case_images: PMC10436565_01
case_images: (A) Abdominal and chest CT before first treatment of Case1. (B) PET-CT before the first treatment of Case1. (C) Abdominal and chest CT after the first treatment of Case1. Red arrows indicate the location of the tumor.
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case_images: f1
case_images: Abdominal computed tomography (CT) ( Figure 1A ) indicated the presence of a mass of approximately 40 x 35 mm in size with an irregular shape in the S5/8 segment of the liver. A chest CT scan ( Figure 1A ) demonstrated an irregular soft tissue mass with a circular shape in the lower lobe of the right lung, indicating a possible metastatic lesion. 18F-FDG PET-CT ( Figure 1B ) demonstrated the presence of several hypodense lesions with ill-defined margins and elevated glucose uptake in the liver, and a nonuniform solid mass with increased glucose metabolism in the lungs. A follow-up CT scan showed that most of the S5/8 liver lesion had been necrotized, and the size of the lung mass was essentially unchanged ( Figure 1C ).
case_images: (A) Histologic examination of tumor tissues by hematoxylin and eosin staining of Case1. (B) Immunohistochemistry of Case1: CgA, NSE, Ki67, Syn. Red arrows indicate positive cells.
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case_images: f2
case_images: A liver biopsy was performed and pathological analysis ( Figure 2A ) revealed tumor cells arranged in a nest-like pattern, exhibiting mild-to-moderate atypia, an abundant cytoplasm containing fine granules, and delicate chromatin. Immunohistochemical analysis ( Figure 2B ) revealed that the tumor cells were positive for synaptophysin (Syn), chromogranin A (CgA), and neuron-specific enolase (NSE).
case_images: PMC10436565_02
case_images: (A) Abdominal MR before first treatment of Case2. (B) Abdominal PET-CT before initial treatment of Case2. (C) Abdominal MR after first treatment of Case2. Red arrows indicate the location of the tumor.
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case_images: f3
case_images: Abdominal MRI revealed several liver masses ( Figure 3A ). No filling defects were observed in the main portal veins or branches. 18F-FDG PET-CT performed in other hospitals before admission did not have a good differential effect; therefore, Ga68-DOTATATE PET-CT was performed, which showed a circular area with increased radioactive uptake (maximum standardized uptake value:24.5), consistent with the appearance of a neuroendocrine tumor in this region ( Figure 3B ). Two months later, a follow-up MRI ( Figure 3C ) showed a decrease in the size of the largest tumor in the S7/8 segment to 17x16 mm, while the tumor size in the S4 segment remained relatively unchanged (17.8x19.9 mm).
case_images: (A) Histologic examination of tumor tissues by hematoxylin and eosin staining of Case2. (B) Immunohistochemistry of Case2: CgA, NSE, Ki67, Syn. Red arrows indicate positive cells.
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case_images: PMC10436565_02_fonc-13-1225583-g004.jpg
case_images: f4
case_images: The pathology report from the liver biopsy as well as immunohistochemistry ( Figure 4A ) staining revealed widespread expression of CgA, Syn, and NSE in the tumor cells ( Figure 4B ).