Primary neuroendocrine tumor of the liver: A diagnostic dilemma in the management of liver mass in pregnancy
Neuroendocrine tumor (NET) commonly occurs in the gastrointestinal tract, however primary NET of the liver is rare, especially during pregnancy. We present a 34-year-old pregnant woman gravida 3 para 2 at 16 weeks period of gestation with primary liver NET discovered incidentally during the antenata...
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| Format: | Article |
| Language: | English |
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Elsevier
2022-06-01
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| Series: | Radiology Case Reports |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S193004332200228X |
| _version_ | 1818269272727617536 |
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| author | Ian Chik, MD, MRCS, DrGenSurg Jane Wai Yee Chuah, MD, MRCS Zamri Zuhdi, MBBS, MS Firdaus Hayati, MD, DrGenSurg |
| author_facet | Ian Chik, MD, MRCS, DrGenSurg Jane Wai Yee Chuah, MD, MRCS Zamri Zuhdi, MBBS, MS Firdaus Hayati, MD, DrGenSurg |
| author_sort | Ian Chik, MD, MRCS, DrGenSurg |
| collection | DOAJ |
| description | Neuroendocrine tumor (NET) commonly occurs in the gastrointestinal tract, however primary NET of the liver is rare, especially during pregnancy. We present a 34-year-old pregnant woman gravida 3 para 2 at 16 weeks period of gestation with primary liver NET discovered incidentally during the antenatal check-up. She has no risk factors for hepatocellular carcinoma. Her serum alpha-fetoprotein was elevated. A plain magnetic resonance imaging (MRI) of the liver delineating a large well-defined exophytic liver mass at segment V/VI measuring 7.1 × 7.4 × 7.8 cm. Given inconclusive MRI findings coupled with low-risk factors of HCC, we had decided to follow up her liver mass with imaging 6 weekly. She then underwent a right hepatectomy with a caesarean delivery at 32 weeks of gestation in the same setting. The histopathological formal report revealed a neuroendocrine tumor, grade 2 with a Ki-67 index of 3% with negative lymphovascular and perineural invasion, but positive for porta hepatis lymph nodes metastasis. A follow up after 1 year shows both patient and her infant are healthy. Antenatal discovery of liver masses poses a diagnostic and management dilemma to clinicians. A multidisciplinary approach and collective decision making are crucial to determine the best approach tailored to the maternal and fetal benefit. In cases of inconclusive non-contrast MRI in pregnancy with low-risk factors and lack of clinical evidence of HCC, follow-up with imaging modalities aiming to intervene at the third trimester can offer safer, and promising outcomes. |
| first_indexed | 2024-12-12T20:51:45Z |
| format | Article |
| id | doaj.art-1cf3eca44fa14cdba49385b6699ff375 |
| institution | Directory Open Access Journal |
| issn | 1930-0433 |
| language | English |
| last_indexed | 2024-12-12T20:51:45Z |
| publishDate | 2022-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Radiology Case Reports |
| spelling | doaj.art-1cf3eca44fa14cdba49385b6699ff3752022-12-22T00:12:23ZengElsevierRadiology Case Reports1930-04332022-06-0117619962000Primary neuroendocrine tumor of the liver: A diagnostic dilemma in the management of liver mass in pregnancyIan Chik, MD, MRCS, DrGenSurg0Jane Wai Yee Chuah, MD, MRCS1Zamri Zuhdi, MBBS, MS2Firdaus Hayati, MD, DrGenSurg3Department of Surgery, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur, MalaysiaDepartment of Surgery, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur, MalaysiaDepartment of Surgery, Faculty of Medicine, Hospital Canselor Tuanku Muhriz, Cheras, Kuala Lumpur, MalaysiaDepartment of Surgery, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Kota Kinabalu, Sabah, Malaysia; Corresponding authorNeuroendocrine tumor (NET) commonly occurs in the gastrointestinal tract, however primary NET of the liver is rare, especially during pregnancy. We present a 34-year-old pregnant woman gravida 3 para 2 at 16 weeks period of gestation with primary liver NET discovered incidentally during the antenatal check-up. She has no risk factors for hepatocellular carcinoma. Her serum alpha-fetoprotein was elevated. A plain magnetic resonance imaging (MRI) of the liver delineating a large well-defined exophytic liver mass at segment V/VI measuring 7.1 × 7.4 × 7.8 cm. Given inconclusive MRI findings coupled with low-risk factors of HCC, we had decided to follow up her liver mass with imaging 6 weekly. She then underwent a right hepatectomy with a caesarean delivery at 32 weeks of gestation in the same setting. The histopathological formal report revealed a neuroendocrine tumor, grade 2 with a Ki-67 index of 3% with negative lymphovascular and perineural invasion, but positive for porta hepatis lymph nodes metastasis. A follow up after 1 year shows both patient and her infant are healthy. Antenatal discovery of liver masses poses a diagnostic and management dilemma to clinicians. A multidisciplinary approach and collective decision making are crucial to determine the best approach tailored to the maternal and fetal benefit. In cases of inconclusive non-contrast MRI in pregnancy with low-risk factors and lack of clinical evidence of HCC, follow-up with imaging modalities aiming to intervene at the third trimester can offer safer, and promising outcomes.http://www.sciencedirect.com/science/article/pii/S193004332200228XCase reportHepatocellular carcinomaNeuroendocrine tumor |
| spellingShingle | Ian Chik, MD, MRCS, DrGenSurg Jane Wai Yee Chuah, MD, MRCS Zamri Zuhdi, MBBS, MS Firdaus Hayati, MD, DrGenSurg Primary neuroendocrine tumor of the liver: A diagnostic dilemma in the management of liver mass in pregnancy Radiology Case Reports Case report Hepatocellular carcinoma Neuroendocrine tumor |
| title | Primary neuroendocrine tumor of the liver: A diagnostic dilemma in the management of liver mass in pregnancy |
| title_full | Primary neuroendocrine tumor of the liver: A diagnostic dilemma in the management of liver mass in pregnancy |
| title_fullStr | Primary neuroendocrine tumor of the liver: A diagnostic dilemma in the management of liver mass in pregnancy |
| title_full_unstemmed | Primary neuroendocrine tumor of the liver: A diagnostic dilemma in the management of liver mass in pregnancy |
| title_short | Primary neuroendocrine tumor of the liver: A diagnostic dilemma in the management of liver mass in pregnancy |
| title_sort | primary neuroendocrine tumor of the liver a diagnostic dilemma in the management of liver mass in pregnancy |
| topic | Case report Hepatocellular carcinoma Neuroendocrine tumor |
| url | http://www.sciencedirect.com/science/article/pii/S193004332200228X |
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