Renal Metastasis from a Primary Hepatic Neuroendocrine Tumor: A Case Report and Literature Review

Abstract

Neuroendocrine tumors (NET) are a diverse collection of neoplasms with varying biological characteristics, histologic patterns, and therapeutic responses. We present a rare case of a 41-year-old female who was diagnosed with a primary NET of the liver and had multiple kidney and bone metastases. Primary hepatic NETs are rare, and metastasis to the kidney makes this case one of the few in the literature. The patient was admitted to the hospital because of pain in the lower extremities. Several imaging examinations revealed multiple lesions in the bone, kidney, and liver. Sandostatin and Denosumab treatments are started against the tumor and bone metastases. At first, the team thought the case was a NET of the liver and synchronous renal cell carcinoma. However, after the total excision of the kidney, pathology was reported as the NET metastasis to the kidney. Despite showing regression in bone metastases, the lesion in the the liver has advanced. 177Lu-DOTATATE treatment was added to the current treatment regimen. Renal metastasis from a primary hepatic NET can be challenging to diagnose and treat. Since there are no guidelines specifically designed for this type of case, multiple treatment modalities must be discussed with a multidisciplinary team to choose the best option for patients

Keywords

• Neuroendocrine tumor
• primary hepatic neuroendocrine tumor
• renal metastasis
• sandostatin

Primer Karaciğer Nöroendokrin Tümörünün Böbrek Metastazı: Nadir Olgu ve Literatür Taraması

Abstract

Nöroendokrin tümörler (NET), değişen biyolojik özelliklere, histolojik yapılara ve terapötik yanıtlara sahip çok çeşitli neoplazmalar koleksiyonudur. Bu makalede karaciğerde primer NET tanısı alan, çok sayıda böbrek ve kemik metastazı bulunan 41 yaşında kadın hastayı sunuyoruz. Primer hepatik NET’ler nadirdir ve böbreğe metastaz olması durumu daha da nadir hale getirir. Hasta alt ekstremite ağrısı nedeniyle hastaneye başvurdu. Çeşitli görüntülemelerde kemik, böbrek ve karaciğerde çok sayıda lezyon ortaya çıktı. Tümör ve kemik metastazlarına karşı Sandostatin ve Denosumab tedavilerine başlandı. Ekip ilk başta vakanın karaciğerde nöroendokrin bir tümör ve senkron renal hücreli karsinom olduğunu düşündü. Ancak böbreğin total eksizyonu sonrasında patoloji, NET’in böbreğe metastazı olarak rapor edildi. Kemik metastazlarında gerileme görülmesine rağmen karaciğerdeki primer lezyonu ilerledi. Mevcut tedavi rejimine 177Lu-DOTATATE tedavisi eklendi. Primer hepatik NET’ten kaynaklanan renal metastazın teşhis ve tedavisi zor olabilir. Bu tip vakalar için özel olarak tasarlanmış bir kılavuz bulunmadığından, hastalar için en iyi seçeneğin seçilebilmesi için birden fazla tedavi yönteminin multidisipliner bir ekiple tartışılması gerekir.

Keywords

• Nöroendokrin tümör
• primer karaciğer nöroendokrin tümörü
• böbrek metastazı
• sandost

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