Primary hepatic neuroendocrine tumor with repeated diarrhea and flushing face: A case report and literature review.

Introduction and importance: Primary hepatic neuroendocrine tumors (PHNET) are neuroendocrine tumors (NETs) originate from liver, they are rare kind of NETs, and only account for about 0.3 % of all NETs. The main symptom of PHNET is abdominal pain, diarrhea and flushing only account for about 7.2 % and 4.3 %, respectively. We report a PHNET patient with diarrhea and flushing face and review cases in the literature. Case presentation: A 50-year-old male patient came to our hospital for repeated diarrhea and flushing face for more than 2 years. The patient was hepatitis B virus carrier. Contrast-enhanced computed tomographic scan of the abdomen showed multiple tumors in both right and left hepatic lobes. An ultrasound-guided percutaneous needle biopsy was performed. Pathological examination of the biopsy showed the neoplasm were consisted of cells having an eosinophilic cytoplasm and round to oval hyperchromatic nuclei, indicating adenocarcinoma. To further identify the nature of the masses, immunohistochemical examination was performed, the result was positive for β-catenin, Ber-EP4, CgA, CK19, Syn, Ki-67 (3 %). Finally, the patient accepted transcatheter arterial chemoembolization treatment, and his symptoms did not occur ever after. Clinical discussion: PHNET is neuroendocrine tumor which originates from liver, it is a rare disease. The main clinical manifestation of PHNET is abdominal pain, in comparison, abdominal mass, weight loss, nausea, vomiting, diarrhea and flushing are relatively rare,In our case, the patient had repeated diarrhea, and his face turned blushing each time when diarrhea occurred. Fine needle aspiration biopsy guided by ultrasound was made, after immunohistochemical examinations, the patient was diagnosed PHNET. Treatments of PHNET include surgical resection, chemotherapy, TACE, percutaneous ethanol injection treatment (PEIT) and transplantation. The patient accepted TACE treatment, his diarrhea and blushing face were controlled. Conclusion: We reported a PHNET patient who had symptoms of repeated diarrhea and flushing face, and accepted transcatheter arterial chemoembolization treatment. Transcatheter arterial chemoembolization is an effective treatment for PHNET patient with diarrhea.