Abstract
A 38-year-old woman with severe obesity (BMI : 40 kg/m2) had a huge tumor in the right hepatic lobe. The tumor was 13×8 cm in size, with an intrahepatic metastasis in S3. On pathology of a tumor biopsy, a well-differentiated neuroendocrine tumor was diagnosed. A primary site other than the liver could not be found. On biochemistry, tumor marker and endocrine hormone levels were normal. On immunohistochemistry, tumor cells were positive for chromogranin and synaptophysin, and the Ki67 index was 4.3%. A pre-operative diagnosis of a nonfunctional primary hepatic neuroendocrine tumor (Grade 2) with intrahepatic metastasis was made. A surgical resection was done even though the patient was very obese and had a large tumor with an intrahepatic metastasis, since of the Ki67 index level was low and the tumor was well differentiated which indicated a low biological malignant potential. A right hepatic trisegmentectomy and RFA were performed for the intrahepatic metastatic tumor. The patient has been doing well and is without a reccurence after 2 years of postoperative follow up. Hepatic resection should be considered the first choice of treatment for primary hepatic neuroendocrine tumor in patients with low Ki67 index levels and well-differentiated tumors, even if an intrahepatic metastasis is present.
