Hepatic Carcinoid Tumor Research Articles

The Outcome of Primary Hepatic Carcinoid Tumor: A Retrospective Study Based on Propensity Score Matched Survival Analysis.

BackgroundPrimary hepatic carcinoid tumor (PHCT) is rare and has unclear clinical characteristics and prognosis.MethodsA retrospective study using data from the SEER database for patients diagnosed with PHCT used univariate and multivariate Cox models to screen for independent prognostic factors. The outcomes of patients in the surgical and nonsurgical groups were compared, and Propensity Score Matching (PSM) analysis was used to reduce confounder bias.ResultsA total of 186 PHCT patients were identified and the median survival was 65 (95% CI [43.287, 86.713]) months. Tumor size(HR = 2.493, 95% CI[1.222,5.083], p = 0.012), male(HR = 1.690, 95% CI[1.144,2.497], p = 0.008), age(HR = 2.583, 95% CI[1.697,3.930], p < 0.001), SEER stage(HR = 1.555, 95% CI[1.184,2.044], p = 0.002) and surgery(HR = 0.292, 95% CI[0.135,0.634], p = 0.002) were significantly correlated with patient prognosis. In multivariate analysis, sex(HR = 3.206, 95% CI[1.311,7.834], p = 0.011) and surgery(HR = 0.204, 95% CI[0.043,0.966], p = 0.0045) were independent predictors of patient prognosis. Females are potentially susceptible to PHCT but have a better prognosis. With consistent baseline data, surgical patients have a better prognosis.ConclusionsPHCT is uncommon and survival time is longer than that of other primary liver cancers. We found that none-surgery was potentially independent risk factors for poor prognosis.

A Rare Case of Delayed Gastric Ulcerations Several Months After Y-90 Radioembolization for Hepatic Carcinoid Tumor

Radioembolization using Yttrium-90 (Y-90) resin microspheres infused through the hepatic arteries is a common treatment modality for primary and secondary hepatic tumors. We present a case of delayed symptoms and endoscopic evidence of gastric ulcerations due to radioembolic microspheres months after Y-90 therapy. A 71 year old male presented with epigastric pain and intractable nausea with history of metastatic carcinoid tumor involving the liver. He underwent radioembolization of a unresectable liver lesion with two treatments of SIR-Spheres Yttrium-90 resin microspheres approximately 6 months previously. Endoscopic evaluation revealed several non-bleeding, cratered gastric ulcerations within the lesser curvature of the stomach and gastric antrum measuring up to 15 mm. MRI Abdomen with contrast showed stable liver lesions with no other changes and serum gastrin level was unremarkable. CD34 immunohistochemistry staining of gastric biopsies demonstrated focally ulcerated gastric mucosa, foveolar epithelial hyperplasia and decreased capillary networking. Additionally, H&E stain showed scattered basophilic globules within the gastric mucosa consistent with radioembolic Y-90 microspheres. Gastric ulceration is an uncommon, but well-described complication of locoregional treatment of hepatic tumors with radioembolization treatment such as Y-90. Typically, this occurs due to reflux of microspheres into the gastroduodenal artery from the hepatic artery at the time of non-target embolization. Damage to the mucosal and submucosal surfaces is thought to be caused by direct radiation exposure from microspheres as well as occlusion of the arterial supply to gastric tissues. Although there is no consensus on the most efficacious treatment strategy, endoscopic management of hemorrhage combined with institution of PPIs and avoidance of NSAIDs is generally enough to provide full recovery. In patients with a prior history of Y-90 treatment who present with endoscopic evidence of gastric ulcerations, non-target embolization resulting in arterial reflux of microspheres into the gastric mucosa should be considered as a possible etiology.2686_A Figure 1. Endoscopic image of large cratered ulcer2686_B Figure 2. CD34 stain, used in vascular-associated tissue, showing decrease capillary network with presence of Y-90 microspheres2686_C Figure 3. H&E, 10X stain showing foveolar and smooth muscle hyperplasia with Y-90 microspheres in gastric mucosa

One case of primary hepatic carcinoid tumor with multiple metastases

One case of primary hepatic carcinoid tumor with multiple metastases

Primary Hepatic Carcinoid Tumor: A Case Report and Literature Review

This article reports a case of primary carcinoid tumors of the liver and reviews previous cases of the disease. A 37-year-old man had multiple masses in the liver and was diagnosed with primary hepatic carcinoid tumors (PHCT) by immunohistochemistry. He refused any treatments and died 18 months later. PHCT is easily missed or misdiagnosed. This disease develops slowly, and it has a long course. Immunohistochemistry is the best diagnostic method. Surgical resection and hepatic artery embolism are the recommended treatments.

