A Rare Case of Neuroendocrine Tumor with Liver Metastasis

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. Radiological and nuclear medicine examinations of a 61-year-old male patient admitted to our clinic with complaints of abdominal pain and abdominal swelling revealed multiple hypodense mass lesions consistent with diffuse metastasis in the liver. Liver biopsy showed neuroendocrine tumor in hepatic metastases. 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. In conclusion, it should be kept in mind that although neuroendocrine tumors, which are rare, have been asymptomatic until recently, despite their slow course, they may present as non-functional with extensive liver metastasis.

Keywords

• Hepatic metastases
• Liver
• Neuroendocrine tumor

Nadir Karaciğer Metastaz Nedeni; Nöroendokrin Tümör (Bir olgu Nedeniyle)

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 61 yaşındaki erkek hastanın yapılan radyolojik incelelemelerde karaciğerde diffüz metastazla uyumlu çok sayıda hipodens kitle lezyonları saptandı. Yapılan karaciğer biyopsisi, hepatik nöroendokrin tümör metastazı ile uyumlu bulundu. Diffüz karaciğer tutulumu birlikte hastanın yaşının ileri olması nedeni ile cerrahi rezeksiyon düşünülmedi. Hastaya uzun etkili somatostatin analoğu başlandı. Takiplerde hastanın semptomları geriledi Sonuç olarak nadir görülen nöroendokrin tümörleri yavaş seyrinin aksine tümüyle yakın zaman kadar asemptomatik seyretmesine karşın, yaygın karaciğer metastazıyla birlikte afonksiyone olarak prezente olabileceği göz önünde bulundurulmalıdır.

Keywords

• Karaciğer
• nöroendokrin tümör
• Hepatik metastaz

References

1. 1. Solcia E, Kloppel G, Sobin LH. Histological typing of endocrine tumours. Second edition WHO Heidelberg:Springer-Verlag; 2000; 38-74. 2. Rindi G, Villanacci V, Ubiali A. Biological and molecular aspects of gastroenteropancreatic neuroendocrine tumors. Digestion 2000; 62:19-26. 3. Adam M, Douglas GA. Neuroendocrine Tumors: Review and Clinical Update 2007;51:12-20. 4. Taal BG, Visser O. Epidemiology of neuroendocrine tumours. Neuroendocrinology 2004;80:3–7. 5. Sutcliffe R, Maguire D, Ramage J, et al. Management of neuroendocri liver metastases. Am J Surg 2004;187:39–46. 6. Mazzaferro V, Pulvirenti A, Coppa J. Neuroendocrine tumor metastatic to the liver: how to select patients for liver transplantation Hepatology 2007;47:460–466. 7. Benevento A, Boni L, Frediani L, et al. Result of liver resection as treatment for metastases from noncolorectal cancer. J Surg Oncol 2000;74:24-29. 8. 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;11:7676–7683. 9. Frilling A, Rogiers X, Malago M, et al. Liver transplantation in patients with liver metastases of neuroendocrine tumors. Transplant Proc. 1998;30:3298-3300. 10. Ahlman H, Friman S, Cahlin C, et al. Liver transplantation for treatment of metastatic neuroendocrine tumors. Ann N.Y Acad Sci 2004;1014:265-269. 11. Sarmiento JM, Que FG. Hepatic surgery for metastases from neuroendocrine tumors. Surg Oncol Clin N Am 2003;12:231-242. 12.Nobels FRE, Kwekkeboom DJ, Bouillon R, et al. Chromogranin A: its clinical value as marker of neuroendocrine tumors. Eur J Clin Invest 1998;28:431-438 13. Sekiya K, Ghatei MA, Salahuddin MJ, et al. Production of GAWK (Chromogranin-B 420-493)-like immunoreactivity by endocrine tumors and its possible diagnostic value. J Clin Invest 1989;83:1834-1842 14. Chamberlain RS, Canes D, Brown KT, Y et al. Hepatic neuroendocrine metastases: does intervention alter outcomes? J Am Coll Surg 2000; 190:432-445. 15. Plöckinger U, Wiedenmann B. Diagnosis of non-functioning neuroendocrine gastro-enteropancreatic tumours. Neuroendocrinology 2004;80:35–38. 16. Chatal JF, Le Bodic MF, Kraeber-Bodere F, et al. Nuclear medicine applications for neuroendocrine tumors. World J Surg 2000; 24:1285-1289. 17. 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.