Primary Hepatic Cystic Carcinoid Tumor Mimicking Hydatid Cyst

A 47-year-old woman with a three-month history of abdominal pain and feeling of an abdominal mass was referred to our clinic. Physical examination revealed hepatomegaly and a mass from right upper quadrant to epigastrium. On laboratory examinations, she had anemia (hemoglobin: 8.5; MCV: 78 fl) with normal liver function tests. She was negative for hepatitis B surface antigen (HBsAg), hepatitis B e-antigen (HBeAg) and anti-HCV. Immunodiagnostic tests for ecchinococcal antibody were also negative. Her alpha fetoprotein (AFP) and carbohydrate embryonic antigen (CEA) were also negative. Abdominal ultrasound demonstrated three hepatic echogenic cystic masses, measuring 20×14 cm in size. Abdominal CT-scan revealed three masses with peripheral enhancing (Figure 1) and other abdominal organs were normal (Figure 1).With these imaging findings, patient was provisionally diagnosed with hydatid cyst of liver. After walling of cysts with wet saline hypertonic sponge, the big cyst first aspirated a dark fluid. After collapse of cyst, pricyst was hypervascular. The other cysts were evacuated, respectively. Three pricysts and solid component of them were resected with difficulty and bleeding. Three units of blood were transfused intraoperatively. Macroscopically, specimen consisted of several fragments of creamy, cystic tissue measuring 10×10 cm and thickness of the wall was 0.3 to 0.4 cm. Microscopically, the cystic lesion was made of small and uniform cells with central nuclei and a moderated amount of finely granular cytoplasm. Cells were arranged in the combination forms of trabeculae, ribbons and glands with compact nest separated by a delicate fibrovascular stroma. Immunohistochemical (IHC) stain was positive for neuron-specific enolase (NSE), synaptophysin, and also strongly positive for chromogranin (Figure 2d). These evidences were compatible with a cystic carcinoid tumor of liver (Figure 2).