case_images: PMC8092117_01
case_images: PMC8092117_02
case_images: MRI. MRI imaging of the liver in 2010 showing two minute tumors (A one progressed (arrowhead) B) in March 2016 while the other (thin arrow) (C) remained stable.
case_images: fonc-11-646992-g001.jpg
case_images: PMC8092117_02_fonc-11-646992-g001.jpg
case_images: f1
case_images: On January 2014, the total body CT scan and liver MRI confirmed the partial response (most lesions remained centimetric) ( Figure 1A ), and a 68Ga-DOTATOC PET scan did not demonstrate any activity. Octreotide LAR was reintroduced, but three months later MRI showed a further increase in the size of the larger lesion with a necrotic appearance ( Figure 1B ), while the other hepatic nodules remained stable ( Figure 1C ). 18Fluorodeoxyglucose PET scan showed major hypermetabolism of this nodule (standardized uptake value 22.8) with no activity elsewhere ( Figure 2 ).
case_images: 18FDG-PET. 18FDG-PET image from March 2016: major uptake in the progressing lesion; no other suspect foci was seen.
case_images: fonc-11-646992-g002.jpg
case_images: PMC8092117_02_fonc-11-646992-g002.jpg
case_images: f2
case_images: Octreotide LAR was reintroduced, but three months later MRI showed a further increase in the size of the larger lesion with a necrotic appearance ( Figure 1B ), while the other hepatic nodules remained stable ( Figure 1C ). 18Fluorodeoxyglucose PET scan showed major hypermetabolism of this nodule (standardized uptake value 22.8) with no activity elsewhere ( Figure 2 ).
case_images: Poorly differentiated tumor (A) Large cell neuroendocrine carcinoma composed by large cells with high mitotic index (> 20 mitoses/2mm2). HES, x20. (B) Immunostaining CKAE1/AE3, monoclonal antibody, clone AE1/AE3/PCK26, Ventana, x20. (C) Immunostaining KI67 : high nuclear expression (> 70%) monoclonal antibody, clone MIB1, Agilent Dako, x20. (D) Immunostaining Chromogranin A, monoclonal antibody, clone LK2H10, Ventana, X20. (E) Immunostaining Synaptophysin, monoclonal antibody, clone SP11, Ventana, X20. (F) Immunostaining CD56, monoclonal antibody, clone MRQ-42, Ventana/Cell marque, X20.
case_images: fonc-11-646992-g003.jpg
case_images: PMC8092117_02_fonc-11-646992-g003.jpg
case_images: f3
case_images: The histologic study showed two neuroendocrine proliferations with different differentiations ( Figures 3  and  4 ).
case_images: Well differentiated tumor. (A) Well-differentiated neuroendocrine tumour with glandular architecture. HES, x 20. (B) Immunostaining CKAE1/AE3, monoclonal antibody, clone AE1/AE3/PCK26, Ventana, x20. (C) Immunostaining KI67: low nuclear expression (< 1%) monoclonal antibody, clone MIB1, Agilent Dako, x20. (D) Immunostaining Chromogranin A, monoclonal antibody, clone LK2H10, Ventana, X20. (E) Immunostaining Synaptophysin, monoclonal antibody, clone SP11, Ventana, X20. (F) Immunostaining CD56, monoclonal antibody, clone MRQ-42, Ventana/Cell marque, X20.
case_images: fonc-11-646992-g004.jpg
case_images: PMC8092117_02_fonc-11-646992-g004.jpg
case_images: f4
case_images: The histologic study showed two neuroendocrine proliferations with different differentiations ( Figures 3  and  4 ).