Analysis Of Primary Hepatic And Gallbladder Neuroendocrine Neoplasms

Part One Analysis of 17 cases of primary hepatic neuroendocrine neop- lasmsObjective: To retrospectively analyze the clinical data of 17 patients with primary hepatic neuroendocrine neoplasms in this study in order to improve the knowledge,diagnosis and treatment of the disease.Method: Selected from 992 patients confirmed with neuroendocrine neoplasms,the clinical manifestations,laboratory examinations,imaging findings,pathological grades,and treatment of 17 patients diagnosed as primary hepatic neuroendocrine neoplasms from January 1,2006 to December31,2017 in the Fourth Hospital of Hebei Medical University were retrospectively analyzed.All patients were followed up until January 30,2018.Result: There were 11 female patients,accounting for 64.7%,with a median age of 56 years.Seven(41.2%)patients were found on physical examination.There were 5(29.4%)cases of abdominal pain or discomfort.At the first visit,4(23.5%)patients had elevated transaminases,4(23.5%)patients had elevated bilirubin,5(29.4%)patients had elevated alkaline phosphatase,and 8(47.1%)patients had elevated ?-glutamyl transpeptidase.AFP was elevated in 6 patients(40%);CEA was elevated in 3 patients(20%);CA19-9 was elevated in 7 patients(46.7%);ferritin was elevated in 8 patients(66.7%).The tumor was located in the right lobe of the liver in 9 cases(52.9%)and the single tumor in 9 cases(52.9%).Imaging showed continuous mild enhancement in the arterial phase,venous phase,and delayed phase,and low density changes relative to the liver.No portal vein tumor emboli were formed.4 patients(23.5%)were found to have distant metastases,including adrenal,portal lymph node,retroperitoneal lymph nodes,gallbladder and peritoneum were invaded.There were 3 cases of NET G2;2 cases of NET G3;10 cases ofNEC,including 2 cases of LCNEC and 3 cases of SCNEC;2 cases of HCC and SCNEC.7 cases were treated with surgery alone;4 cases received surgery combined with TACE;2 cases were treated with surgery combined with other treatments;3 cases did not receive surgery,and TACE,EP,and octreotide acetate were used for treatment;1 case was discharged automatically.A total of 9 patients were followed up,4 patients were treated with surgery alone,NET G2 was 2 cases,the survival period was 23 months and 36 months respectively;HCC and SCNEC were 1 case,survival period was more than 1month;NEC was 1 case,survival period was 2 months.2 patients undergoing surgery combined with TACE were LCNEC with a survival period of 53 months and 77 months respectively.1 case received surgery combined with microwave therapy was NET G3,with a 6-month survival period.1 case of surgery combined with EP regimen chemotherapy was NEC with a survival period of 80 days.1 case was NEC.Because of poor general conditions,it was untreated and discharged automatically.The survival period was 14 days.Summary: Primary hepatic neuroendocrine neoplasms are mainly seen in middle-aged patients and are more common in women.The clinical manifestations are non-specific and are mostly found during physical examination.Past history of hepatitis B,imaging suggestive of cirrhosis,liver occupying,may also be primary hepatic neuroendocrine tumors.Increases in alkaline phosphatase and ?-glutamyl transpeptidase may be related to it.The tumor markers CA19-9 and ferritin were significantly elevated and had certain diagnostic value for this disease.The density of tumors on CT images was lower than that of liver parenchyma.The enhancement of arteries showed medium to high enhancement,and the venous phase continued to strengthen,but the degree of enhancement was reduced and rarely accompanied by portal vein tumor thrombus formation.Surgery is the main treatment,combined with TACE is superior to surgery combined with microwave ablation,chemotherapy and other treatments.Part Two Analysis of 5 cases of primary gallbladder neuroendocrine neoplasmsObjective: In this study,the clinical data of 5 patients were retrospectively analyzed,in order to improve the understanding of the disease and the experience in diagnosis and treatment.Method: Selected from 992 patients confirmed with neuroendocrine neoplasms,the clinical manifestations,laboratory examinations,imaging findings,pathological grades,and treatment of 5 patients diagnosed as primary gallbladder neuroendocrine neoplasms from January 1,2006 to December 31,2017 in the Fourth Hospital of Hebei Medical University were retrospectively analyzed.All patients were followed up until January 30,2018.Result: Males accounted for 3 cases(60%),with a median age of 58 years.Four patients(80%)had clinical manifestations of abdominal pain or discomfort.No abnormal liver function was found in 2 patients(40%).All patients' serum AFP test results were in the normal range.2 cases(40%)of elevated serum CEA.2 cases(40%)of elevated serum CA19-9.3 cases(60%)of elevated serum ferritin.Imaging of 5 patients all indicated liver metastasis.All patients were neuroendocrine carcinomas,including 3 cases of LCNEC and 1 case of SCNEC.Four patients were treated with surgery alone,and one patient was treated with cisplatin(intraperitoneal injection)and paclitaxel systemic chemotherapy.A total of 4 patients were followed up,1 patient who's pathological type was SCNEC received surgery combined with chemotherapy,and the survival period was 125 months,and is still alive.The remaining 3patients were treated with surgery alone and all died.Among them,2 cases were LCNEC,and the survival period was 2 months and 25 months respectively.One case of NEC had a survival period of 4 months.Summary: Primary gallbladder neuroendocrine neoplasms are mainly seen in middle-aged patients.This article shows that there is no significant difference in gender.Its clinical manifestations are non-specific,mainly manifested as epigastric pain.Imaging suggests gallbladder malignancies and gallstones may be primary gallbladder neuroendocrine tumors.Increases in alkaline phosphatase and ?-glutamyl transpeptidase may be related to it.Tumor markers such as CA19-9 and ferritin are significantly elevated and have a certain diagnostic value for this disease.The imaging examination showed no specific manifestations and liver metastases were prone to occur.Surgery is the main treatment,and combined with systemic chemotherapy helps to prolong survival.Conclusion: Primary hepatic and gallbladder neuroendocrine neoplasms are mainly seen in middle-aged patients and are more common in women.The clinical manifestations are mainly epigastric pain or discomfort,and mostly found on physical examination.Increases in alkaline phosphatase and?-glutamyl transpeptidase may be associated with primary hepatic and gallbladder neuroendocrine neoplasms.The elevation of tumor markers CA19-9 and ferritin has a certain diagnostic value for this disease.Past history of hepatitis B,imaging suggestive of cirrhosis,liver occupying,may also be primary hepatic neuroendocrine neoplasms.Imaging suggests gallbladder malignancies,combined with gallstones,may also be primary gallbladder neuroendocrine neoplasms.Surgery is the main method of treatment,the combination of TACE with primary hepatic neuroendocrine neoplasms is superior to surgery combined with microwave ablation,chemotherapy and other treatments.Combination of systemic chemotherapy with primary gallbladder neuroendocrine neoplasms helps to prolong survival.