Imaging findings of primary hepatic carcinoid tumor with an emphasis on MR imaging: case study.

Carcinoid tumors are slow-growing tumors originating in the neuroendocrine cells, and occur most frequently within the gastrointestinal tract. Although the liver is the most common site for metastatic carcinoid tumors, primary hepatic carcinoid tumors are exceedingly rare and reports of the imaging findings have been very scarce. We herein report imaging findings with an emphasis on magnetic resonance imaging in two cases of primary hepatic carcinoid tumors. In both cases, the tumors showed cystic areas with hemorrhagic components and early enhanced solid areas.

Extensive hepatic necrosis after transarterial chemoembolization

A 62-year-old man with a metastatic hepatic carcinoid tumor originating from the distal ileum underwent transarterial chemoembolization (TACE) of the right hepatic artery with cisplatin, adriamycin, and mitomycin C (Fig. 1). Four days later, patient had a sudden change in mental status, generalized weakness, and intractable vomiting. On examination, patient was jaundiced, hypotensive, and febrile. The abdomen was non-distended and non-tender, and the liver was not palpable. Patient was septic with markedly elevated liver enzymes. Computed tomography scan of the abdomen showed a wedge-shaped distribution of abnormal gas collections concentrated into the right lobe corresponding to the site of TACE (Fig. 2). Heterogeneity with diminished attenuation suggested necrosis of the chemoembolized metastatic tumor. The portal vein was patent. Blood cultures grew Gram-positive bacteria, and the patient was treated with antibiotics. Patient was not a surgical candidate due to the extent of hepatic necrosis and eventually died of multiorgan failure as a result of sepsis. CT scan immediately after TACE may reveal small amounts of intrahepatic gas as a result of necrosis from ischemic liver damage [1]. Liver failure and sepsis may

17年間の経過で増大した肝原発カルチノイド腫瘍の一例

17年間の経過で増大した肝原発カルチノイド腫瘍の一例

Primary hepatic carcinoid tumors: A case report and literature review

Primary hepatic carcinoid is a rare disease and requires meticulous workup for the search of primary in other organs. A 56-year-old male, known hypertensive, presented in November 2007 with epigastric discomfort and indigestion on and off for 2 months. There was no history of diarrhea, flushing attacks, or cardiac symptoms. He had no family history of carcinoids or any other chronic disease. On examination, he was afebrile, pulse rate was 83/min, and BP was 166/95 mm Hg. Per-abdominal examination revealed mild tenderness in the epigastrium and enlarged liver. Computerized tomography abdomen showed a capsulated huge liver lesion (11 × 10 × 13 cm) in the left lobe of the liver, displacing the left hepatic artery, while rest of the liver was normal. There was no evidence of carcinoid tumor in any other organ. He was operated and left hepatic lobectomy was done. Histology showed primary hepatic carcinoid. He is being followed up in our OPD till date and has shown no recurrence. Primary hepatic carcinoid is a rare disease which is not associated with the symptoms of carcinoid syndrome in majority of patients, and therefore should be diagnosed after extensive search for primary in the other organs. Ultimate diagnosis should be made by histology and immunohistochemistry.

Outcomes of laparoscopic and open resection for neuroendocrine liver metastases

We sought to compare the outcomes in patients with hepatic carcinoid tumor metastases treated with open versus laparoscopic liver resection. A retrospective analysis of our liver surgery database was performed. All patients who underwent liver resection for hepatic carcinoid tumor metastases were included. Patients were divided into 2 groups depending on the surgical approach. Patients with concomitant primary and metastatic liver lesions underwent open resection. Thirty-six patients underwent resection over a 10-year period (21 open and 15 laparoscopic). Both groups were similar in terms of gender, body mass index, tumor size, incidence of carcinoid syndrome, and extent of resection (P > .05). The laparoscopic group had less mean operative time (2.7 vs 5.4 hours), less mean blood loss (158.3 vs 538.9 mL), and a shorter hospital stay (3.2 vs 7.5 days; P < .05 for all). Complications were similar in both groups (20% vs 33%; P = .21). Two laparoscopic cases required conversion. The 3-year disease-free survival for the laparoscopic group was 73.3% compared to 47.6% for the open group (P = .2). To our knowledge, this is the first reported study comparing laparoscopic versus open liver resection in the treatment of liver metastases from carcinoid tumors. Our series confirms that selective cases can safely be managed laparoscopically.

