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Primary hepatic neuroendocrine tumor in a patient with acute HBV hepatitis: An unusual neoplasia.

We present the case of a 67-year-old woman with no previous medical history, with a flu-like clinic of 14 days, associated with arthralgia and jaundice. Additional tests showed hyperbilirubinemia (TB: 12.03 mg/dL) and liver enzymes with a hepatocellular injury pattern (AST: 1906 IU/L, ALT: 1611 IU/L). Studies were conducted, with viral markers: HBsAg: 1351; HBeAg: 12.39; HBc IgM: 27.17 and HBV DNA-426, and abdominal ultrasonographic: Solid liver lesion (SLL) in segment IV adjacent to the portal vein of 21x17 mm. With the diagnosis of acute VHB hepatitis and SLL, diagnostic tests were extended. The abdominal CT (Fig. 1) and MRI showed the lesion described between segments III and IV suggestive of hepatocellular carcinoma. Liver biopsy (FNA) was performed giving a result of periportal and lobular chronic hepatitis, the SLL biopsy could not be performed due to its location. After the conversion to negative of HBsAg and HBc, the antiHBs positivity (acute hepatitis cured) and facing the suggestive HCC lesion, resection of segment IVa was performed, with intraoperative ultrasound that ruled out cirrhosis and other intrahepatic tumors. Highly favorable postoperative course, patient discharged on the fourth postoperative day. Pathology described a 3x3x2.5 cm tumor with poorly defined edges and free margins. Histological examination showed organoid architecture and travecular areas with cellular elements of round nuclei with clumped chromatin, and immunohistochemical techniques showed synaptophysin +, chromogranin -, and a proliferation rate of 5% compatible with a nonfunctioning primary hepatic neuroendocrine tumor (PHNT). Given the findings, a PET-SCAN was made without observing other injuries and chromogranin A was in normal range. Two years after surgery, the patient has had no recurrence.