Primary hepatic neuroendocrine carcinoma
Authors:
J. Dvořáčková 1; J. Mačák 1; F. Fakhouri 1; J. Horáček 1; J. Plášek 2
Authors‘ workplace:
Ústav patologie Lékařské fakulty Ostravské univerzity a Fakultní nemocnice v Ostravě
1; Interní klinika Lékařské fakulty Ostravské univerzity a Fakultní nemocnice v Ostravě
2
Published in:
Čes.-slov. Patol., 48, 2012, No. 1, p. 49-52
Category:
Original Article
Overview
Primary neuroendocrine carcinoma of the liver is a rare tumour, probably arising from scattered neuroendocrine cells of the bile duct. We present the case of a 72-year-old male who experienced gradual weight loss and diarrhoea. Given the fact that he had stayed in the Dominican Republic, a parasitic disease was initially suspected. However, this was not confirmed. Further examination showed tumour infiltration of the liver. Fine needle aspiration cytology of the tumour site was performed.
The diagnostic procedure revealed neuroendocrine carcinoma. The tumour cells expressed the following neuroendocrine markers (chromogranin, synaptophysin, CD56 and NSE) as well as the epithelial marker AE1-AE3. The tumour was considered metastasis of the primary tumour located in the gastrointestinal tract. A thorough clinical examination was performed including gastroscopy, colonoscopy, In-111 Octreoscan scintigraphy, computed tomography and magnetic resonance imaging. These methods revealed metastases in the vertebrae, pelvis, long bones and skull. No other tumour sites were found in the lungs, gastrointestinal tract or pancreas. The patient became increasingly cachexic and later died.
An autopsy showed massive multicentric tumour infiltration of the liver. Histological examination revealed well differentiated neuroendocrine carcinoma which transformed into intermediate and small cells. The autopsy found no tumour sites in the gastrointestinal tract, lungs or pancreas. The results were suggestive of primary neuroendocrine carcinoma of the liver.
Keywords:
neuroendocrine carcinoma – liver – primary tumour
Sources
1. Edmondson HA. Carcinoid tumor. In: Edmondson HA. Tumors of the Liver and Intrahepatic Bile Ducts. Atlas of tumor Pathology, fascicle 25. Washington: AFIP; 1958: 105–111.
2. Soga J. Primary hepatic endocrinomas (carcinoids and variant neoplasms). A statistical evaluation of 126 reported cases. J Exp Clin Cancer Res 2002; 21: 457–468.
3. Modlin IM, Kidd M, Latich I, et al. Current status of gastrointestinal carcinoids. Cancer 1997; 79: 813–829.
4. Yp X, JY Y. Primary neuroendocrine carcinoma of the liver. Ultrastruct Pathol 1986; 10: 331–336.
5. Alpert LI, Zak FG, Werthamer S, Bochetto JF. Cholangiocarcinoma: a clinicopathologic study of five cases with ultrastructural observations. Hum Pathol 1974; 5: 709–728.
6. Primack A, Wilson J, OęConnor GT, et al. Hepatocellular carcinoma with the carcinoid syndrome. Cancer 1971; 27: 1182–1189.
7. Zhao J, de Krijger RR, Meier D, et al. Genomic alterations in well-differentiated gastrointestinal neuroendocrine tumors (carcinoids). Marked differences indicating diversity in molecular pathogenesis. Am J Pathol 2000; 157: 1431–1438.
8. Deehan DJ, Heys SD, Kernohan N, Eremin O. Carcinoid tumour of the gallbladder: two case reports and a review of published works. GUT 1993; 34: 1274–1276.
9. Khetan N, Bose NCH, Arya SV. Carcinoid tumor of the gallbladder: report of a case. Surg Today 1995; 25: 1047–1049.
10. Ozawa K, Kinoshita M. A case of double carcinoid tumors of the gallbladder. Dig Dis Sci 2003; 48: 1760–1761.
11. Zou YP, Li WM, Liu HR, Li N. Primary carcinoid tumor of the gallbladder: a case report and brief review of the literature. World J Surg Oncol 2010; 8: 12.
