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Volume 15
Issue 19
10.3390/diagnostics15192535
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Case Report

Synchronous Pulmonary and Cecal High-Grade Neuroendocrine Carcinomas Presenting as Hepatic Metastases: A Diagnostic Challenges and Literature Review

by
Georgiana Elena Sârbu
1,2,
Alina Ecaterina Jucan
1,2,*,
Claudiu Vasile Mihai
3,
Carmen Atodiresei
2,
Madalina Ene
2,
Carmen Ungureanu
4,
Ioana Ruxandra Mihai
5,
Otilia Nedelciuc
1,2,
Mihaela Dranga
1,2,
Cristina Cijevschi Prelipcean
2 and
Catalina Mihai
1,2
1
Department of Gastroenterology, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
2
Department of Gastroenterology, Saint Spiridon County Hospital, 700111 Iasi, Romania
3
Department of Radiology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
4
Department of Morphofunctional Sciences I—Pathology, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
5
Department of Rheumatology and Rehabilitation, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania
*
Author to whom correspondence should be addressed.
Diagnostics 2025, 15(19), 2535; https://doi.org/10.3390/diagnostics15192535
Submission received: 19 July 2025 / Revised: 29 September 2025 / Accepted: 6 October 2025 / Published: 8 October 2025
(This article belongs to the Special Issue Diagnosis and Management of Neuroendocrine Tumors)
Versions Notes

Abstract

Background and Clinical Significance: Neuroendocrine neoplasms (NENs) are a group of malignancies that may remain clinically silent for many years. The presence of hepatic metastases can be the first clue leading to diagnosis. Case Presentation: We report the case of a 67-year-old man with intermittent tiredness and suspicious hepatic nodules detected on routine abdominal ultrasound. Contrast-enhanced ultrasonography showed arterial hyperenhancement with early washout, suggestive of metastases. Synchronous high-grade neuroendocrine carcinomas (NECs) of the lung and cecum were identified. Although the liver lesions were initially presumed to arise from the cecal tumor, liver biopsy immunohistochemistry was TTF-1 positive/CDX2 negative, whereas the cecal lesion was TTF-1 negative/CDX2 positive. This mutually exclusive immunophenotype confirmed two separate primary carcinomas. Given the high-grade histology, the patient received platinum-based chemotherapy and achieved a partial response. Conclusions: This case illustrates the diagnostic complexity of synchronous lesions and highlights the “mirage of the first lesion” phenomenon, in which the initially detected tumor may not represent the true primary site. A comprehensive, multidisciplinary strategy is crucial for establishing the correct diagnosis and guiding optimal management.
Keywords: neuroendocrine neoplasms; hepatic metastases; contrast-enhanced ultrasonography; cecal biopsy; liver biopsy neuroendocrine neoplasms; hepatic metastases; contrast-enhanced ultrasonography; cecal biopsy; liver biopsy

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MDPI and ACS Style

Sârbu, G.E.; Jucan, A.E.; Mihai, C.V.; Atodiresei, C.; Ene, M.; Ungureanu, C.; Mihai, I.R.; Nedelciuc, O.; Dranga, M.; Cijevschi Prelipcean, C.; et al. Synchronous Pulmonary and Cecal High-Grade Neuroendocrine Carcinomas Presenting as Hepatic Metastases: A Diagnostic Challenges and Literature Review. Diagnostics 2025, 15, 2535. https://doi.org/10.3390/diagnostics15192535

AMA Style

Sârbu GE, Jucan AE, Mihai CV, Atodiresei C, Ene M, Ungureanu C, Mihai IR, Nedelciuc O, Dranga M, Cijevschi Prelipcean C, et al. Synchronous Pulmonary and Cecal High-Grade Neuroendocrine Carcinomas Presenting as Hepatic Metastases: A Diagnostic Challenges and Literature Review. Diagnostics. 2025; 15(19):2535. https://doi.org/10.3390/diagnostics15192535

Chicago/Turabian Style

Sârbu, Georgiana Elena, Alina Ecaterina Jucan, Claudiu Vasile Mihai, Carmen Atodiresei, Madalina Ene, Carmen Ungureanu, Ioana Ruxandra Mihai, Otilia Nedelciuc, Mihaela Dranga, Cristina Cijevschi Prelipcean, and et al. 2025. "Synchronous Pulmonary and Cecal High-Grade Neuroendocrine Carcinomas Presenting as Hepatic Metastases: A Diagnostic Challenges and Literature Review" Diagnostics 15, no. 19: 2535. https://doi.org/10.3390/diagnostics15192535

APA Style

Sârbu, G. E., Jucan, A. E., Mihai, C. V., Atodiresei, C., Ene, M., Ungureanu, C., Mihai, I. R., Nedelciuc, O., Dranga, M., Cijevschi Prelipcean, C., & Mihai, C. (2025). Synchronous Pulmonary and Cecal High-Grade Neuroendocrine Carcinomas Presenting as Hepatic Metastases: A Diagnostic Challenges and Literature Review. Diagnostics, 15(19), 2535. https://doi.org/10.3390/diagnostics15192535

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