Answer for BIR CoW 30 Apr 2023
Neuroendocrine tumor of liver
Findings
Ill defined T1 hypointense /T2 hyperintense lesion showing diffusion restriction with low ADC values in the segment VI of right lobe of liver. Another well defined T2 hyerintense lesion showing diffusion restriction with low ADC values in segment II of left lobe of liver. On contrast administration ,the lesion shows early arterial phase enhancement and portal venous phase washout. IMPRESSION : 1. Multifocal HCC 2.HCC with liver metastasis HPE and IHC done which is positive for SYNAPTOPHYSIN (100% cells ), Ki67(10%cells) & CD34. IMPRESSION : NEUROENDOCRINE TUMOR GRADE- II
Discussion
Neuroendocrine tumors are relatively rare tumors of the GIT ,accounting for <2% of GI neoplasms. They are classified into three grades – grade I to III Primary liver NET tumor is extremely rare. Have distinct clinical presentation than other NET’s More common in females and middle aged population. PHNET’S are endocrinologically silent masses distinct from net metastasis to liver which is commonly associated with carcinoid syndrome. PHNET’S are most often detected based on symptoms related to mass effect , weight loss and palpable mass rather than carcinoid syndrome. Radiologically very difficult to differentiate phnet’s from other solid hepatic tumors, HCC and cholangiocarcinoma and is primarily a HPE diagnosis. Radiologically PHNET’s have highly varied appearances ranging from solid to cystic lesions as well as diffuse to well defined borders. They have rich arterial supply accounting for its early arterial enhancement and washout in portal and delayed phases. Immunohistochemistry is performed as the definitive diagnosis for PHNETs, typically after they have already been resected. NETs are associated with immunoreactivity for chromogranin A, neuron specific enolase, and synaptophysin. The tumor in our case was immunoreactive for synaptophysin.
Findings
Ill defined T1 hypointense /T2 hyperintense lesion showing diffusion restriction with low ADC values in the segment VI of right lobe of liver. Another well defined T2 hyerintense lesion showing diffusion restriction with low ADC values in segment II of left lobe of liver. On contrast administration ,the lesion shows early arterial phase enhancement and portal venous phase washout. IMPRESSION : 1. Multifocal HCC 2.HCC with liver metastasis HPE and IHC done which is positive for SYNAPTOPHYSIN (100% cells ), Ki67(10%cells) & CD34. IMPRESSION : NEUROENDOCRINE TUMOR GRADE- II
Discussion
Neuroendocrine tumors are relatively rare tumors of the GIT ,accounting for <2% of GI neoplasms. They are classified into three grades – grade I to III Primary liver NET tumor is extremely rare. Have distinct clinical presentation than other NET’s More common in females and middle aged population. PHNET’S are endocrinologically silent masses distinct from net metastasis to liver which is commonly associated with carcinoid syndrome. PHNET’S are most often detected based on symptoms related to mass effect , weight loss and palpable mass rather than carcinoid syndrome. Radiologically very difficult to differentiate phnet’s from other solid hepatic tumors, HCC and cholangiocarcinoma and is primarily a HPE diagnosis. Radiologically PHNET’s have highly varied appearances ranging from solid to cystic lesions as well as diffuse to well defined borders. They have rich arterial supply accounting for its early arterial enhancement and washout in portal and delayed phases. Immunohistochemistry is performed as the definitive diagnosis for PHNETs, typically after they have already been resected. NETs are associated with immunoreactivity for chromogranin A, neuron specific enolase, and synaptophysin. The tumor in our case was immunoreactive for synaptophysin.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
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Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!