12. Roskams T, de Vos R, van der Oord JJ, Desmet V. Cells with neuroendocrine features in regenerating human liver. APMIS Suppl. 1991; 23: 32–39.
13. Dala R, Shoosmith J, Lilenbaum R, Cabello-Inchausti B. Primary hepatic neuroendocrine carcinoma: an underdiagnosed entity. Ann Diagn Pathol 2006; 10: 28–31.
14. Nwokediuko SCH, Uchenna I, Esther O, Ocheukwu O, Augustine O, Charity A. Relating long survival in hepatocellular carcinoma presentig with carcinoid syndrome. Gastroenterol Res 2010; 3: 46–49.
15. Blobel GA, Gould VE, Moll R, et al. Coexpression of neuroendocrine markers and epithelial cytoskeletal proteins in bronchopulmonary neuroendocrine neoplasms. Lab Invest 1985; 52: 39–51.
16. Kimura N, Sasano N, Namiki T, Nakazato Y. Coexpression of cytokeratin, neurofilament and vimentin in carcinoid tumors. Virchows Arch A Pathol Anat Histopathol 1989; 415: 69–77.
17. Ishak KG, Goodman ZD, Stocker JT. Tumors of the liver and intrahepatic bile ducts, third edition, Atlas of tumor Pathology, fascicle 31. Washington: AFIP; 2001: 274–275.
18. Lau PPL, Tint KA, Tse GMK, et al. Primary hepatic carcinoids: report of two cases. Pathology 2006; 38: 458–461.
19. Broaddus RR, Herzog CE, Hicks MJ. Neuroendocrine tumors (carcinoids and neuroendocrine carcinoma) presentig at extra-appendiceal sites in childhood and adolescence. Arch Pathol Lab Med 2003; 127: 1200–1203.
20. Nikfarjam M, Muralidharan V, Christophi C. Primary hepatic carcinoid tumours. HPB 2004; 6: 13–17.
21. Ferrero A, Gallino C, DęAloisio G, Gandini G, Garavoglia M. Primary neuroendocrine carcinoma of the liver: difficult diagnosis of a rare neoplasm. Acta Chir Belg 1999; 99: 299–302.
22. Ishizu A, Yokoyama K, Yoshiki T. Primary neuroendocrine carcinoma of the liver diagnosed at autopsy. J Gastroenterol Hepatol 2003; 18: 1002–1004.
23. Iwao M, Nakamuta M, Enjoji M, et al. Primary hepatic carcinoid tumor: case report and review of 53 cases. Med Sci Monit 2001; 7: 746–750.
24. Kaya G, Pasche Ch, Osterheld MC, Chaubert P, Fontolliet Ch. Primary neuroendocrine carcinoma of the liver: an autopsy case. Pathol Int 2001; 51: 874–878.
25. Pilichowska M, Kimura N, Ouchi A, et al. Primary hepatic carcinoid and neuroendocrine carcinoma: clinicopathological and immunohistochemical study of five cases. Pathol Int 1999; 49: 318–324.
26. Yosuda E, Takeshita A, Murata S, et al. Neuroendocrine carcinoma of the liver associated with dermatomyositis: autopsy case and review of the literature. Pathol Int 2003; 56: 749–754.
27. Kim YH, Kwon R, Jung GJ, et al. Extrapulmonary small-cell carcionoma of the liver. J Hepatobiliary Pancreat Surg 2004; 11: 333–337.
28. Sengoz M, Abacioglu U, Salepci T, et al. Extrapulmonary small cell carcinoma: multimodality treatment results. Tumori 2003; 89: 274–277.
29. Zanconati F, Falconieri G, Lamovec J, Zidar A. Small cell carcinoma of the liver: a hitherto unreported variant of hepatocellular carcinoma. Histopathology 1996; 29: 449–453.
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