J Korean Neurosurg Soc.  2015 Dec;58(6):550-553. 10.3340/jkns.2015.58.6.550.

Metastatic Brain Neuroendocrine Tumor Originating from the Liver

• Lee GJ
• Jo KW
• Kim J
• Park IY

• KMID: 2151158
• DOI: http://doi.org/10.3340/jkns.2015.58.6.550

Abstract

A 67-year-old male presented with left temporal hemianopsia and left hemiparesis. A contrast-enhanced magnetic resonance image revealed a 4.5x3.5x5.0 cm rim-enhancing mass with central necrosis and associated edema located in the left occipital lobe. Of positron emission tomography and abdominal computed tomography, a 9-cm mass with poor enhancement was found in the right hepatic lobe. Craniotomy and right hemihepatectomy was performed. The resected specimen showed histological features and immunochemical staining consistent with a metastatic neuroendocrine tumor (NET). Four months later, the tumors recurred in the brain, liverand spinal cord. Palliative chemotherapy with etoposide and cisplatin led to complete remission of recurred lesions, but the patient died for pneumonia. This is the first case of a metastatic brain NET originating from the liver. If the metastatic NET of brain is suspicious, investigation for primary lesion should be considered including liver.

Keyword

Liver; Neuroendocrine tumor; Treatment; Chemotherapy

MeSH Terms

Aged
Brain*
Cisplatin
Craniotomy
Drug Therapy
Edema
Etoposide
Hemianopsia
Humans
Liver*
Male
Necrosis
Neuroendocrine Tumors*
Occipital Lobe
Paresis
Pneumonia
Positron-Emission Tomography
Spinal Cord
Cisplatin
Etoposide

Figure

• 

  Fig. 1 A : Axial, T1-weighted, post-gadolinium image of the brain. B : Positron emission tomography-computed tomography (PET-CT). C : Axial, T1-weighted, post-gadolinium image of the liver. Note a rim-enhancing mass with central necrosis and associated edema in the right occipital lobe of brain and right hepatic lobe.

• 

  Fig. 2 Histopathologic findings of brain and liver mass show a round to oval stippled and scant, pink dranular cytoplasm with H&E (A and B) and brain mass are strongly stained with CD56 (C). This finding reveals that brain mass is a neuroendocrine tumor which is the same pathology with liver tissue.

• 

  Fig. 3 A : Axial, T1-weighted, post-gadolinium image of the brain. B : Abdomen enhanced CT at 4 months after first craniotomy and hepatectomy. Note suspicious recurrence in the occipital lobe, inferior right cerebellum, and segment 8 of the liver.

• 

  Fig. 4 A : PET-CT scan after whole-brain radiation therapy. Note the multifocal FDG uptake in the cervical, thoracic and lumbar spinal cord and malignant tumor in right hepatectomy state. B : Spine post-gadolinium image. Note metastasis along the meninges at the T12–L1 level and cauda equine along the lumbar spine.

• 

  Fig. 5 A : PET-CT. B : spine post-gadolinium image. C : T1-weighted, post-gadolinium image of the brain. D : Abdomen enhanced CT. Note that previously enhancing tumors have disappeared.

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