Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 6, 2022; 10(7): 2222-2228
Published online Mar 6, 2022. doi: 10.12998/wjcc.v10.i7.2222
Primary hepatic neuroendocrine neoplasm diagnosed by somatostatin receptor scintigraphy: A case report
Miho Akabane, Yuta Kobayashi, Keiichi Kinowaki, Satoshi Okubo, Junichi Shindoh, Masaji Hashimoto
Miho Akabane, Yuta Kobayashi, Satoshi Okubo, Junichi Shindoh, Masaji Hashimoto, Division of Hepatobiliary-pancreatic Surgery, Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo 105-8470, Japan
Keiichi Kinowaki, Department of Diagnostic Pathology, Toranomon Hospital, Tokyo 105-8470, Japan
Author contributions: Akabane M wrote the manuscript; Kobayashi Y contributed to the operation and follow-up, the manuscript design and coordination, and helped draft the manuscript; Kinowaki K contributed to pathological diagnosis; and all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Miho Akabane, MD, Doctor, Division of Hepatobiliary-pancreatic Surgery, Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2, toranomon, minato-ku, Tokyo 105-8470, Japan. akabane.miho@gmail.com
Received: July 3, 2021
Peer-review started: July 3, 2021
First decision: July 14, 2021
Revised: July 15, 2021
Accepted: January 22, 2022
Article in press: January 22, 2022
Published online: March 6, 2022
Processing time: 241 Days and 19.7 Hours
Abstract
BACKGROUND

Primary hepatic neuroendocrine neoplasm (NEN) is a rare condition, and it is difficult to differentiate between primary and metastatic hepatic NENs. Herein, we report a case of primary hepatic NEN that initially mimicked a hemangioma but showed a gradual increase in size on long-term careful observation.

CASE SUMMARY

A 47-year-old woman was incidentally diagnosed with a 12-mm liver mass, suspected to be a hemangioma. Since then, regular follow-up had been carried out. Ten years later, she was referred to our institute due to the tumor (located in segment 4) having increased to 20 mm. Several imaging studies depicted no apparent extrahepatic lesion. Positron emission tomography (PET)/computed tomography exhibited significant accumulation in the mass lesion, which made us consider the possibility of malignancy. Left hepatectomy was performed. The histopathological diagnosis was neuroendocrine tumor grade 2, with somatostatin receptor 2a/5 positivity. Postoperative somatostatin receptor scintigraphy (SRS) showed no other site, leading to the diagnosis of NEN of primary hepatic origin. The gradual growth of the hepatic NEN over 10 years suggested that it was likely to be a primary liver tumor.

CONCLUSION

In this case, positivity on PET and postoperative SRS may have helped determine whether the tumor was primary or metastatic.

Keywords: Hepatic neoplasm; Scintigraphy; Surgery; Positron-emission tomography; Clinical decision-making; Case report

Core Tip: The clinical diagnosis of primary hepatic neuroendocrine neoplasm (NEN) remains challenging due to its rarity and difficulty in differentiating between primary and metastatic NENs. We present a case of primary hepatic NEN that presented with exceedingly gradual growth over 10 years, initially mimicking a hemangioma. Close preoperative observation, positron emission tomography findings, and postoperative somatostatin receptor scintigraphy findings greatly contributed to the final diagnosis. This case highlights the importance of close preoperative observations of NENs. In addition, the clinical usefulness of these modalities for correct diagnosis has been suggested, although regular postoperative follow-up is required.