case_images: PMC11132830_01
case_images: Right upper quadrant ultrasound demonstrated heterogeneous hepatic echotexture with innumerable echogenic masses, suggesting a metastatic process.
case_images: CRIONM2024-8792291.001.jpg
case_images: PMC11132830_01_CRIONM2024-8792291.001.jpg
case_images: fig1
case_images: Right upper quadrant ultrasound (RUQ US) demonstrated heterogeneous hepatic echotexture with innumerable echogenic masses, suggesting a metastatic process (Figure 1).
case_images: Axial section obtained from computed tomography of the abdomen and pelvis shows numerous hypovascular liver masses measuring up to 4.8 cm.
case_images: CRIONM2024-8792291.002.jpg
case_images: PMC11132830_01_CRIONM2024-8792291.002.jpg
case_images: fig2
case_images: Contrast-enhanced abdominal/pelvic computed tomography (CT A/P) revealed numerous hypovascular liver masses measuring up to 4.8 cm, along with sclerotic and lucent foci within the iliac bones, vertebral bodies, and partially imaged sternum, raising concerns for metastatic disease (Figures 2-4).
case_images: Coronal section obtained from computed tomography of the abdomen and pelvis shows numerous hypovascular liver masses measuring up to 4.8 cm (blue arrow).
case_images: CRIONM2024-8792291.003.jpg
case_images: PMC11132830_01_CRIONM2024-8792291.003.jpg
case_images: fig3
case_images: Contrast-enhanced abdominal/pelvic computed tomography (CT A/P) revealed numerous hypovascular liver masses measuring up to 4.8 cm, along with sclerotic and lucent foci within the iliac bones, vertebral bodies, and partially imaged sternum, raising concerns for metastatic disease (Figures 2-4).
case_images: Coronal sections obtained from computed tomography of the abdomen and pelvis show sclerotic (orange arrow) and lucent foci (yellow arrows) within the iliac bones and vertebral bodies.
case_images: CRIONM2024-8792291.004.jpg
case_images: PMC11132830_01_CRIONM2024-8792291.004.jpg
case_images: fig4
case_images: Contrast-enhanced abdominal/pelvic computed tomography (CT A/P) revealed numerous hypovascular liver masses measuring up to 4.8 cm, along with sclerotic and lucent foci within the iliac bones, vertebral bodies, and partially imaged sternum, raising concerns for metastatic disease (Figures 2-4).
case_images: Morphologic features and immunoprofile are consistent with LCNEC. The origin of tumor could not be determined by IHC analysis. Neuroendocrine carcinomas may be TTF-1 positive, regardless of origin. Few cells weakly positive for CDX-2 suggest an appendix, pancreas, or intestinal primary. Immunohistochemistry showed positive CK7, AE1/AE3, synaptophysin, chromogranin, CD56, TTF-1 and p63 (scattered cells, weak), CDX-2 (few cells, weak), and Ki-67 proliferation index (99%).
case_images: CRIONM2024-8792291.005.jpg
case_images: PMC11132830_01_CRIONM2024-8792291.005.jpg
case_images: fig5
case_images: Immunohistochemistry results were positive for CK7, AE1/AE3, synaptophysin, chromogranin, CD56, TTF-1 and p63 (scattered cells, weak), and CDX-2 (few cells, weak), suggesting possible appendiceal, pancreatic, or intestinal primary; Ki-67 proliferation index was 99%, suggesting aggressive behavior (Figure 5).
case_images: CT abdomen and pelvis was performed 2 months after starting chemotherapy which demonstrated a slight decrease in the size of hepatic metastatic lesions, which may represent a partial response to therapy (blue arrow).
case_images: CRIONM2024-8792291.006.jpg
case_images: PMC11132830_01_CRIONM2024-8792291.006.jpg
case_images: fig6
case_images: A repeat CT of the patient's chest, abdomen, and pelvis was performed 2 months after starting chemotherapy, which demonstrated a slight decrease in the size of hepatic metastatic lesions, which may represent a partial response to therapy (Figure 6).