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Liver metastasis with unknown primary origin

Constantin Alina, Plotogea Oana, Ilie Madalina, Constantinescu G., Macovei B., Asmarandei R., Stanciulescu Elena-Luminita, Diaconu Camelia, Popa B.
Abstract: Pancreatic neuroendocrine tumors (pNETs) are usually slow growing tumors and their malignant potential is often underestimated. Most of them are malignant at diagnosis (50-80%, except for insulinoma) and have an aggressive course with liver metastases as well as other sites. These heterogeneous neoplasms are divided into two groups: functioning tumors, which secrete a variety of peptide hormones and nonfunctioning tumors (up to 90% of pNETs), which often show metastases at the time of diagnosis. We report a case of 44 years old male, non-smoker, recently diagnosed with type II diabetes mellitus, admitted for fatigue, loss of appetite and severe weight loss. Laboratory tests showed discrete inflammatory syndrome, while chest X-ray was normal. Abdominal ultrasound revealed hyperechoic lesions in both liver lobes. Tumor markers (carcinoembryonic antigen, alpha-fetoprotein and CA19-9) were elevated. The upper endoscopy and colonoscopy described no lesions. Abdominal computed tomography (CT) revealed hepatic metastases with unknown primary site, while contrast-enhanced ultrasound (CEUS) highlighted a hypoechoic hypervascular mass in the pancreatic tail. Chromogranin A, urinary 5-hydroxyindoleacetic acid, serotonin and neuron-specific enolase were normal. Ultrasound-Guided Liver Biopsy from the hepatic metastases was performed in order to establish the diagnosis. The histopathological and immunohistochemical results were decisive. Poorly differentiated pancreas neuroendocrine tumor (G3) was the diagnosis supported by the Ki67 index > 20 %.The patient was referred to medical oncology.

Keywords: liver metastasis, pancreatic neuroendocrine tumors, ultrasound-guided liver biopsy


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