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Primary hepatic neuroendocrine tumors: comparing CT and MRI features with pathology.

Wang LX, Liu K, Lin GW, Jiang T - Cancer Imaging (2015)

Bottom Line: Primary hepatic neuroendocrine tumors (PHNET) are extremely rare and difficult to distinguish from primary and metastatic liver cancers since PHNETs blood supply comes from the liver artery.According to the 2010 WHO classification system, PHNETs are divided into three grades based on histological criteria.Portal venous tumor thrombus was seen in one case.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Beijing Chaoyang Hospital, Capital University of Medical Sciences, Beijing, 100020, China.

ABSTRACT

Background: Primary hepatic neuroendocrine tumors (PHNET) are extremely rare and difficult to distinguish from primary and metastatic liver cancers since PHNETs blood supply comes from the liver artery. This study aims to investigate CT and MR imaging findings of primary hepatic neuroendocrine tumor (PHNET) and correlation with the 2010 WHO pathological classification.

Methods: We examined CT and MRI scans from 29 patients who were diagnosed with PHNET and correlated the data with the 2010 WHO classification of neuroendocrine tumors.

Results: According to the 2010 WHO classification system, PHNETs are divided into three grades based on histological criteria. Grade 1 tumors are singular, solid nodules with enhancement at the arterial phase on CT and MRI scans. In grade 1 tumors, the dynamic-contrast enhancement curve shows rapid wash-in in the arterial phase. Grade 2 tumors can have a singular or multiple distribution pattern, necrosis, and nodule or marginal ring-like enhancements. Grade 3 tumors have multiple lesions, internal necrosis, and evidence of hemorrhage. Portal venous tumor thrombus was seen in one case. As tumor grades increase, the capsule begins to lose integrity and tumor apparent diffusion coefficient (ADC) values decrease(grade 1: 1.39 ± 0.20× 10(-3) mm(2)/s versus grade 2: 1.26 ± 0.23× 10(-3) mm(2)/s versus grade 3: 1.14 ± 0.17× 10(-3) mm(2)/s).

Conclusion: CT and MRI can reflect tumor grade and pathological features of PHNETs, which are helpful in accurately diagnosing PHNETs.

No MeSH data available.


Related in: MedlinePlus

CT scan and histology of grade 1 PHNET. Post-contrast CT image of the arterial phase (a), the portal venous phase (b) and the delayed phase (c) shows marked enhancement in the PHNET relative to the liver parenchyma (right lobe at the arterial phase), and slight hyperattenuation relative to the surrounding liver parenchyma in the delayed phases. The integrity of the capsule is maintained. The mitosis rate shows up as hypo-density and no enhancement on the dynamic enhanced CT scan. HE staining of the tumor (d) shows tumor cells arranged as solid nests, consistent cell size and mitosis rate was 1/10 HPF. Magnification: D = 100X
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Fig1: CT scan and histology of grade 1 PHNET. Post-contrast CT image of the arterial phase (a), the portal venous phase (b) and the delayed phase (c) shows marked enhancement in the PHNET relative to the liver parenchyma (right lobe at the arterial phase), and slight hyperattenuation relative to the surrounding liver parenchyma in the delayed phases. The integrity of the capsule is maintained. The mitosis rate shows up as hypo-density and no enhancement on the dynamic enhanced CT scan. HE staining of the tumor (d) shows tumor cells arranged as solid nests, consistent cell size and mitosis rate was 1/10 HPF. Magnification: D = 100X

Mentions: Based on CT imaging (Table 1) and MRI data (Table 2), all G1 liver lesions were singular with only one lesion located in left lobe and remaining lesions the in right lobe. A CT scan of one patient revealed central necrosis in the absence of hemorrhage and cystic change. One patient had calcification and mild enhancement. For the other 6 patients, pre- and post-enhanced CT densities were homogenous and showed marked enhancement (Fig. 1), while the dynamic-contrast enhancement curves of seven lesions (87.5 %) appeared as type III. All lesions showed enhanced capsules in the delayed phase of post-enhancement CT while one lesion appeared plateau-like type. Seven out of eight patients with G1 PHNETs underwent a MRI examination in addition to a CT scan (Table 2). The lesions showed hypointensity on pre-enhanced T1-weighted and homogeneous, mildly high intensity or high intensity on T2-weighted imaging. Enhancements on post-enhanced MRI scans had markedly high (6 cases) and mildly high intensities (1 case). The ADC values in the liver tumors were lower than the surrounding normal liver tissue (1.39 ± 0.20 × 10−3 mm2/s versus (2.0 ± 0.38 × 10−3 mm2/s). All lesions showed enhanced capsules in the delayed phase of post-enhancement MRI scans. These data further confirm that G1 lesions were benign or low-grade malignant tumors and distinguishable from hepato-cellular carcinoma.Table 1


Primary hepatic neuroendocrine tumors: comparing CT and MRI features with pathology.

