Presentation
Abdominal pain and focal lesion by US.
Patient Data
The right hepatic lobe (segments VIII and VII) fairly defined a large focal lesion. The lesion shows internal cystic areas and peripheral enhancement showing contrast enhancement on the portal venous phase and slight contrast washout at the delayed phase.
Otherwise normal CT scan of the abdomen and pelvis.
CT-guided biopsy of the hepatic focal lesion shows cores of tumor tissue formed of groups of epithelial cells showing mild nuclear pleomorphism and hyperchromasia, arranged in solid nests. There's moderate desmoplasia. No necrosis. Examination revealed red blood cells.
Diagnosis: right hepatic focal lesion, infiltrating epithelial type neoplasm (neuroendocrine tumor).
Case Discussion
The radiological features of the hepatic focal lesion suggested an aggressive (neoplastic) lesion with internal cystic areas of degeneration. Still, the patient's young age, negative HBB and C virus infections and non-cirrhotic liver made HCC unlikely. However, a neoplastic mass lesion, such as biliary cystadenocarcinoma or cholangiocarcinoma, was still considered. The biopsy revealed a hepatic neuroendocrine tumor.
Primary hepatic neuroendocrine tumors (carcinoids) are an extremely rare type of neuroendocrine tumor.
Radiographic features, there are no specific imaging features and cases are diagnosed retrospectively.
Somatostatin-receptor nuclear medicine studies (In-111 pentetreotide (Octreoscan)) should be positive.
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