Hepatic Carcinoid Research Articles

Pathological findings and differential diagnoses of lymph node diseases in slaughtered cattle in Brazil: A study of 2000 samples.

Slaughterhouse inspections play a crucial role in the sanitary control of zoonoses and foodborne diseases. This study aimed to identify and analyze the frequencies of lymph node diseases in cattle slaughtered for human consumption, using the samples sent to the anatomic pathology service of the Federal Laboratory for Agricultural Defense (Laboratório Federal de Defesa Agropecuária), Minas Gerais, Brazil, from January 2015 to September 2022. In total, 2000 lymph node samples were analyzed, and additional information was individually retrieved. Lesions were most frequently identified in thoracic lymph nodes. Bacterial isolation and quantitative polymerase chain reaction (qPCR) were performed using samples suspected of tuberculosis. Tuberculosis cases accounted for 89.3% of the samples. Histopathology was more sensitive than other ancillary tests for diagnosing tuberculosis. Paraffin-embedded tissues from lymphoma cases were subjected to immunophenotyping using anti-CD3 and anti-CD79a immunohistochemistry. Frozen and/or paraffin-embedded tissues from lymphoma cases were used to identify the enzootic bovine leukosis (EBL) retrovirus through qPCR. Other diagnoses included primary (T- and B-cell lymphoma) and metastatic neoplasms (squamous cell carcinoma, pulmonary adenocarcinoma, undifferentiated carcinoma, undifferentiated adenocarcinoma, undifferentiated sarcoma, undifferentiated round cell tumor, mesothelioma, hepatic carcinoid, meningioma, and seminoma), actinogranulomas (pyogranulomatous lymphadenitis [actinobacillosis and actinomycosis]), idiopathic lymphadenitis (neutrophilic and/or histiocytic, granulomatous, and suppurative), and miscellaneous nonspecific lymphadenopathies (depletion/lymphoid atrophy, lymphangiectasia, erythrocyte drainage, parasitic eosinophilic lymphadenitis, follicular hyperplasia, and toxic granulomatous lymphadenitis). The combination of histopathology with complementary techniques is important for successful diagnosis, especially in complex cases of high epidemiological, economic, and zoosanitary importance, such as tuberculosis and EBL.

Well‐differentiated hepatic carcinoid in a dog: Long‐term survival following partial hepatectomy

AbstractAn 11‐year‐old, female, spayed Shetland sheepdog was referred for a 48‐hour onset of lethargy, inappetence, pigmenturia and intra‐abdominal mass of unknown origin. Laboratory sampling identified regenerative anaemia, hyperbilirubinemia, hypercholesterolemia and elevated alanine transaminase and alkaline phosphatase. Bilirubinuria and haematuria were noted on urinalysis. Thoracic radiographs were unremarkable. Ultrasonographic examination identified free abdominal fluid and a heterogeneous mass associated with a medial liver lobe. Haemoabdomen was confirmed, and partial hepatectomy was performed. Histopathology identified neoplastic cells arranged in nests and rosettes. On immunohistochemistry, neoplastic cells were positive for neuron‐specific enolase and synaptophysin and negative for S100, chromogranin A and cytokeratin. Transmission electron microscopy revealed small round electrodense granules consistent with neuroendocrine granules. A final diagnosis of hepatic carcinoid was made. The dog received no adjuvant treatment. Re‐staging with conventional imaging was performed every 3 months. No local recurrence or metastatic disease was identified within a 21‐month follow‐up period.

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

Histopathological and Immunohistochemical Study of a Hepatic Carcinoid in a Cat

Histopathological and Immunohistochemical Study of a Hepatic Carcinoid in a Cat

Utility of Indium-111 Octreotide to Identify a Cardiac Metastasis of a Carcinoid Neoplasm

Carcinoid heart disease is classically described as right-sided valvular pathology. Solid cardiac metastases from carcinoid tumors are seldom reported. A multimodality imaging approach is needed to diagnose and localize this disease. Biopsy remains the gold standard to confirm the diagnosis of carcinoid. Octreotide uptake is characteristic of carcinoid tumor but not myxoma; thus, an indium-111 octreotide scan is very specific for the diagnosis of carcinoid tumor and helps in assessing the extent of carcinoid disease. We present a case in which an indium-111 octreotide scan revealed uptake in three distinct masses in the colon, liver, and right ventricle. The results of the scan were contradictory to the biopsy results, which were diagnostic for hepatic carcinoid and cardiac myxoma.

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.

