Neuroendocrine tumours (NETs) are
rare, accounting for only about 2% of all gastrointestinal tumours. Most are
non-functioning, and present fairly late with symptoms related to hepatic metastases.
A 55 years old man was referred to our hospital for loss of appetite,
weight loss and upper right quadrant pain. Standard ultrasonography showed
multiple liver multilocular cysts with mixed echostructure (hyperechoic aspect with
fluid content). The Contrast enhanced ultrasound procedure showed strong early wall,
septas and tissue parts enhancement in the arterial phase, followed by rapid
emptying in the portal phase. In real time elastography, hepatic lesions appear
with predominantly hard strain pattern surrounded by normal ‘‘soft’’ tissue. The
average histogram was 57 while strain ratio was 3.14. For a better examination
of the pancreas an echoendoscopic ultrasound examination was performed. A 2.1
cm tumor of the uncinate process of the pancreas was identified. Biopsy was
performed using an echoendoscopic approach from pancreatic and liver tumors. Histological
examination was consistent with a well differentiated NET. Plasma Chromogranin
A and serotonin levels were high. The patient was referred to the oncologic
department and currently is under treatment with somatostatin analogues.
The imaging finding of a pseudocystic lesion of the liver, implies several
differential diagnoses, ranging from echinococcosis, biliary cystadenomas,
biliary cystadenocarcinoma up to liver metastases. In this case presentation,
the new ultrasound techniques such as contrast enhanced ultrasound, real time
elastography, and echoendoscopic ultrasound had an important approach in establishing
the diagnosis.
