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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 PHNET. Post-contrast CT image of the arterial phase (a), portal venous phase (b), and delayed phase (c). The PHNET (5.4 × 5.7 cm in size) has marginal ring-like and septal enhancements (right lobe). Arterial phases reveal a wash-in pattern at the periphery of the tumor. Portal phase and delayed phase reveal slight peripheral hyper-attenuation compared with the surrounding liver parenchyma. HE staining shows liver tumor cells arranged in an island. Atypia and nucleoli were not readily apparent but nuclear chromatins were distributed in fine granules (d). Mitosis rate was 2–3/10 HPF and blood sinus was abundant in the intestinal with no hemorrhage
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Fig2: CT scan and histology of grade PHNET. Post-contrast CT image of the arterial phase (a), portal venous phase (b), and delayed phase (c). The PHNET (5.4 × 5.7 cm in size) has marginal ring-like and septal enhancements (right lobe). Arterial phases reveal a wash-in pattern at the periphery of the tumor. Portal phase and delayed phase reveal slight peripheral hyper-attenuation compared with the surrounding liver parenchyma. HE staining shows liver tumor cells arranged in an island. Atypia and nucleoli were not readily apparent but nuclear chromatins were distributed in fine granules (d). Mitosis rate was 2–3/10 HPF and blood sinus was abundant in the intestinal with no hemorrhage

Mentions: For the ten patients with G2 PHNETs, CT scans revealed both single and multiple lesions with necrosis (Table 1). Nodular or marginal-ring enhancements were presented on post-enhanced CT images (Fig. 2). Seven out of ten patients had single lesions that appeared with capsule-enhancement in the delayed phase. One case appeared as cystic and solid and was presumed to be echinococcosis on unenhanced, post-enhanced CT imaging and a pre-operational ultrasound because the patient lived in an area with an echinococcosis epidemic. This case was later confirmed to be a G2 PHNET based on pathology following surgical resection. Three cases had multiple lesions and were misdiagnosed as metastases on CT and MRI scans, but were later determined to be G2 PHNETs based on needle biopsies. Furthermore, MRI revealed necrosis and cystic change in these lesions. Signal intensities were heterogeneous on T1- and T2-weighted imaging with significant necrosis (Fig. 2) and appeared as hypointensity on T1WI and mildly high intentsity on T2WI. The ADC values on diffusion-weighted imaging (DWI) were lower relative to normal liver tissue (1.26 ± 0.23 × 10−3 mm2/s versus 2.02 ± 0.26 × 10−3 mm2/s, respectively). Nodular or marginal-ring enhancements were presented on post-enhanced MR images. Dynamic enhanced curves (9/10) with CT and MRI appeared as type III in the tumor margin or solid area.Fig. 2


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 PHNET. Post-contrast CT image of the arterial phase (a), portal venous phase (b), and delayed phase (c). The PHNET (5.4 × 5.7 cm in size) has marginal ring-like and septal enhancements (right lobe). Arterial phases reveal a wash-in pattern at the periphery of the tumor. Portal phase and delayed phase reveal slight peripheral hyper-attenuation compared with the surrounding liver parenchyma. HE staining shows liver tumor cells arranged in an island. Atypia and nucleoli were not readily apparent but nuclear chromatins were distributed in fine granules (d). Mitosis rate was 2–3/10 HPF and blood sinus was abundant in the intestinal with no hemorrhage
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: CT scan and histology of grade PHNET. Post-contrast CT image of the arterial phase (a), portal venous phase (b), and delayed phase (c). The PHNET (5.4 × 5.7 cm in size) has marginal ring-like and septal enhancements (right lobe). Arterial phases reveal a wash-in pattern at the periphery of the tumor. Portal phase and delayed phase reveal slight peripheral hyper-attenuation compared with the surrounding liver parenchyma. HE staining shows liver tumor cells arranged in an island. Atypia and nucleoli were not readily apparent but nuclear chromatins were distributed in fine granules (d). Mitosis rate was 2–3/10 HPF and blood sinus was abundant in the intestinal with no hemorrhage
Mentions: For the ten patients with G2 PHNETs, CT scans revealed both single and multiple lesions with necrosis (Table 1). Nodular or marginal-ring enhancements were presented on post-enhanced CT images (Fig. 2). Seven out of ten patients had single lesions that appeared with capsule-enhancement in the delayed phase. One case appeared as cystic and solid and was presumed to be echinococcosis on unenhanced, post-enhanced CT imaging and a pre-operational ultrasound because the patient lived in an area with an echinococcosis epidemic. This case was later confirmed to be a G2 PHNET based on pathology following surgical resection. Three cases had multiple lesions and were misdiagnosed as metastases on CT and MRI scans, but were later determined to be G2 PHNETs based on needle biopsies. Furthermore, MRI revealed necrosis and cystic change in these lesions. Signal intensities were heterogeneous on T1- and T2-weighted imaging with significant necrosis (Fig. 2) and appeared as hypointensity on T1WI and mildly high intentsity on T2WI. The ADC values on diffusion-weighted imaging (DWI) were lower relative to normal liver tissue (1.26 ± 0.23 × 10−3 mm2/s versus 2.02 ± 0.26 × 10−3 mm2/s, respectively). Nodular or marginal-ring enhancements were presented on post-enhanced MR images. Dynamic enhanced curves (9/10) with CT and MRI appeared as type III in the tumor margin or solid area.Fig. 2

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