Primary Carcinoid Tumor of the Liver: A Rare Entity

Purpose: A 71year-old female with past medical history of hypertension and hypothyroidism presented with symptoms of progressively worsening fatigue and a distended abdomen. She denied history of jaundice, vomiting, flushing or diarrhea. Physical exam was significant for hepatomegaly and a palpable liver mass. Laboratory data was non remarkable with the exception of albumin (2.9 g/dl). Computed tomography(CT) showed a heterogeneously enhancing mass in posterior segment of the right liver lobe measuring 5 cm, highly suspicious for neoplasm along with multiple hepatic cysts, the largest measuring approximately 8 cm. CT guided biopsy of the liver showed a well differentiated neuroendocrine neoplasm. Immunohistochemical staining demonstrated diffuse and strong staining with synaptophysin and moderate with chromogranin consistent with a carcinoid tumor. Microscopy revealed well differentiated neoplasm with nested and/or organoid and trabecular growth pattern and focal calcification. Proliferation index was approximately 5% to 10%. An extensive careful examination was carried out to exclude the presence of a primary extrahepatic carcinoid tumor; no extrahepatic tumors were detected. Chemoembolization was planned to decrease the tumor size and burden. Primary Hepatic Carcinoid tumors (PHCT) is a rare entity with less than 100 cases reported in current literature. Most reported cases of PHCT seem to occur in middle age and are more frequently diagnosed in females (59%). More than 84% of PHCT stain positive immunochemically for chromogranin. Patients typically present with non-specific symptoms such as progressive fatigue, weight loss, abdominal pain, fullness, and/or palpable mass. A very small percentage of patients present with classic carcinoid syndrome (abdominal pain, diarrhea, skin flushing). Although rare, as our case demonstrates, PHCT should be included in the differential diagnosis of a hepatic mass.Figure: [368]

Ultrasonic diagnosis of hepatic carcinoid tumors

Objective To explore the ultrasonic presentations of primary hepatic carcinoid tunors.Methods The ultrasonic data of 9cases of hepatic carcinoid tumors,who were pathologically confirmed from September 2002to November 2008in our hospital,were retrospectively analyzed.Results Ultrasonic examination showed that the diameters of the 9tumors were all5cm.The tumors had an irregular morphology and presented with strong or high echo with inhomogeneous echo inside.The tumors had no noticeable capsule and had clear borders and rich blood supply.Wide bleeding and necrosis of tumor could cause the cystic mass.There were no primary nidus or tumor emboli of portal veins.Conclusion Ultrasonic diagnosis of liver carcinoid tumors still lacks specific presentations,and efforts should be made to persistently summarize the experience to improve the diagnosis.

Primary hepatic carcinoid tumor

Primary hepatic carcinoid tumor is rare and poses a challenge for diagnosis and management. We presented a case of primary hepatic carcinoid tumor in a 53-year-old female with a complaint of right upper abdominal pain. Computer tomography scans revealed a hypervascular mass in segment 4 of the liver. An ultrasonography-guided biopsy showed a carcinoid tumor. No other lesions were found by the radiological investigations. Surgery resection was performed and histopathological examination revealed a primary hepatic carcinoid tumor. Three years later, recurrence was found and transcatheter arterial chemoembolization was performed. After transcatheter arterial chemoembolization, the patient has been free of symptom and had no radiological disease progression for over 6 months. Surgical resection combination with transcatheter arterial chemoembolization is effective to offer excellent palliation.

