| Objective:This essay is to investigate the clinical characteristics, diagnosis and treatment of primary hepatic neuroendocrine tumors.Methods:The case and clinical data from a patient who was dignosed as primary hepatic neuroendocrine tumors, according to the postoperative pathology and immunohistochemical verification, was analysed retrospectively. The source of this case is from the hepatobiliary pancreatic surgery, belongs to the Second Affiliated Hospital of Dalian Medical University in September, 2014.Results: This essay includes a female patient who is 59 years old. Ultrasound revealed a6.6×5.1cm heterogeneous hepatic tumor over posterior segment. There is no obvious expansion over extrahepatic bile duct and no abnormity over bile cyst and pancreatic.The diameter of portal vein is not wide. MRI reveals two big abnormal signals over the two lobe of liver, about 20×27mm、48×70mm respectively. Mixed signal is observed over the right hepatic lobe lesion and fluid level is reached. The left hepatic lobe lesion T1 shows low signal, and higher signal in T2. Uneven obvious reinforcement appears in arterial enhancement scan, and contrast agent exit is not obvious in vein and delay.Larger lesions in the right hepatic lobe T1 shows a slightly low and low signal, and mixed signals in T2. Ring sample and patch sample obviously improved in arterial phase, and contrast agent part exit in vein and delay. The patient has the right liver resection, the left liver resection and gallbladder removal. The operation reveals no sclerosing change in the liver. A tumour about 6×5cm was seen in the VII section of liver, which is high tension and rich surface vessels. A White quality toughening nodules about 0.4cm can be seen in the V section of the liver surface. In the III section within the liver parenchyma, a 2.5×2.0cm goitre is observed as circle and tough texture.The III section of left lobe of liver is removed. The tumor is white and tough texture when splitting liver parenchyma. The V section of nodular liver surface and the VI, VII of liver is removed, tumor is cystic or solid. Dark bloody fluid is shown as liquid ingredients; it is high tension and tumor part is dark red and brittle. Histomorphology shows medium tumor cell volume, abundant cytoplasm and round nuclei. Chromatin is fine granular and small nucleoli can be seen. Oncocyte is patchy in distribution and few intercellular substance. Vascular is rich and part is tumor embolus. There is no clear boundaries between tumor and hepatic tissue. Immunohistochemistry showed AE1/AE3(+),CD56(+),CK20(-),CDX-2(-),Hepatocyte(-),cg A(+),Syn(+),villin(+),NSE(+),Ki-67 index of about 10%. The patients are fine in postoperatiove phase and alive. Till January,2015, there is no recurrence and metastatic lesion in follow-up visits.Conclusion: Primary hepatic neuroendocrine tumors is rare and shows no specificity in clinical manifestation. Imaging examination can provide reference, and tumor is cystic or cystic solid. CT or MRI observes tumor with inhomogeneous and obvious strengthen. Contrast medium exist not obviously in venous and delay phase. Under the condition of negative AFP, no hepatitis and cirrhosis, it considers this illness combining with other inspections. The nosogenesis of liver neuroendocrine tumors is not clear and definite. It has no specific markers. Usual Immunohistochemical markers include cg A, NSE, synaptophysin and so on. cg A is the first choice; the sensitivity and specificity of 5-hydroxyindoleacetic acid is pretty high. The diagnosis of liver neuroendocrine tumors excludes extrahepatic metastasis and then it can be diagnosed as primary hepatic neuroendocrine tumors. Operational treatment is primary choice, and interventional therapy, biotherapy and molecular targeted therapy assists. If it is unresectable and no distant metastasis, liver transplantation could be a substitute. In conclusion, the prognosis is acceptable. |
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