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Euro Gastroenterology 2019 & Clinical Pharmacy 2019 Archives of General Internal Medicine | ISSN: 2591-7951 | Volume 3
Page 25
March 25-26, 2019 | Amsterdam, Netherlands
&
GASTROENTEROLOGY AND HEPATOLOGY
4th International Conference on
CLINICAL PHARMACY & PHARMACY PRACTICE
9th World Congress on
Joint Event on
OF EXCELLENCE
IN INTERNATIONAL
MEETINGS
YEARS
PRIMARY HEPATIC NEUROENDOCRINE TUMORS, A RARE ENTITY – MULTI-
MODAL APPROACH FOR DIAGNOSIS AND MANAGEMENT
Sana Amir Akbar, Yasir Rashed, Hassaan Bari and Faisal Hanif
Shaukat Khanum Memorial Cancer Hospital & Research Centre, Pakistan
Neuroendocrine tumors (NET) of the liver are generally metastatic lesions from other more common primary
sites. Liver is an unusual primary site for a NET with only 150 reported cases in English literature. Here we
present a case of a primary hepatic NET.
A 64 years old gentleman with no known comorbids presented in outpatient department with 3 weeks history
of pain in right upper abdomen associated with generalized weakness and poor appetite. Examination was un-
remarkable except for non-tender hepatomegaly. CT scan liver showed a large 18.1 cm lesion in right lobe that
was atypical for HCC. Viral markers for Hepatitis B & C were non-reactive.
To confirm the diagnosis, biopsy of the lesion was performed that showed NET. Upper and lower GI endoscopies
and whole body octreotide scan was performed to locate the primary lesion. These investigations revealed no
lesion elsewhere in the body, so he was diagnosed with primary hepatic NET. It was managed with 1 cycle of neo
adjuvant chemotherapy to reduce the size of the lesion followed by right portal venous embolization to increase
the volume of future remnant liver. Right hepatic trisectionectomy was performed 1 month after PV emboliza-
tion. Final histopatholgy showed 23 cm NET, WHO Grade-II with 2 mm nearest parenchymal margin.
Post-operative course was unremarkable and he was discharged on the 6th POD in stable condition. On his sec-
ond follow-up visit, 8 weeks after surgery, he presented with right leg DVT and bilateral pulmonary embolism
that was managed with therapeutic dose of enoxaparin and lifelong anticoagulation. Currently he is alive, dis-
ease free and on regular follow up.
In conclusion primary hepatic NETs are challenging to diagnose but they can be successfully managed with
multi modal treatment.
Sana Amir Akbar et al., Arch Gen Intern Med 2019, Volume 3 | DOI: 10.4066/2591-7951-C1-023
Sana Amir Akbar is a medical professional and is a hardworking and empathetic individual. She is aware of the limited
medical facilities available for her fellow countrymen when they fell ill. In Pakistan every 10th person suffers from hep­
atitis with very few specialist centres / trained doctors in hepatobiliary surgery, that is why she is interested to become
a hepatobiliary surgeon in future. She is also interested in clinical research and is currently working on various research
projects at her institute. Her educational background includes MBBS from Allama Iqbal Medical College, Lahore and one
year of house job / internship from Jinnah Hospital, Lahore. She has recently cleared her intermediate module of resi-
dency training. Currently she is a working as a resident doctor in general surgery at Shaukat Khanum Memoral Cancer
Hospital & Research Centre, Lahore, Pakistan and is in fourth year of her FCPS-II training.
BIOGRAPHY