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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

MRI and histology of grade 3 PHNET. Transverse T1-weighted (a), transverse T2-weighted (b), contrast-enhanced dynamic T1-weighted at the arterial phase (c) and delayed phase (d). Figure e and f illustrate liver arterial reconstruction, and transverse diffusion-weighted imaging(b = 800 s/mm2, respectively). This grade 3 tumor (8.4 cm in size) was located in the right lobe with a cystic change in the liver wall. Multiple satellite nodules show marked peripheral enhancement in the arterial phase and slight hyper-intensity relative to the surrounding liver parenchyma in the delayed phase. Diffusion-weighted imaging (Figure f) shows high peripheral signal intensity, which reflects the diffuse restriction of water. Figure e confirms that the tumor blood supply comes from the liver artery. HE staining of liver tumor cells with atypia, varying sizes, multiple mitosis rates, and irregular nucleoli (g). Staining for the neuroendocrine marker, synaptophysin (Syn) was positive (h). Magnifications: G and H = 100X
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Fig3: MRI and histology of grade 3 PHNET. Transverse T1-weighted (a), transverse T2-weighted (b), contrast-enhanced dynamic T1-weighted at the arterial phase (c) and delayed phase (d). Figure e and f illustrate liver arterial reconstruction, and transverse diffusion-weighted imaging(b = 800 s/mm2, respectively). This grade 3 tumor (8.4 cm in size) was located in the right lobe with a cystic change in the liver wall. Multiple satellite nodules show marked peripheral enhancement in the arterial phase and slight hyper-intensity relative to the surrounding liver parenchyma in the delayed phase. Diffusion-weighted imaging (Figure f) shows high peripheral signal intensity, which reflects the diffuse restriction of water. Figure e confirms that the tumor blood supply comes from the liver artery. HE staining of liver tumor cells with atypia, varying sizes, multiple mitosis rates, and irregular nucleoli (g). Staining for the neuroendocrine marker, synaptophysin (Syn) was positive (h). Magnifications: G and H = 100X

Mentions: Four out of eleven cases with G3 PHNETs were singular and the remaining seven cases appeared as diffuse, multi-nodular or marginal-ring enhancement on CT. Three multi-nodular cases were misdiagnosed as metastases and two cases were misdiagnosed as hepatocellular carcinoma with diffuse intra-liver metastases. This misdiagnosis further suggests that a combination of a detailed clinical history and lab tests are essential in the accurate diagnosis of PHNET. The dynamic-contrast enhancement curves illustrated type III. Hemorrhage was seen in one tumor (Fig. 3) with no evidence of lymph node metastases. However, one case had tumor thrombus in the portal vein in and 10 cases had necrosis, heterogeneous hypo-intensity on T1WI and high intensity or mildly high intensity on T2WI as illustrated by MRI. On T2WI, one case showed the liquid-liquid level and another showed hypo-intensity in the lower part. All patients (9/9) showed multi-nodular or marginal-ring markedly high enhancements on post-enhanced MRI and at the margins or solid area of the tumor dynamic-contrast enhancement curves (type III). ADC values were lower in liver lesions compared to the surrounding normal liver tissue (1.14 ± 0.17 × 10−3 mm2/s versus 1.97 ± 0.30 × 10−3 mm2/s, respectively). In one case, tumor thrombus appeared as a filling-defect in the portal vein.


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

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

MRI and histology of grade 3 PHNET. Transverse T1-weighted (a), transverse T2-weighted (b), contrast-enhanced dynamic T1-weighted at the arterial phase (c) and delayed phase (d). Figure e and f illustrate liver arterial reconstruction, and transverse diffusion-weighted imaging(b = 800 s/mm2, respectively). This grade 3 tumor (8.4 cm in size) was located in the right lobe with a cystic change in the liver wall. Multiple satellite nodules show marked peripheral enhancement in the arterial phase and slight hyper-intensity relative to the surrounding liver parenchyma in the delayed phase. Diffusion-weighted imaging (Figure f) shows high peripheral signal intensity, which reflects the diffuse restriction of water. Figure e confirms that the tumor blood supply comes from the liver artery. HE staining of liver tumor cells with atypia, varying sizes, multiple mitosis rates, and irregular nucleoli (g). Staining for the neuroendocrine marker, synaptophysin (Syn) was positive (h). Magnifications: G and H = 100X
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: MRI and histology of grade 3 PHNET. Transverse T1-weighted (a), transverse T2-weighted (b), contrast-enhanced dynamic T1-weighted at the arterial phase (c) and delayed phase (d). Figure e and f illustrate liver arterial reconstruction, and transverse diffusion-weighted imaging(b = 800 s/mm2, respectively). This grade 3 tumor (8.4 cm in size) was located in the right lobe with a cystic change in the liver wall. Multiple satellite nodules show marked peripheral enhancement in the arterial phase and slight hyper-intensity relative to the surrounding liver parenchyma in the delayed phase. Diffusion-weighted imaging (Figure f) shows high peripheral signal intensity, which reflects the diffuse restriction of water. Figure e confirms that the tumor blood supply comes from the liver artery. HE staining of liver tumor cells with atypia, varying sizes, multiple mitosis rates, and irregular nucleoli (g). Staining for the neuroendocrine marker, synaptophysin (Syn) was positive (h). Magnifications: G and H = 100X
Mentions: Four out of eleven cases with G3 PHNETs were singular and the remaining seven cases appeared as diffuse, multi-nodular or marginal-ring enhancement on CT. Three multi-nodular cases were misdiagnosed as metastases and two cases were misdiagnosed as hepatocellular carcinoma with diffuse intra-liver metastases. This misdiagnosis further suggests that a combination of a detailed clinical history and lab tests are essential in the accurate diagnosis of PHNET. The dynamic-contrast enhancement curves illustrated type III. Hemorrhage was seen in one tumor (Fig. 3) with no evidence of lymph node metastases. However, one case had tumor thrombus in the portal vein in and 10 cases had necrosis, heterogeneous hypo-intensity on T1WI and high intensity or mildly high intensity on T2WI as illustrated by MRI. On T2WI, one case showed the liquid-liquid level and another showed hypo-intensity in the lower part. All patients (9/9) showed multi-nodular or marginal-ring markedly high enhancements on post-enhanced MRI and at the margins or solid area of the tumor dynamic-contrast enhancement curves (type III). ADC values were lower in liver lesions compared to the surrounding normal liver tissue (1.14 ± 0.17 × 10−3 mm2/s versus 1.97 ± 0.30 × 10−3 mm2/s, respectively). In one case, tumor thrombus appeared as a filling-defect in the portal vein.

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