Hepatic neuroendocrine tumor
Discussion:
- The patient was diagnosed as metastatic adenocarcinoma of the liver with an unknown primary (on imaging & liver biopsy) 15 years ago in another health facility and was treated with cisplatin-based chemotherapy. Unfortunately, the previous imaging and histopathology record was not available for review. The patient had no history of pulmonary tuberculosis.
- After abdominal ultrasound examination and triphasic CT abdomen, further investigations were done, particularly for GIT malignancy, tuberculosis, amebiasis, and hydatid disease, all of which were negative. The case was discussed in our tumor board meeting and decided to proceed with the hepatic lesion biopsy, under anthelmintic (albendazole 400 mg bid for four weeks) cover.
- Procedure: Ultrasound-guided Tru-cut biopsy of the hepatic lesion. Microscopic Description: The tumor is well-circumscribed limited by pseudo-fibrous pseudo-capsule. The tumor proliferation is composed of the small nests of syncytial cells with abundant basophilic cytoplasm and hyperchromatic nuclei showing sometimes inconspicuous nucleoli or some pseudo-inclusions. Some of the tumor cells show pseudo-glandular cavities and some are filled by large hyaline bodies. The stroma between the nests is very highly vascularized and in the nest, some cells are multinucleated. Moderate atypia but no abnormal mitosis is seen. These morphological features are suggestive of hepatic neuroendocrine tumor. Immunostaining: The immunostains with the antibody anti-Pancytokeratin (AE1/AE3), anti-CK7, and anti-Synaptophysin are diffusely positive. CK19 is focally positive. CK20 is also positive in rare cells. The immunostain with the antibody anti-Vimentin highlight the reached vascular channels surrounding the tumor nest. The immunostains with the antibody chromogranin, antibody anti-hepatocyte, anti-CD10, anti-smooth actin, alpha-fetoprotein, antibody anti-HMB45, anti-S100, and the antibody anti-Glypican are negative. The Ki67 index is 1%. Final Diagnosis: Neuroendocrine tumor, low grade (< 2 mitoses per 10 high-power field, Ki67 <1%).
- I123-MIBG & octreotide scans were done after the liver biopsy result.
- The patient was referred to the medical oncologist for further management.
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