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Chen F, Li WW, Mo JF, Chen MJ, Wang SH, Yang SY, Song ZW. Neuroendocrine carcinoma of the common hepatic duct coexisting with distal cholangiocarcinoma: A case report and review of literature. World J Gastrointest Surg 2024; 16:1449-1460. [PMID: 38817298 PMCID: PMC11135321 DOI: 10.4240/wjgs.v16.i5.1449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 03/13/2024] [Accepted: 04/15/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Neuroendocrine carcinoma (NEC) of the extrahepatic bile duct is very rare, and the treatment and prognosis are unclear. Herein, we report the case of a middle-aged female with primary large cell NEC (LCNEC) of the common hepatic duct combined with distal cholangiocarcinoma (dCCA). Additionally, after a review of the relevant literature, we summarize and compare mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) and pure NEC to provide a reference for selecting the appropriate treatment and predicting the prognosis of this rare disease. CASE SUMMARY A 62-year-old female presented to the hospital due to recurrent abdominal pain for 2 months. Physical examination showed mild tenderness in the upper abdomen and a positive Courvoisier sign. Blood tests showed elevated liver transaminase and carbohydrate antigen 199 levels. Imaging examination revealed a 1-cm tumour in the middle and lower segments of the common bile duct. Pancreaticoduodenectomy + lymph node dissection was performed, and hepatic duct tumours were unexpectedly found during surgery. Pathology suggested poorly differentiated LCNEC (approximately 0.5 cm × 0.5 cm × 0.4 cm), Ki-67 (50%), synaptophysin+, and chromogranin A+. dCCA pathology suggested moderately differentiated adenocarcinoma. The patient eventually developed lymph node metastasis in the liver, bone, peritoneum, and abdominal cavity and died 24 months after surgery. Gene sequencing methods were used to compare gene mutations in the two primary bile duct tumours. CONCLUSION The prognosis of MiNEN and pure NEC alone is different, and the selection of treatment options needs to be differentiated.
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Affiliation(s)
- Fei Chen
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Wei-Wei Li
- Graduate School, Bengbu Medical College, Bengbu 233000, Anhui Province, China
| | - Juan-Fen Mo
- The Key Laboratory, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Min-Jie Chen
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Su-Hang Wang
- Department of Pathology, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Shu-Ying Yang
- Department of Intensive Medicine, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
| | - Zheng-Wei Song
- Department of Hepatobiliary Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing 314000, Zhejiang Province, China
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2
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Chopde A, Gupta V, Jadhav A, Kumar R, Ramadwar M, Patkar S, Goel M. Neuroendocrine Tumours of Extrahepatic Biliary Tract: Report of Four Cases with Literature Review. Indian J Surg Oncol 2024; 15:212-217. [PMID: 38818000 PMCID: PMC11133290 DOI: 10.1007/s13193-022-01621-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/10/2022] [Indexed: 11/30/2022] Open
Abstract
Neuroendocrine tumours (NETs) originating from extrahepatic bile duct are an extremely rare entity. They are typically slow growing tumours with malignant potential. Commonly presenting as obstructive jaundice, preoperative clinico-radiologic differentiation between extrahepatic biliary tract neuroendocrine tumours and cholangiocarcinoma is difficult and the final diagnosis is usually established after surgical histopathology and immunohistochemistry examination. R0 resection offers the only curative option with good long-term outcomes for well-differentiated NETs (grade1, grade2, and grade3) while the aggressive poorly differentiated neuroendocrine carcinoma (NEC) needs multimodality approach. We present our experience of management of four cases including three cases of grade II NET and one case of NEC undergoing surgical resection at a single centre with a short review of available literature.
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Affiliation(s)
- Amit Chopde
- Department of Surgical Oncology, GI and HPB Services, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012 India
| | - Vikas Gupta
- Department of Surgical Oncology, GI and HPB Services, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012 India
| | - Akshaya Jadhav
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Rajiv Kumar
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Mukta Ramadwar
- Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India
| | - Shraddha Patkar
- Department of Surgical Oncology, GI and HPB Services, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012 India
| | - Mahesh Goel
- Department of Surgical Oncology, GI and HPB Services, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, 400012 India
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3
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Rayes R, Partovi O, Strohbeen S, Bureau BL, Giorgadze T, Mostafa M, Asmi N. A Case of Distal Common Bile Duct Obstruction Due to a Neuroendocrine Tumor. Cureus 2024; 16:e52729. [PMID: 38384597 PMCID: PMC10879725 DOI: 10.7759/cureus.52729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
Neuroendocrine tumors (NETs) are a rare subset of malignancies in the biliary tract that may have an aggressive and initially asymptomatic course. A 93-year-old female presented with four days of abdominal pain with associated nausea, jaundice, and brown-colored urine. A CT scan revealed a soft-tissue lesion measuring 1.9 x 1.5 x 1.9 cm within the distal-most aspect of the common bile duct and papilla with marked bile duct dilatation, pancreatic duct dilatation, and multiple hepatic lesions of varying sizes. The biliary stricture was palliated with a stent via endoscopic retrograde cholangiopancreatography. Biopsies taken from the biliary mass were consistent with a well-differentiated NET: World Health Organization, Grade 3. The patient was minimally symptomatic after stenting and was discharged home. She ultimately decided not to pursue further treatment and passed away two months after the initial presentation. Currently, surgical excision is considered the main and only curative treatment for localized NETs, although chemotherapy and radiation therapy may be suitable. Early detection and treatment of these rare NETs in the biliary tree can potentially result in curative treatment.
