REPORT

Patient’s name: Emin Rama January 22, 2019

Age: 63

A 63-year-old male presented with symptoms of a cold at his physician’s office in December
2017. A routine abdominal U/S showed some unspecific changes on the liver, abdominal MR
was performed next. The MR scan of the abdomen + pelvis showed 3 neoplastic lesions in the
liver and a single lesion (6x7cm in size) on the sacral bone.

In February 2018, an exploratory laparotomy was performed and biopsy was taken from the
neoplastic lesions on the liver. Many metastatic changes were noted on the liver during
laparotomy, also a pelvic tumor fixed on the sacral bone.

The biopsy of the pelvic tumor showed round tumor cells forming trabecular formations, which
were also seen on the specimen from the liver (edge of the liver, specifically) biopsy, and areas
of necrosis that were specific to the pelvic tumor only.

An MI of 7/10 high power field (HPF) and immunohistochemistry showed an expression of

Synaptophysin (Syn), CD56 and only focal CgA. No expression of TTF1, pCEA and low levels
of PAX2 and PAX8. Ki67 levels vary from 40-82% in different areas.

The findings support a well differentiated Neuroendocrine Carcinoma (NEC-G3).

Afterwards, during March 2018, a surgery was performed to excise the pelvic tumor,
subsegmentectomy SVII and segmentectomy sIVb and sV were also performed. No biopsy was
taken this time.
During the same month, patient presented to the ER with a case of strangulated ileus and
gangrene (60cm) of small bowel requiring prompt surgery.

Repeated abdominal MRI was performed 3 months ago showing multiple secondary deposits
and post-op sequels.

Physical examination: Patient appears well, auscultation of the lungs and heart is clean, BP
110/70, pulse: 72. Liver and spleen couldn’t be palpated. A deep mass was palpated on the left
iliac bone(?).

EKG showed sinus rhythm, axis QRS +80, no elevation/depression was noted in ST and T
wave.

Conclusion: G3 Neuroendocrine tumor with unknown primary origin. Histologic diagnosis was
established based on the biopsies from liver and the pelvic mass.

Next Step: MRI of abdomen, thorax MSCT, and/or FDG-PET/CT should be performed. As for
the therapy, biological therapy of any sort is not recommended since the proliferative index is
too high. Instead FOLFIRINOX.
REPORT