Ten years survival with excellent outcome after living donor liver transplantation from 70 years old donor for primary hepatic neuroendocrine carcinoma: Case report

BACKGROUNDPrimary hepatic carcinoid tumors (PHCT) are rare entities; they are even rarer than extrahepatic neuroendocrine gastrointestinal tumors with only about 95 cases reported in the literature. An extrahepatic primary tumor must be excluded to confirm the diagnosis of PHCT. CASE PRESENTATIONWe report a case of a 42-year-old male patient with a primary hepatic neuroendocrine carcinoma, who successfully underwent living donor liver transplantation from his 70 years old mother with 10 years follow-up. Both donor and recipient are still alive and in the good health. CONCLUSIONLiving liver donation from elderly donors for the patients with irresectable neuroendocrine liver malignancies can be as safe as deceased donation or liver donation from young donors (age<50). Living donation from elderly donors might significantly expand the donor pool for patients with liver neuroendocrine tumors (NET) and potentially reduce waiting list mortality. Especially young patients with irresectable NET can benefit from this option. However, case–control studies are needed to verify the advantage of living liver transplantation (LDLT) for the patients with irresectable liver NET and to define selection criteria for these patients.

Primary hepatic carcinoid tumor: a case report

Primary hepatic carcinoid tumor: a case report

One case of primary hepatic carcinoid tumor

病人,女,40岁.因体检发现肝左叶占位性病变7 d于2009年4月29日入院.无腹痛、腹胀、发热,无体重改变.查体:一般状况好,无皮肤巩膜黄染.腹部平软,全腹无压痛.肝脏右肋缘下未触及,未扪及肿块.实验室检查:血尿便常规、生化全检、凝血项目和甲胎蛋白(AFP)均正常;乙型肝炎标志物和丙型肝炎抗体均为阴性.超声检查:肝左叶可见4.3 cm×4.5 cm×6.8 cm偏低回声团,边界清,似有声晕.内回声不均匀,可见1.5 cm×1.9 cm、1.0 cm×1.4 cm无回声区.CT检查:肝脏大小形态正常.于肝左叶紧贴第二肝门见异常密度肿块,大小约5.6 cm×4.6 cm,平扫密度不均匀,增强后不均匀强化。

CT and MRI findings of primary hepatic carcinoid tumor

Objective To investigate the imaging findings of primary hepatic carcinoid tumor with dynamic MRI and spiral CT.Methods Eleven cases with pathologically confirmed primary hepatic carcinoid tumor were analyzed retrospectively.Four cases were examined with spiral CT,and 8 cases were examined with MRL Results Two of 11 cases had multiple tumors,presenting as two or more nodular lesions,while the remaining 9 cases had single tumor.Four cases showed well-defined low density on the plain scan of CT,with central irregular cystic areas.Lesions enhanced unevenly on arterial phase of CT,with no enhancement in the central part The edge of lesions showed delayed reduced enhancement on portal vein phase.than the arterial phase,while non-enhanced lesions in the center areas.Eight cases were detected by MRI,seven On MRI,7 of 8 lesions showed uneven low signal on T_1WI and high signal with central low intensity on T_2WI.On arterial phase of MRI,7 cases had uneven enhancement at the peripheral part and irregular non-enhanced signal in center.Lesions showed delayed mild enhancement in the peripheral parts,with a relatively smaller non-enhanced central area.One case was cystic,with high signal included in the extensive low density on T_1WI.The case appeared high signal on T_2WI and had uneven enhancement at the edge on arterial phase,low signal on delayed phase.Conclusion Primary hepatic carcinoid tumor exhibits some imaging features on plain and dynamic contrast-enhanced MRI and spiral CT,which can be the clue for the diagnosis. Key words: Liver neoplasms; Tomography,X-ray computed; Magnetic resonance imaging

Caudate lobe resection: an Egyptian center experience

Hepatectomy is a technically challenging surgery, and of all aspects of hepatic resection, caudate lobe resection is the most difficult. Knowledge of the anatomy of the caudate lobe is necessary to achieve safe caudate lobe resection. Hospital records of 54 patients, who had caudate lobe resection in our center from January 2000 to August 2007, were retrieved. The demographic data, clinicopathological features, and perioperative events were extracted and analyzed. Out of a total of 500 patients who had various forms of hepatic resection during the period in question, only 54 had caudate lobe resection (10.8%). Isolated caudate lobe resection (ICLR) was performed in 16 (29.6%) patients while the remainder had caudate lobe resection as a part of a major hepatectomy. Indications for hepatectomy in patients with ICLR include hepatocellular carcinoma, primary hepatic carcinoid tumor, cavernous hemangioma, and adenoma. Mean operative time for ICLR was 230 +/- 50 min while it was 240 +/- 50 min for right hepatectomy and 245 +/- 55 min for left hepatectomy. The associated mean blood loss was 1200 +/- 200, 1300 +/- 350, and 1350 +/- 350 ml, respectively. None of these were statistically significant. In patients who had ICLR, there was no mortality while three patients developed postoperative complications (bile leak in two patients and one patient with wound infection). Various forms of perioperative complications were noticed in six patients. All these patients, who also showed 7.8% mortality, had major hepatectomy. Caudate lobe resection is a technically challenging procedure. Isolated caudate lobe resection is a safe procedure with good outcome in well selected patients. It is, however, associated with increased perioperative risks when associated with major hepatectomy.