Wang LX, Liu K, Lin GW, Jiang T - Cancer Imaging (2015)

CT scan and histology of grade 1 PHNET. Post-contrast CT image of the arterial phase (a), the portal venous phase (b) and the delayed phase (c) shows marked enhancement in the PHNET relative to the liver parenchyma (right lobe at the arterial phase), and slight hyperattenuation relative to the surrounding liver parenchyma in the delayed phases. The integrity of the capsule is maintained. The mitosis rate shows up as hypo-density and no enhancement on the dynamic enhanced CT scan. HE staining of the tumor (d) shows tumor cells arranged as solid nests, consistent cell size and mitosis rate was 1/10 HPF. Magnification: D = 100X
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4536757&req=5

Fig1: CT scan and histology of grade 1 PHNET. Post-contrast CT image of the arterial phase (a), the portal venous phase (b) and the delayed phase (c) shows marked enhancement in the PHNET relative to the liver parenchyma (right lobe at the arterial phase), and slight hyperattenuation relative to the surrounding liver parenchyma in the delayed phases. The integrity of the capsule is maintained. The mitosis rate shows up as hypo-density and no enhancement on the dynamic enhanced CT scan. HE staining of the tumor (d) shows tumor cells arranged as solid nests, consistent cell size and mitosis rate was 1/10 HPF. Magnification: D = 100X
Mentions: Based on CT imaging (Table 1) and MRI data (Table 2), all G1 liver lesions were singular with only one lesion located in left lobe and remaining lesions the in right lobe. A CT scan of one patient revealed central necrosis in the absence of hemorrhage and cystic change. One patient had calcification and mild enhancement. For the other 6 patients, pre- and post-enhanced CT densities were homogenous and showed marked enhancement (Fig. 1), while the dynamic-contrast enhancement curves of seven lesions (87.5 %) appeared as type III. All lesions showed enhanced capsules in the delayed phase of post-enhancement CT while one lesion appeared plateau-like type. Seven out of eight patients with G1 PHNETs underwent a MRI examination in addition to a CT scan (Table 2). The lesions showed hypointensity on pre-enhanced T1-weighted and homogeneous, mildly high intensity or high intensity on T2-weighted imaging. Enhancements on post-enhanced MRI scans had markedly high (6 cases) and mildly high intensities (1 case). The ADC values in the liver tumors were lower than the surrounding normal liver tissue (1.39 ± 0.20 × 10−3 mm2/s versus (2.0 ± 0.38 × 10−3 mm2/s). All lesions showed enhanced capsules in the delayed phase of post-enhancement MRI scans. These data further confirm that G1 lesions were benign or low-grade malignant tumors and distinguishable from hepato-cellular carcinoma.Table 1

Bottom Line: Primary hepatic neuroendocrine tumors (PHNET) are extremely rare and difficult to distinguish from primary and metastatic liver cancers since PHNETs blood supply comes from the liver artery.According to the 2010 WHO classification system, PHNETs are divided into three grades based on histological criteria.Portal venous tumor thrombus was seen in one case.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Beijing Chaoyang Hospital, Capital University of Medical Sciences, Beijing, 100020, China.

ABSTRACT

Background: Primary hepatic neuroendocrine tumors (PHNET) are extremely rare and difficult to distinguish from primary and metastatic liver cancers since PHNETs blood supply comes from the liver artery. This study aims to investigate CT and MR imaging findings of primary hepatic neuroendocrine tumor (PHNET) and correlation with the 2010 WHO pathological classification.

Methods: We examined CT and MRI scans from 29 patients who were diagnosed with PHNET and correlated the data with the 2010 WHO classification of neuroendocrine tumors.

Results: According to the 2010 WHO classification system, PHNETs are divided into three grades based on histological criteria. Grade 1 tumors are singular, solid nodules with enhancement at the arterial phase on CT and MRI scans. In grade 1 tumors, the dynamic-contrast enhancement curve shows rapid wash-in in the arterial phase. Grade 2 tumors can have a singular or multiple distribution pattern, necrosis, and nodule or marginal ring-like enhancements. Grade 3 tumors have multiple lesions, internal necrosis, and evidence of hemorrhage. Portal venous tumor thrombus was seen in one case. As tumor grades increase, the capsule begins to lose integrity and tumor apparent diffusion coefficient (ADC) values decrease(grade 1: 1.39 ± 0.20× 10(-3) mm(2)/s versus grade 2: 1.26 ± 0.23× 10(-3) mm(2)/s versus grade 3: 1.14 ± 0.17× 10(-3) mm(2)/s).

Conclusion: CT and MRI can reflect tumor grade and pathological features of PHNETs, which are helpful in accurately diagnosing PHNETs.

No MeSH data available.


Related in: MedlinePlus