Primary Hepatic Carcinoid Tumor Detected Incidentally in Patient with Recurrent Peptic Ulcer Perforation

ABSTRACT

The liver is a common site for carcinoid metastases, and primary hepatic carcinoid tumor (PHCT) is a very rare entity. The diagnosis of PHCT is principally based on the histopathological confirmation of carcinoid tumor and the exclusion of a nonhepatic primary tumor. A 45-year-old man who presented with an intraabdominal abscess caused by recurrent peptic ulcer perforation had a huge heterogeneous mass in the central portion of the liver. The preoperative impression was peripheral cholangiocellular carcinoma. Central bisectionectomy was performed together with difficult adhesiolysis. On surgical exploration, there were no extrahepatic lesions. The postoperative course was uneventful, except for biloma formation, and the pathologic biopsy result was carcinoid tumor with positive immunohistochemical staining for chromogranin A. Our patient has been free of symptoms, including peptic ulcer, and there have been no abnormal findings on the follow-up abdominal images for 1 year. Accordingly, the diagnosis was primary hepatic carcinoid. In conclusion, PHCT should be diagnosed by the absence of extrahepatic lesion on surgical exploration and follow up throughout the clinical and imaging studies. A preoperative suspicion of PHCT is significant for conducting clinical investigations of a tumor's characteristics.