8467 From Highly Suspected Hemochromatosis to Liver Metastasis Neuroendocrine Tumor

Abstract

Abstract Disclosure: M.E. Chacon Cruz: None. M. Sanchez Cordero: None. G. Guerra Velazquez: None. K.C. Velez Rivera: None. A neuroendocrine cancer, often referred to as a neuroendocrine tumor (NET) or neuroendocrine neoplasm begins in the specialized cells of the body's neuroendocrine system. These cells have traits of both hormone-producing endocrine cells and nerve cells. The carcinoid is the most common neuroendocrine tumor causing liver metastases, especially when of midgut origin. However, although appendix is the most common location for midgut carcinoids it most unusually gives rise to hepatic spread. NETs are described as functional or non-functional, depending on the release of hormones. About 60% of NETs are non-functional. Case of a 66 year old male patient with medical history of ESRD on HD, PPM placement, hypertension, type 2 diabetes mellitus, and auditory impairment presents to ED of this institution after presenting with RUQ abdominal pain of one day of evolution. Patient's pain is associated with food intake or changes in diet. Laboratory work on admission patient found with leukocytosis in 16.69, anemia 10.5 and transaminitis ALT 180, AST 176 and ALP 589. Abdominal ultrasound shows Hepatomegaly with a slightly irregular surface contour. Correlate for chronic liver disease. Abdomino pelvic CT showed Hepatomegaly with a diffusely heterogeneous parenchyma and ill-defined nodular foci of hypoattenuation. During admission liver enzyme and alkaline phosphatase continue in increasing trend up to 1,172 IU/L. Ferritin in 12,203, Transferrin saturation in 23.71%. Hemochromathosis DNA not detected, Angiotensin convert enzyme in 73 U/L, tumor marker alpha-fetoprotein in 1.8 ng/ml, carcinoembryoninc antigen in 25.63 ng/ml, CA19-9 in 903 U/ml, Serotonin 23 ng/ml. MRCP was ordered and show Hepatomegaly with innumerable T2 hyperintense nodules replacing the hepatic parenchyma, may be related to cirrhosis including regenerative nodules. Interventional radiologist was consulted for liver biopsy and came back positive for Malignant Neuroendocrine Tumor, Favor Metastatic Tumor This case illustrates the challenges physicians face in quickly identifying and diagnosing pathologies as unusual as neuroendocrine tumor. Furthermore, it points out that primary care physicians should consider this disease in the differential diagnosis (DDx) in case of non-specific signs and symptoms such as abdominal pain and how the DDx can change depending on the patient's clinical symptoms and evolution. The case shows us how, with the physical examination that the patient presented, his skin was like that described in hemochromatosis, skin hyperpigmentation (Bronze Skin), weakness, diabetes mellitus, along with elevated levels of ferritin, transaminitis, alkaline phosphatase and the finding of iron deposit in the kidney using CT, our differential diagnosis was our first diagnosis, until the genetics for hemochromatosis came back negative and the liver biopsy was positive for neuroendocrine tumor. Presentation: 6/2/2024