is highly suspected clinically.

No MeSH data available.


Related in: MedlinePlus