Abstract

Neuroendocrine tumors (NET) are a diverse collection of neoplasms with varying biological characteristics, histologic patterns, and therapeutic responses. We present a rare case of a 41-year-old female who was diagnosed with a primary NET of the liver and had multiple kidney and bone metastases. Primary hepatic NETs are rare, and metastasis to the kidney makes this case one of the few in the literature. The patient was admitted to the hospital because of pain in the lower extremities. Several imaging examinations revealed multiple lesions in the bone, kidney, and liver. Sandostatin and Denosumab treatments are started against the tumor and bone metastases. At first, the team thought the case was a NET of the liver and synchronous renal cell carcinoma. However, after the total excision of the kidney, pathology was reported as the NET metastasis to the kidney. Despite showing regression in bone metastases, the lesion in the the liver has advanced. ¹⁷⁷Lu-DOTATATE treatment was added to the current treatment regimen. Renal metastasis from a primary hepatic NET can be challenging to diagnose and treat. Since there are no guidelines specifically designed for this type of case, multiple treatment modalities must be discussed with a multidisciplinary team to choose the best option for patients.