Non-functional neuroendocrine tumor in a patient with diffuse liver metastases: A case report

Year 2010, Volume: 9 Issue: 1, 27 - 31, 01.04.2010

Kendal Yalçın Zuhat Urakçı Remzi Beştaş Feyzullah Uçmak

Abstract

Neuroendocrine tumors arise from neuroendocrine system cells, and constitute a heterogeneous group of neoplasms. In this case report, a case of non-functional neuroendocrine tumor presented with diffuse liver metastases is discussed. In the initial evaluation, massive hepatomegaly was detected in a 62-year-old female admitted to our clinic due to symptoms of abdominal pain and bloating. There was no detectable abnormality except hyperthyroidism in the laboratory studies. Numerous hypodense mass lesions compatible with diffuse hepatic metastases were found in radiological examinations. Liver biopsy showed neuroendocrine tumor in hepatic metastases. No focus was found for the primary site of tumor. Surgical resection as a treatment option was not applicable because of her advanced age and diffuse liver metastases. Long-acting somatostatin analogue was prescribed for the patient. In the follow-up, despite reduction in the patient's symptoms, there was no change in the tumor size. In conclusion, it should be kept in mind that rare neuroendocrine tumors may present with asymptomatic diffuse liver metastases with a non-functional tumor, despite the fact that these tumors have an indolent course.

Keywords

Liver, neuroendocrine tumor, hepatic metastases

Diffüz karaciğer metastazı ile başvuran bir hastada fonksiyonel olmayan nöroendokrin tümör: Olgu sunumu

Abstract

Nöroendokrin tümörler, nöroendokrin sistem hücrelerinden köken alan heterojen bir neoplazma grubundan oluşmaktadırlar. Bu olgu sunumunda diffüz karaciğer metastazı ile seyreden non-fonksiyone bir nöroendokrin tümör olgusu tartışılmıştır. Kliniğimize karın ağrısı ve karında şişlik şikayetleri ile başvuran 62 yaşındaki bayan hastanın yapılan ilk değerlendirmesinde masif hepatomegali saptandı. Laboratuar incelemelerinde hipertiroidi dışında anlamlı bir bulgu bulunmadı. Radyolojik incelelemelerde ise karaciğerde diffüz metastazla uyumlu çok sayıda hipodens kitle lezyonları saptandı. Yapılan karaciğer biyopsisi, hepatik nöroendokrin tümör metastazı ile uyumlu bulundu. Hastada primer odak bulunamadı. Diffüz karaciğer tutulumu birlikte hastanın yaşının ileri olması nedeni ile cerrahi rezeksiyon duşünülmedi. Hastaya uzun etkili somatostatin analoğu başlandı. Takiplerde hastanın semptomları gerilemesine rağmen radyolojik bulgularda gerileme gözlenmedi. Sonuç olarak nadir görülen nöroendokrin tümörlerin alışılageldiği yavaş seyrinin aksine tümüyle yakın zamana kadar asemptomatik seyretmesine karşın, yaygın karaciğer metastazıyla birlikte afonksiyone olarak prezente olabileceği göz önünde bulundurulmalıdır.

Keywords

Karaciğer, nöroendokrin tümör, hepatik metastaz

References

• Solcia E, Kloppel G, Sobin LH. Histological typing of endocrine tumours. Second edition WHO Heidelberg:Springer-Verlag; 2000; 38-74.
• Rindi G, Villanacci V, Ubiali A. Biological and molecular aspects of gastroenteropancreatic neuroendocrine tumors. Digestion 2000; 62:19-26.
• Adam M, Douglas GA. Neuroendocrine Tumors: Review and Clinical Update 2007;51:12-20.
• Taal BG, Visser O. Epidemiology of neuroendocrine tumours. Neuroendocrinology 2004;80:3–7.
• Sutcliffe R, Maguire D, Ramage J, et al. Management of neuroendocri liver metastases. Am J Surg 2004;187:39–46
• Mazzaferro V, Pulvirenti A, Coppa J. Neuroendocrine tumor metastatic to the liver: how to select patients for liver transplantation? J Hepatology 2007;47:460–6.
• Benevento A, Boni L, Frediani L, et al. Result of liver resection as treatment for metastases from noncolorectal cancer. J Surg Oncol 2000;74:24-9.
• Blonski WC, Reddy KR, Shaked A, et al. Liver transplantation for metastatic neuroendocrine: A case report and review of the literature. World J Gastroenter 2005;11:7676–83.
• Frilling A, Rogiers X, Malago M, et al. Liver transplantation in patients with liver metastases of neuroendocrine tumors. Transplant Proc. 1998;30:3298-300.
• Ahlman H, Friman S, Cahlin C, et al. Liver transplantation for treatment of metastatic neuroendocrine tumors. Ann N.Y Acad Sci 2004;1014:265-9.
• Sarmiento JM, Que FG. Hepatic surgery for metastases from neuroendocrine tumors. Surg Oncol Clin N Am 2003;12:231-42.
• Chamberlain RS, Canes D, Brown KT, Y et al. Hepatic neuroendocrine metastases: does intervention alter outcomes? J Am Coll Surg 2000; 190:432-45.
• Plöckinger U, Wiedenmann B. Diagnosis of non-functioning neuroendocrine gastro-enteropancreatic tumours. Neuroendocrinology 2004;80:35–8.
• Yao JC, Hassan M, Phan A, et al. One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol. 2008;26: 3063-72.
• David RS, John DH, Anthony G. Neuroendocrin Carcinoma of unknown primary site. 2009:36;52-9.
• Chatal JF, Le Bodic MF, Kraeber-Bodere F, et al. Nuclear medicine applications for neuroendocrine tumors. World J Surg 2000; 24:1285-9.
• Olausson M, Friman S, Cahlin C, et al. Indications and resuls of liver transplantation in patients with neuroendocrine tumors. World J Surg 2002;26:998-1004.