title: Primary hepatic carcinoid: a case report and literature review.
abstract: 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.
authors.affiliation: Department of Internal Medicine, Santa Croce Hospital, Via Michele Coppino 26, Cuneo, Italy. fenoglio.l@ospedale.cuneo.it
authors.forename: Luigi Maria
authors.initials: LM
authors.lastname: Fenoglio
authors.forename: Sara
authors.initials: S
authors.lastname: Severini
authors.forename: Domenico
authors.initials: D
authors.lastname: Ferrigno
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gollè
authors.forename: Cristina
authors.initials: C
authors.lastname: Serraino
authors.forename: Christian
authors.initials: C
authors.lastname: Bracco
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Castagna
authors.forename: Chiara
authors.initials: C
authors.lastname: Brignone
authors.forename: Fulvio
authors.initials: F
authors.lastname: Pomero
authors.forename: Elena
authors.initials: E
authors.lastname: Migliore
authors.forename: Ezio
authors.initials: E
authors.lastname: David
authors.forename: Mauro
authors.initials: M
authors.lastname: Salizzoni
mesh_terms: D000368:Aged; D002276:Carcinoid Tumor / Q000175:diagnosis*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis*; D008297:Male