Role of advanced imaging in primary hepatic neuroendocrine tumor with borderline raised AFP and negative chromogranin staining: A case report

Primary hepatic neuroendocrine tumors (PHNETs) are rare, accounting for approximately 0.3 % of all neuroendocrine tumors (NETs) and are often difficult to diagnose due to their nonspecific symptoms and imaging features. Standard diagnostic and treatment protocols are lacking due to their rarity, but imaging and immunohistochemistry (IHC) remain key tools for diagnosis. A 68-year-old male presented with abdominal discomfort and loss of appetite. Imaging revealed a large exophytic mass in the left lobe of the liver. After ruling out extrahepatic primary sources, a left lobe hepatectomy was performed. Histopathology confirmed the diagnosis of PHNET, with positive IHC staining for synaptophysin and CK-7. Postoperative PET-CT ruled out any distant metastases. The patient had an uneventful recovery. PHNETs are believed to originate from ectopic neuroendocrine cells in the liver, though several theories exist. Imaging alone cannot conclusively diagnose PHNETs, as they mimic other hepatic tumors like hepatocellular carcinoma. Histopathological examination, along with IHC markers like chromogranin and synaptophysin, is essential for diagnosis. Surgical resection remains the treatment of choice, with good outcomes despite the risk of recurrence. Non-surgical therapies, such as chemotherapy or ablation, are under investigation but lack consensus. PHNETs are rare and challenging to diagnose, requiring imaging and IHC for confirmation. Surgery offers the best prognosis, making personalized, surgery-centered treatment plans essential for management. Comprehensive follow-up, including functional imaging, is necessary to monitor recurrence or metastasis. •This case highlights a rare Primary Hepatic Neuroendocrine Tumor (PHNET), accounting for only 0.3% of all NETs•Imaging revealed a large exophytic liver mass; after ruling out extrahepatic sources, a left lobe hepatectomy was performed, leading to an uneventful recovery.•Histopathology confirmed PHNET with positive synaptophysin and CK-7 staining, but negative chromogranin, aiding in precise diagnosis.•PET-CT and Ga-68 DOTANOC PET/CT scans ruled out metastases and identified a possible postoperative seroma, emphasizing the importance of imaging in monitoring.•Surgical resection remains the best option for PHNET, offering both diagnostic confirmation and curative potential, despite the risk of recurrence