case_images: PMC5337862_01
case_images: Hepatic tumor with multiple acinar-like structures. These structures contain eosinophilic secretions (thyroid-like morphologic characteristic) with brisk mitotic figures and neoplastic cells with "salt and pepper" chromatin (hematoxylin-eosin, original magnification x40).
case_images: CRIPA2017-7931975.001.jpg
case_images: PMC5337862_01_CRIPA2017-7931975.001.jpg
case_images: fig1
case_images: The cells were round to oval with scant eosinophilic cytoplasm that had "salt-and-pepper" chromatin (Figure 1) and brisk mitotic activity.
case_images: Chromogranin immunostain with focal expression in the tumor (original magnification x40).
case_images: CRIPA2017-7931975.002.jpg
case_images: PMC5337862_01_CRIPA2017-7931975.002.jpg
case_images: fig2
case_images: Immunohistochemical staining of the larger mass showed focal reactivity for chromogranin (Figure 2) and diffuse reactivity for synaptophysin, consistent with the diagnosis of a neuroendocrine carcinoma.
case_images: Cytokeratin 7 immunostain in the neoplastic cells (original magnification x40).
case_images: CRIPA2017-7931975.003.jpg
case_images: PMC5337862_01_CRIPA2017-7931975.003.jpg
case_images: fig3
case_images: The tumor showed diffuse positive immunostain for keratin and cytokeratin 7 (Figure 3) and patchy reactivity with vimentin.
case_images: Ki-67 expression in tumor cells (20% mitotic labeling index, original magnification x40).
case_images: CRIPA2017-7931975.004.jpg
case_images: PMC5337862_01_CRIPA2017-7931975.004.jpg
case_images: fig4
case_images: With a mitotic count of 16 or 17 mitoses per 10 high-power fields (HPFs) and Ki-67 labeling index of 20% (Figure 4), the diagnosis of intermediate grade (G2) NET, likely metastatic, was made.
case_images: Recurrent hepatic neuroendocrine tumor in 2007 with low-grade morphologic characteristics and a low mitotic count (hematoxylin-eosin, original magnification x40).
case_images: CRIPA2017-7931975.005.jpg
case_images: PMC5337862_01_CRIPA2017-7931975.005.jpg
case_images: fig5
case_images: On microscopy, the tumor showed follicular thyroid-like morphologic characteristics reminiscent of a thyroid follicular carcinoma (Figure 5).
case_images: Synaptophysin immunoexpression in the tumor (original magnification x40).
case_images: CRIPA2017-7931975.006.jpg
case_images: PMC5337862_01_CRIPA2017-7931975.006.jpg
case_images: fig6
case_images: The tumor once again stained positive for neuroendocrine markers, including synaptophysin (Figure 6) and chromogranin, in addition to keratin, cytokeratin 7 (Figure 7), and vimentin, confirming the diagnosis of recurrent PHNET.
case_images: Cytokeratin 7 immunoexpression in the neoplastic cells (original magnification x40).
case_images: CRIPA2017-7931975.007.jpg
case_images: PMC5337862_01_CRIPA2017-7931975.007.jpg
case_images: fig7
case_images: The tumor once again stained positive for neuroendocrine markers, including synaptophysin (Figure 6) and chromogranin, in addition to keratin, cytokeratin 7 (Figure 7), and vimentin, confirming the diagnosis of recurrent PHNET.
case_images: Ki-67 expression in the tumor cells (2% mitotic labeling index, original magnification x40).
case_images: CRIPA2017-7931975.008.jpg
case_images: PMC5337862_01_CRIPA2017-7931975.008.jpg
case_images: fig8
case_images: Interestingly, this tumor was a low-grade (G1) tumor with a mitotic count of 1 per 10 HPFs and a Ki-67 labeling index of 2% (Figure 8).
case_images: Metastatic hepatic neuroendocrine tumor in 2016 with morphologic characteristics similar to the previous hepatic tumors and an intermediate mitotic count (hematoxylin-eosin, original magnification x40).
case_images: CRIPA2017-7931975.009.jpg
case_images: PMC5337862_01_CRIPA2017-7931975.009.jpg
case_images: fig9
case_images: On microscopy, the tumor showed similar morphologic characteristics to the 2 previous primary and recurrent hepatic tumors (Figure 9).
case_images: Synaptophysin immunoexpression in the tumor (original magnification x40).
case_images: CRIPA2017-7931975.010.jpg
case_images: PMC5337862_01_CRIPA2017-7931975.010.jpg
case_images: fig10
case_images: Cytokeratin 7 immunostain with strong and diffuse expression in the neoplastic cells (original magnification x40).
case_images: CRIPA2017-7931975.011.jpg
case_images: PMC5337862_01_CRIPA2017-7931975.011.jpg
case_images: fig11
case_images: Ki-67 expression in the tumor cells. The mitotic labeling index was 5% (original magnification x40).
case_images: CRIPA2017-7931975.012.jpg
case_images: PMC5337862_01_CRIPA2017-7931975.012.jpg
case_images: fig12
case_images: The tumor characteristics and immunohistochemical profile were consistent with the diagnosis of PHNET metastasis. The Ki-67 labeling index was 5% (Figure 12) with a mitotic count of 2 mitoses per 10 HPFs, thereby grading the metastasis as G2.