Giant Hepatic Carcinoid: A Rare Tumor with a Favorable Prognosis

Primary hepatic carcinoids are rare tumors that are often diagnosed at a locally advanced stage. Their primary nature can only be ascertained after thorough investigations and long-term follow-up to exclude another primary origin. As with secondary neuroendocrine liver tumors, surgical resection remains the mainstay of therapy. Despite their large size and often central location liver resection is often feasible, offering long-term survival and cure to most patients. In selected patients liver transplantation appears to be a good indication for tumors not amenable to liver resection. An aggressive surgical attitude is therefore warranted. We report a large and unusually fast-growing liver carcinoid that appeared only marginally resectable in a patient who remains free of disease four years after surgery.

18-year old patient with extrahepatic biliary duct carcinoid – case report

Most patients with obstructive jaundice caused by an etiology other than choledocholithiasis are at risk of adenocarcinoma development. Other types of tumors are less common, although more benign. The presented study described management in case of liver hilar tumors with special regards to common hepatic duct carcinoids.

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

Necrolytic migratory erythema associated with a glucagon‐producing primary hepatic neuroendocrine carcinoma in a cat

In humans, necrolytic migratory erythema (NME) is a syndrome with a characteristic skin rash that is associated most often with a pancreatic glucagonoma and is recognized as part of the glucagonoma syndrome. In veterinary medicine, NME (also called as superficial necrolytic dermatitis, hepatocutaneous syndrome or metabolic epidermal necrosis) has been described in dogs in association with chronic liver diseases or, less frequently, glucagonoma, but NME associated with glucagonoma has not previously been reported in cats. A 6-year-old male neutered domestic short hair cat was diagnosed with NME associated with a glucagon-producing primary hepatic neuroendocrine carcinoma (hepatic carcinoid). The cat presented with a 2 week history of vomiting and anorexia, and a 5-cm-diameter liver mass was detected by abdominal ultrasound. The cat exhibited general weakness, crusted skin lesions and pain in all four limbs. It was euthanized 11 months after the initial presentation. Histopathological review of the paw pads revealed the classic 'red, white and blue' lesion composed of parakeratotic hyperkeratosis, epidermal hydropic change and hyperbasophilia of the deep epidermis. The liver mass was diagnosed as a neuroendocrine carcinoma (hepatic carcinoid). Neoplastic cells were strongly immunoreactive for glucagon. This is the first case report of NME associated with a glucagon-producing primary hepatic neuroendocrine carcinoma in a cat.

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]

Right- and left-sided carcinoid heart disease without intracardiac shunting.

We present a case of a 54-year-old man with carcinoid heart disease and mitral valve involvement. He had hepatic carcinoid with an extremely elevated urinary excretion of 5-hydroxyindole acetic acid and was referred to our division for shortness of breath and leg edema. Transthoracic echocardiography showed the thickened and retracted tricuspid valve leaflets and severe tricuspid regurgitation. Moderate mitral regurgitation was observed, with the involvement of mitral valve leaflets. A patent foramen ovale was not detected on transesophageal echocardiography. The extremely high concentration of circulating serotonin and/or other vasoactive substances may have contributed to left- as well as right-sided carcinoid heart disease.

Hepatic Artery Embolization for Neuroendocrine Tumors: Postprocedural Management and Complications

There is scant evidence to guide the management of patients after hepatic artery embolization (HAE). We examined length of stay (LOS), laboratory patterns, medication usage, morbidity, and mortality of patients hospitalized after HAE for metastatic neuroendocrine tumors. Data were abstracted retrospectively from electronic medical records on LOS, liver function tests (LFTs), i.v. antibiotics, analgesia, peak temperature, bacteremia, hepatic abscess formation, carcinoid crisis, and metastatic burden on cross-sectional imaging. In 2005-2009, 72 patients underwent 174 HAEs for carcinoid and islet cell tumors. The median LOS was 4 days (range, 1-8 days). There was no correlation between peak LFTs and tumor burden. Declines in LFTs were not uniform before hospital discharge; 25%, 37%, 30%, 53%, and 67% of patients were discharged before their respective aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and total and direct bilirubin levels began to decline, with no readmissions for acute hepatic failure. The median i.v. analgesia dose was 60 mg oral morphine equivalents (range, 3-1,961 mg). Pre-HAE i.v. antibiotics were administered in 99% of cases; post-HAE fever occurred in 37% of patients, with no documented bacteremia. One patient developed a hepatic abscess after HAE. There were two carcinoid crises. The single in-hospital death was associated with air in the portal veins. The duration and intensity of in-hospital care following HAE should be managed on an individual basis. A downward trend in LFTs is not required before discharge. Modest use of i.v. analgesia suggests that many patients could exclusively receive oral analgesics. Given the rarity of serious complications, hospital stays could be shortened, thereby reducing costs and nosocomial risks.

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.