PMC4386800_01
Histological examination with immunohistochemistry and hematoxylin-eosin staining (e/e).. Notes: (A) e/e 20x magnification; (B) chromogranin 20x magnification; (C) Synaptophysin 20x magnification; (D) Ki-67 40x magnification.
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Histological examination revealed the presence of neoplastic proliferation in the solid growth patterns of insular cells; immunohistochemistry (pan-cytokeratin-positive, chromogranin-positive, Synaptophysin-positive, CD56-negative/positive, and Ki-67 <20%) was consistent with the diagnosis of NET (Figure 1).
Liver metastatic NET.. Notes: (A and B) Contrast-enhanced CT. (A) A double-contrast study of the stomach; the difference between the abdominal parenchyma visualized in the two examinations lies in the different degrees of filling of the stomach and in the patient's different breaths. Before treatment, the hepatic lesion of the fourth segment shows inhomogeneous enhancement (yellow arrow). (B) After treatment, the lesion's size and density remain stable (yellow arrow). This is SD according to both the RECIST and CHOI criteria.. Abbreviations: LVR, liver; RPV, right branch of the portal vein; ST, stomach; LKD, left kidney; SPL, spleen; NET, neuroendocrine tumor; CT, computed tomography; SD, stable disease.
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A total body CT scan showed a single secondary nodular lesion in the liver of about 34x30 mm (versus 37x34 mm) (Figures 2A versus 2B), with a slight decrease in its density.
Liver metastatic NET.. Notes: (A-D) Contrast-enhanced CT. (A and C) Double-contrast study of the stomach. The difference between the abdominal parenchyma visualized in the two examinations lies in the different degree of filling of the stomach and in the patient's different breaths. Before treatment, the hepatic lesions of the seventh and eighth segments appear as soft hypodense inhomogeneous lesions (yellow arrow). (B and D) After treatment, the lesions are not more appreciable.. Abbreviations: LVR, liver; ST, stomach; SPL, spleen; LKD, left kidney; NET, neuroendocrine tumor; CT, computed tomography.
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The other secondary lesions (present at the previous exam) were not clearly identified (Figures 3A versus 3B; Figures 3C versus 3D).