Journal of Gastrointestinal & Digestive System
Open Access

Abstract

Background: Neuroendocrine tumors (NET) of the liver are generally metastatic lesions from other more common primary sites. Liver is an unusual primary site for a NET with only 150 reported cases in English literature. Here we present a case of a primary hepatic NET. Case presentation: A 64 years old gentleman with no known comorbid presented in outpatient department with 3 weeks history of pain in right upper abdomen associated with generalized weakness and poor appetite. Examination was unremarkable except for non tender hepatomegaly. CT scan liver showed a large 18.1 cm lesion in right lobe that was atypical for HCC. Viral markers for Hepatitis B & C were non reactive. To confirm the diagnosis, biopsy of the lesion was performed that showed NET. Upper and lower GI endoscopies and whole body octreotide scan was performed to locate the primary lesion. These investigations revealed no lesion elsewhere in the body, so he was diagnosed with primary hepatic NET. It was managed with 1 cycle of neo adjuvant chemotherapy to reduce the size of the lesion followed by right portal venous embolization to increase the volume of future remnant liver. Right hepatic trisectionectomy was performed 1 month after PV embolization. Final histopathology showed 23 cm NET, WHO Grade-II with 2 mm nearest parenchymal margin. Post-operative course was unremarkable and he was discharged on the 6th POD in stable condition. On his second follow-up visit, 8 weeks after surgery, he presented with right leg DVT and bilateral pulmonary embolism that was managed with therapeutic dose of enoxaparin and life long anticoagulation. Currently he is alive, disease free and on regular follow up. Conclusion: Primary hepatic NETs are challenging to diagnose but they can be successfully managed with multi modal treatment.

Biography

Sana is a medical professional. Her educational background includes MBBS from Allama Iqbal Medical College, Lahore and one year of house job / internship from Jinnah Hospital, Lahore. She has recently cleared her intermediate module of residency training. Currently she is a working as a resident doctor in General Surgery at Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan and is in third year of her FCPS-II training.