Abstract
GASTRIC NEUROENDOCRINE TUMOR MIMICKING HEPATOCELLULAR CARCINOMA IN A HEPATITIS ENDEMIC COUNTRY: A CASE REPORT
Tim Lawrence Lin, MD; Patricia Cabral-Prodigalidad, MD; Marcus Brillantes, MD; Ma. Regina Dimaculangan, MD; Olivia Payawal, MD; Joseph Erwin Dumagpi, MD; Nikko Theodore Raymundo, MD
St. Luke’s Medical Center, Global City
Significance: The most common cause of Hepatocellular Carcinoma (HCC) in Asia remains to be chronic hepatitis B infection. Rarely has neuroendocrine tumors manifest in the stomach, let alone metastasize aggressively to the liver and mimic the characteristics of HCC.
Clinical Presentation: We present a case of a 63-year-old Filipino male with a known history of chronic kidney disease from bilateral polycystic kidneys who presented with hematemesis and intermittent progressive epigastric pain. Initial imaging revealed multiple hepatic masses and splenic masses. AFP was elevated, and hepatitis profile revealed concomitant chronic hepatitis B infection. Liver biopsy was done, which revealed hepatocellular carcinoma. However, due to persistent hematemesis, esophagogastroduodenoscopy was done which revealed multiple ulcerating gastric masses where biopsies were taken. As gastric metastases are typically rare for HCC, a diagnosis of NET was entertained. PET-DOTATATE scan revealed multiple-avid lesions in the liver, spleen, pancreas, vertebra, pelvis, and lung. Biopsies of the gastric masses, and repeated liver and splenic mass biopsies with immunostaining all revealed Well-differentiated Neuroendocrine Tumor. An oral targeted therapy, Everolimus, was then initiated. We present a case of a 63-year-old Filipino male with a known history of chronic kidney disease from bilateral polycystic kidneys who presented with hematemesis and intermittent progressive epigastric pain. Initial imaging revealed multiple hepatic masses and splenic masses. AFP was elevated, and hepatitis profile revealed concomitant chronic hepatitis B infection. Liver biopsy was done, which revealed hepatocellular carcinoma. However, due to persistent hematemesis, esophagogastroduodenoscopy was done which revealed multiple ulcerating gastric masses where biopsies were taken. As gastric metastases are typically rare for HCC, a diagnosis of NET was entertained. PET-DOTATATE scan revealed multiple-avid lesions in the liver, spleen, pancreas, vertebra, pelvis, and lung. Biopsies of the gastric masses, and repeated liver and splenic mass biopsies with immunostaining all revealed Well-differentiated Neuroendocrine Tumor. An oral targeted therapy, Everolimus, was then initiated.
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |