A 38-year-old female with no comorbid conditions had come with c/o gradually increasing
abdominal distension, abdominal pain, and jaundice for the past 3 months. O/E patient
was icteric and a tender right hypochondrial mass of size 7 × 5 cm was palpable. Investigations
revealed a deranged liver function with total bilirubin of 15.4, direct bilirubin
10.2, SGOT: 138, SGPT: 196, ALP: 864, and INR: 2.3.USG abdomen revealed a large heteroechoic
lesion in right lobe of liver infiltrating GB with multiple peritoneal deposits suggestive
of HCC. CECT abdomen showed hepatomegaly with large heterogeneously enhancing mass
lesion involving segments 4, 5, 6, and 2 of liver with GB infiltration with metastatic
omental and pelvic deposits suggestive of HCC. Serum levels of alpha-fetoprotein,
cancer antigen 125, and ferritin were normal. EUS-guided biopsy from the liver lesion
confirmed neuroendocrine carcinoma based on the IHC staining. The tumor was immunoreactive
for CK7, synaptophysin SATB2, CGA, INSM 1, and Ki-67 index of 95% which confirmed
the diagnosis of poorly differentiated Grade 3 NEC—small cell carcinoma type. Patient
underwent OGD, colonoscopy, and PET CT to investigate the primary site of NEC which
did not reveal any lesion in other organs. Hence the patient was diagnosed with primary
hepatic neuroendocrine carcinoma. In view of the large tumor size and poor physical
condition of the patient, surgical resection was deferred and planned for chemotherapy.
Liver NETs are one of the rarest subtypes constituting less than 0.3% of NETs and
less than 1% of primary liver tumors with only about 150 cases reported till now.
Thus, it is challenging to diagnose a case of NET as it is similar to HCC and if it
is of primary or metastatic origin and should be kept in mind while investigating
a liver tumor.
