25 August 2025
: Case report 
Rapid Progression of Primary Hepatic Neuroendocrine Carcinoma: A Case Report Demonstrating Drastic Oncological Behavior
Challenging differential diagnosis, Diagnostic / therapeutic accidents, Rare disease, Adverse events of drug therapy
Rina Kobayashi BF 1, Tomohide Hori
ABCDEF 1*, Makoto Yamawaki CDF 2, Shigeki Nakayama DF 1, Satoru Umegae DF 1, Takao Iwanaga DF 1, Ryutaro Nishikawa D 1, Takahiro Shimoyama DF 1, Sakurako Suzuki F 1, Shinichiro Atsumi CDF 3, Hiroshi Hasegawa F 2, Shigehito Nakashima DF 2, Kunihiro Higuchi F 2, Kentaro Onishi F 2, Ryotaro Sakaguchi F 2, Shoichi Morita F 2, Haruka Miyao F 2, Saki Aota F 2, Hikaru Ohtani F 1, Takayuki Yamamoto ADF 1
DOI: 10.12659/AJCR.948500
Am J Case Rep 2025; 26:e948500
Table 2 Graphic and surgical findings of hepatic tumor.
| Modality | Time (days)* | Graphic and surgical findings |
|---|---|---|
| 0 | Cirrhotic liver, developed collaterals, congestive stomach, and splenomegaly were observed | |
| )Figure 2 | Hepatic tumor () was incidentally detected | |
| 13 | Hepatic tumor () was enlarged | |
| )Figure 3 | Tumor thromboses were observed in the right HV () and the anterior branch of the PV () | |
| Hepatic tumor () showed low intensity in T1-weight imaging and high intensity in T2-weighted imaging | ||
| Contrast-enhanced T1-weighted imaging did not show any enhancement at early phase () | ||
| Gadoxetic acid-enhanced MRI did not reveal early wash-in or wash-out in the hepatic tumor () | ||
| 18 | Hepatic tumor () was enlarged | |
| )Figure 4 | Hepatic tumor () was observed as an irregularly-shaped hypoechoic mass by plain US | |
| Doppler US detected few feeding arteries into the hepatic tumor () | ||
| Hepatic tumor () was evaluated as hypovascular | ||
| 18 | Hepatic tumor () was enlarged | |
| )Figure 5 | Tumor thromboses were observed in the right HV () and the anterior branch of the PV () | |
| Early wash-in and wash-out were not observed in the hepatic tumor () | ||
| A solitary and swollen lymph node located dorsal to the PV trunk () appeared | ||
| 39 | Hepatic tumor () was enlarged | |
| )Figure 6 | The primary tumor in the liver () had strong uptake value | |
| Swelled lymph node located dorsal to the PV trunk () showed strong uptake value | ||
| Swollen, massive lymph nodes with strong uptake value appeared around the pancreas head, inferior vena cava, and abdominal aorta () | ||
| Solitary but swollen cervical lymph node () appeared with strong uptake | ||
| 48 | Metastatic cervical lymph node was enlarged | |
| During surgery, metastatic cervical lymph node was palpated as soft, not elastic and hard | ||
| 67 | Hepatic tumor () and metastatic lymph nodes (pink and orange arrows) were enlarged | |
| )Figure 8 | Tumor thromboses extended into the right and middle HVs () | |
| PV thrombosis extended into the left PV and PV trunk () | ||
| Pulmonary arterial thromboses () appeared | ||
| Massive ascites and intraperitoneal dissemination () appeared | ||
| CT – computed tomography; HV – hepatic vein; MRI – magnetic resonance imaging; PET/CT – positron emission-based tomography/computed tomography; PV – portal vein; US – ultrasound. * Time after the initial diagnosis (days). | ||