Liver Transplantation in Primary Hepatic Carcinoid Tumor: Case Report and Literature Review

Ninety percent of all carcinoid tumors develop in the gastrointestinal tract. Although the liver is a usual site for metastases, primary hepatic carcinoid tumors (PHCTs) are extremely rare. The diagnosis is based on histopathologic characteristics and on exclusion of a nonhepatic primary tumor. While liver transplantation (OLT) is a well-established surgical treatment in selected cases of unresectable metastatic carcinoid tumor, its use in PHCT has not been widely described. We report the case of a 50-year-old woman with unresectable PHCT treated with OLT. After 64 months, disease recurred in the liver and mesentery. Laparotomy with multiple radiofrequency ablations of liver lesions and resection of peritoneal deposits was performed; however, in the postoperative period, a fatal myocardial infarct occurred. Our case is the fourth one reported in literature. It confirms long-term survival after OLT in patients with unresectable PHTCs.

Primary hepatic carcinoid tumor: a case report and review of the literature

BackgroundPrimary hepatic carcinoid tumor (PHCT) is very rare and difficult to diagnose before biopsy or operation. We report a patient with a small PHCT and review cases in the literature.Case presentationA 48-year-old Chinese female with underlying hepatitis B virus (HBV) infection was found to have a low echoic hepatic nodule by abdominal ultrasound. Tumor markers were negative. Dynamic liver computed tomography scans showed enhancement of the nodule in the arterial phase and early washout in the portal phase. Hepatocellular carcinoma (HCC) was considered based on the image findings and underlying HBV infection. However, the tumor biopsy revealed a malignant neoplasm that originating from neuroendocrine cells. Pre-operative and intra-operative investigations for the possible other origin of carcinoid tumor were negative, so PHCT was confirmed.ConclusionA small and asymptomatic PHCT is extremely rare. PHCT should be one of the differential diagnoses in patients with small hepatic tumor, even in regions with high prevalence of HBV infection and HCC. Pre-operative biopsy is necessary to avoid misdiagnosis even when HCC is highly suspected clinically.

Primary hepatic carcinoid: A case report and literature review

Carcinoids are tumors derived from neuroendocrine cells and often produce functional peptide hormones. Approximately 54.5% arise in the gastrointestinal tract and frequently metastasize to the liver. Primary hepatic carcinoid tumors (PHCT) are extremely rare; only 95 cases have been reported. A 65-year-old man came to our attention due to occasional ultrasound findings in absence of clinical manifestations. His previous medical history, since 2003, included an echotomography of the dishomogeneous parenchymal area but no focal lesions. A computed tomography scan performed in 2005 showed an enhanced pseudonodular-like lesion of about 2 cm. Cholangio-magnetic resonance imaging identified the lesion as a possible cholangiocarcinoma. No positive findings were obtained with positron emission tomography. Histology suggested a secondary localization in the liver caused by a low-grade malignant neuroendocrine tumor. Immunohistochemistry was positive for anti chromogranin antibodies, Ki67 antibodies and synaptophysin. Octreoscan scintigraphy indicated intense activity in the lesion. Endoscopic investigations were performed to exclude the presence of extrahepatic neoplasms. Diagnosis of PHCT was established. The patient underwent left hepatectomy, followed by hormone therapy with sandostatine LAR. Two months after surgery he had a lymph nodal relapse along the celiac trunk and caudate lobe, which was histologically confirmed. The postoperative clinical course was uneventful, with a negative follow-up for hematochemical, clinical and radiological investigations at 18 mo post-surgery. Diagnosis of PHCT is based principally on the histopathological confirmation of a carcinoid tumor and the exclusion of a non-hepatic primary tumor. Surgical resection is the recommended primary treatment for PHCT. Recurrence rate and survival rate in patients treated with resection were 18% and 74%, respectively.