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Page 4 of 6 Fontes-Sousa et al. J Cancer Metastasis Treat 2018;4:5 I http://dx.doi.org/10.20517/2394-4722.2017.70

A B

Figure 3. Imagiological and functional evaluation at the time of diagnosis of the liver metastasis (2016) (A) MRI showing histologically
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confirmed neuroendocrine tumor liver metastasis (26 mm) and (B) functional and radiological evaluation with PET Ga-DOTANOC
showing high uptake in a hepatic lesion in segment VI; the remaining parenquima was heterogeneous, without focal uptake; additionally,
high uptake was noted on the head of pancreas (suggesting the primary tumor) and one regional lymphatic node. PET: positron emission
tomography; MRI: magnetic resonance imaging

A B

C D E

Figure 4. Biopsy of the liver mass (2016). (A) hepatic parenquima with involvement of solid epithelial neoplasia (40x); (B) cells with
uniform nucleus, round to oval, with fine chromatin and absent or inconspicuous nucleolus; ample and eosinophilic cytoplasm (100x);
immune-histochemical study of the hepatic lesions revealing AE1/AE3+ (C), chromogranin+ (D) and synaptophysin+ (E)

DISCUSSION
The authors want to focus mainly on three points: (1) pancreatic adenocarcinoma biological behavior; (2)
when to consider a hepatic metastatic lesion biopsy when a primary cancer is already identified and (3)
metastatic pancreatic neuroendocrine tumor biological behavior.

Regarding the first point, pancreatic adenocarcinoma appears to have very different biological behaviors and
diverse responses to treatment that are evident in the clinical practice. Specifically in the locally advanced