PMC10436565_01
(A) Abdominal and chest CT before first treatment of Case1. (B) PET-CT before the first treatment of Case1. (C) Abdominal and chest CT after the first treatment of Case1. Red arrows indicate the location of the tumor.
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Abdominal computed tomography (CT) ( Figure 1A ) indicated the presence of a mass of approximately 40 x 35 mm in size with an irregular shape in the S5/8 segment of the liver. A chest CT scan ( Figure 1A ) demonstrated an irregular soft tissue mass with a circular shape in the lower lobe of the right lung, indicating a possible metastatic lesion. 18F-FDG PET-CT ( Figure 1B ) demonstrated the presence of several hypodense lesions with ill-defined margins and elevated glucose uptake in the liver, and a nonuniform solid mass with increased glucose metabolism in the lungs. A follow-up CT scan showed that most of the S5/8 liver lesion had been necrotized, and the size of the lung mass was essentially unchanged ( Figure 1C ).
(A) Histologic examination of tumor tissues by hematoxylin and eosin staining of Case1. (B) Immunohistochemistry of Case1: CgA, NSE, Ki67, Syn. Red arrows indicate positive cells.
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A liver biopsy was performed and pathological analysis ( Figure 2A ) revealed tumor cells arranged in a nest-like pattern, exhibiting mild-to-moderate atypia, an abundant cytoplasm containing fine granules, and delicate chromatin. Immunohistochemical analysis ( Figure 2B ) revealed that the tumor cells were positive for synaptophysin (Syn), chromogranin A (CgA), and neuron-specific enolase (NSE).
PMC10436565_02
(A) Abdominal MR before first treatment of Case2. (B) Abdominal PET-CT before initial treatment of Case2. (C) Abdominal MR after first treatment of Case2. Red arrows indicate the location of the tumor.
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Abdominal MRI revealed several liver masses ( Figure 3A ). No filling defects were observed in the main portal veins or branches. 18F-FDG PET-CT performed in other hospitals before admission did not have a good differential effect; therefore, Ga68-DOTATATE PET-CT was performed, which showed a circular area with increased radioactive uptake (maximum standardized uptake value:24.5), consistent with the appearance of a neuroendocrine tumor in this region ( Figure 3B ). Two months later, a follow-up MRI ( Figure 3C ) showed a decrease in the size of the largest tumor in the S7/8 segment to 17x16 mm, while the tumor size in the S4 segment remained relatively unchanged (17.8x19.9 mm).
(A) Histologic examination of tumor tissues by hematoxylin and eosin staining of Case2. (B) Immunohistochemistry of Case2: CgA, NSE, Ki67, Syn. Red arrows indicate positive cells.
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The pathology report from the liver biopsy as well as immunohistochemistry ( Figure 4A ) staining revealed widespread expression of CgA, Syn, and NSE in the tumor cells ( Figure 4B ).