Primary hepatic neuroendocrine tumour: A rare entity - multimodal approach for diagnosis and management

Neuroendocrine tumours (NETs) of the liver are generally metastatic lesions from broncho-pulmonary or gastrointestinal primary lesions. Liver is an unusual primary site for a NET with only 150 reported cases in literature. We encountered two cases of primary hepatic NET (PHNET) at the Shaukat Khanum Memorial Cancer Hospital, Lahore. Both the patients had abdominal pain and hepatomegaly. Imaging revealed a large mass in the right lobe of the liver in both the cases. The tru-cut biopsy showed neuroendocrine tumour. Extensive workup to look for primary lesion elsewhere in the body turned out to be negative. One patient received neo-adjuvant chemotherapy along with right main portal vein embolisation. Once adequate future liver remnant was achieved, the patient underwent right hepatic trisectionectomy. In the other patient, anticipated future liver remnant was sufficient and underwent surgery without portal vein embolization. No immediate postoperative complication was observed, and both the patients were followed for more than one year.