BACKGROUND Primary hepatic neuroendocrine neoplasm(NEN)is a rare condition,and it is difficult to differentiate between primary and metastatic hepatic NENs.Herein,we report a case of primary hepatic NEN that initially...BACKGROUND Primary hepatic neuroendocrine neoplasm(NEN)is a rare condition,and it is difficult to differentiate between primary and metastatic hepatic NENs.Herein,we report a case of primary hepatic NEN that initially mimicked a hemangioma but showed a gradual increase in size on long-term careful observation.CASE SUMMARY A 47-year-old woman was incidentally diagnosed with a 12-mm liver mass,suspected to be a hemangioma.Since then,regular follow-up had been carried out.Ten years later,she was referred to our institute due to the tumor(located in segment 4)having increased to 20 mm.Several imaging studies depicted no apparent extrahepatic lesion.Positron emission tomography(PET)/computed tomography exhibited significant accumulation in the mass lesion,which made us consider the possibility of malignancy.Left hepatectomy was performed.The histopathological diagnosis was neuroendocrine tumor grade 2,with somatostatin receptor 2 a/5 positivity.Postoperative somatostatin receptor scintigraphy(SRS)showed no other site,leading to the diagnosis of NEN of primary hepatic origin.The gradual growth of the hepatic NEN over 10 years suggested that it was likely to be a primary liver tumor.CONCLUSION In this case,positivity on PET and postoperative SRS may have helped determine whether the tumor was primary or metastatic.展开更多
Liver transplantation has emerged as a potential therapeutic option for select patients with intrahepatic cholangiocarcinoma(iCCA)who are not amenable to curative resection.Recent studies have challenged the tradition...Liver transplantation has emerged as a potential therapeutic option for select patients with intrahepatic cholangiocarcinoma(iCCA)who are not amenable to curative resection.Recent studies have challenged the traditional notion that liver transplantation is contraindicated for iCCA,leading to a paradigm shift in its management.This review provides a comprehensive synthesis of the evidence regarding the role of liver transplantation in the treatment of very early or advanced iCCA and discusses the key challenges and future directions in this rapidly evolving field.For patients with cirrhosis and very early iCCA,liver transplantation has demonstrated excellent long-term survival rates,rivaling those of patients with hepatocellular carcinoma.However,the current transplantation criteria based on tumor size and number may be overly restrictive,excluding potential candidates who could benefit from this treatment.The incorporation of tumor markers into selection criteria may improve prognostic prediction and patient outcomes.In advanced iCCA,liver transplantation remains controversial but holds promise,especially when combined with neoadjuvant and adjuvant therapies.Donor organ scarcity necessitates the consideration of living donor liver transplantation as an alternative,while strategies such as utilizing marginal donors and exploring xenotransplantation offer potential solutions to address the shortage of donor livers.Overall,the evolving understanding of iCCA and the development of novel treatment strategies promise to refine and enhance the role of liver transplantation in the management of this challenging malignancy.展开更多
文摘BACKGROUND Primary hepatic neuroendocrine neoplasm(NEN)is a rare condition,and it is difficult to differentiate between primary and metastatic hepatic NENs.Herein,we report a case of primary hepatic NEN that initially mimicked a hemangioma but showed a gradual increase in size on long-term careful observation.CASE SUMMARY A 47-year-old woman was incidentally diagnosed with a 12-mm liver mass,suspected to be a hemangioma.Since then,regular follow-up had been carried out.Ten years later,she was referred to our institute due to the tumor(located in segment 4)having increased to 20 mm.Several imaging studies depicted no apparent extrahepatic lesion.Positron emission tomography(PET)/computed tomography exhibited significant accumulation in the mass lesion,which made us consider the possibility of malignancy.Left hepatectomy was performed.The histopathological diagnosis was neuroendocrine tumor grade 2,with somatostatin receptor 2 a/5 positivity.Postoperative somatostatin receptor scintigraphy(SRS)showed no other site,leading to the diagnosis of NEN of primary hepatic origin.The gradual growth of the hepatic NEN over 10 years suggested that it was likely to be a primary liver tumor.CONCLUSION In this case,positivity on PET and postoperative SRS may have helped determine whether the tumor was primary or metastatic.
文摘Liver transplantation has emerged as a potential therapeutic option for select patients with intrahepatic cholangiocarcinoma(iCCA)who are not amenable to curative resection.Recent studies have challenged the traditional notion that liver transplantation is contraindicated for iCCA,leading to a paradigm shift in its management.This review provides a comprehensive synthesis of the evidence regarding the role of liver transplantation in the treatment of very early or advanced iCCA and discusses the key challenges and future directions in this rapidly evolving field.For patients with cirrhosis and very early iCCA,liver transplantation has demonstrated excellent long-term survival rates,rivaling those of patients with hepatocellular carcinoma.However,the current transplantation criteria based on tumor size and number may be overly restrictive,excluding potential candidates who could benefit from this treatment.The incorporation of tumor markers into selection criteria may improve prognostic prediction and patient outcomes.In advanced iCCA,liver transplantation remains controversial but holds promise,especially when combined with neoadjuvant and adjuvant therapies.Donor organ scarcity necessitates the consideration of living donor liver transplantation as an alternative,while strategies such as utilizing marginal donors and exploring xenotransplantation offer potential solutions to address the shortage of donor livers.Overall,the evolving understanding of iCCA and the development of novel treatment strategies promise to refine and enhance the role of liver transplantation in the management of this challenging malignancy.