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Affiliation(s)
- Ramsey Rayes
- Internal Medicine, Medical College of Wisconsin, Wauwatosa, USA
| | - Omeed Partovi
- Internal Medicine, Medical College of Wisconsin, Wauwatosa, USA
| | | | | | | | | | - Nisar Asmi
- Internal Medicine, Medical College of Wisconsin, Wauwatosa, USA
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4
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Silva JF, Lopes S, Macedo G. An unexpected cause of common bile duct obstruction diagnosed by endoscopic ultrasound-guided fine-needle biopsy. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2023; 115:533. [PMID: 36633171 DOI: 10.17235/reed.2023.9393/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
A 43-years-old woman with previous cholecystectomy presented as an outpatient with abnormal liver tests. A diagnosis of well-differentiated neuroendocrine tumor (NET) was made and a 68Ga-DOTA-somatostatin analogue positron emission tomography revealed no apparent metastatic disease.
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Affiliation(s)
| | - Susana Lopes
- Gastroenterology , Centro Hospitalar Universitário de São João
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5
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Moradi A, Lamsehchi N, Khaki S, Nasiri-Toosi M, Jafarian A. Liver Transplant for Patients With Neuroendocrine Tumor: A Report of 2 Exceptional Cases and Literature Review. EXP CLIN TRANSPLANT 2023; 21:578-585. [PMID: 37584538 DOI: 10.6002/ect.2023.0110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
Patients with neuroendocrine tumors with unresec-table liver involvement can benefit from liver transplant. There is a specific set of guidelines for neuroendocrine tumors with liver metastasis that involve less than 50% of the liver. However, beyond those guidelines, there are reports of exceptional criteria patients who benefited from liver transplant. Here, we present 2 unusual cases of patients with exceptional circumstances and with neuroendocrine tumors who underwent liver transplant. The first case describes a patient with an extremely rare neuroen-docrine tumor of the proximal common bile duct that caused liver biliary cirrhosis. The patient underwent tumor resection and liver transplant concurrently. The second case describes a patient with a neuroendocrine tumor of unknown primary origin with more than 50% hepatic involvement who received a liver transplant after downstaging. In our center, patients with unresectable hepatic metastases from neuroendoc-rine tumors are currently selected for liver transplant based on well-established criteria. However, these 2 cases did not meet the criteria for consideration of liver transplant; thus, multidisciplinary team sessions were held to discuss these 2 cases. After a period of nonsurgical treatment and evaluation of the tumor behavior, we selected the patients as candidates for liver transplant based on the favorable tumor behavior and favorable response to treatment. For both patients, we did not observe any signs of tumor recurrence during follow-up. The outcomes were acceptable, and the patients tolerated treatment well. Considering the favorable tumor pathology (G1 phase and low Ki67 index), we suggest that more studies should be conducted to evaluate the outcomes of patients with low-grade tumors and that the criteria for patients with low-grade tumors could be extended based on such future data.
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Affiliation(s)
- Alimohammad Moradi
- From the Department of General Surgery Division of Hepato-Pancreatico-Biliary Surgery and Organ Transplantation Surgery, Tehran University of Medical Sciences, Tehran, Iran
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6
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Taj R, Perez S, Jih LJ, Huynh C, Berumen J, Bouvet M. Primary extrahepatic biliary neuroendocrine tumor: a case report. J Surg Case Rep 2023; 2023:rjad277. [PMID: 37251245 PMCID: PMC10224785 DOI: 10.1093/jscr/rjad277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 04/30/2023] [Indexed: 05/31/2023] Open
Abstract
Extrahepatic biliary neuroendocrine tumors (EBNETs) are extremely rare and difficult to diagnose. The vast majority are diagnosed postoperatively on histological evaluation of surgical specimens. Workup and treatment principles are largely based on retrospective series and case reports. Complete surgical resection is the gold standard treatment for these lesions. Here we present a case of a 77-year-old male with a biopsy-proven EBNET incidentally discovered during evaluation for fatty liver disease. Further workup did not show any other suspicious lesions. Resection of the tumor and multiple Roux-en-Y hepaticojejunostomy was performed. Final pathology revealed grade 1, well-differentiated neuroendocrine tumor. This is the third case reported in the literature with a confirmed preoperative EBNET diagnosis based on endoscopic biopsy results. This case highlights the feasibility of preoperative diagnosis of EBNETs and emphasizes the importance of complete surgical resection.
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Affiliation(s)
- Raeda Taj
- Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Sean Perez
- Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Lily J Jih
- Department of Pathology, University of California San Diego, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Christina Huynh
- Department of Surgery, University of California San Diego, San Diego, CA, USA
| | - Jennifer Berumen
- Department of Surgery, University of California San Diego, San Diego, CA, USA
- VA San Diego Healthcare System, San Diego, CA, USA
| | - Michael Bouvet
- Correspondence address. Department of Surgery, University of California San Diego, Moores Cancer Center, 3855 Health Sciences Drive #0987, La Jolla, CA 92093-0987, USA. Tel: 858-822-6191; Fax: 858-249-0483; E-mail:
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7
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Torbenson M, Venkatesh SK, Halfdanarson TR, Navin PJ, Kamath P, Erickson LA. Primary neuroendocrine tumors and primary neuroendocrine carcinomas of the liver: a proposal for a multidiscipline definition. Hum Pathol 2023; 132:77-88. [PMID: 35809684 DOI: 10.1016/j.humpath.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 06/28/2022] [Accepted: 07/01/2022] [Indexed: 02/07/2023]
Abstract
Primary hepatic neuroendocrine tumors and primary hepatic neuroendocrine carcinomas are rare and pose challenges for both diagnosis and for determining whether the tumor is primary to the liver versus metastatic disease. The lack of a uniform definition for primary hepatic neuroendocrine neoplasms is also a limitation to understanding and treating these rare tumors. Recently, there have been significant histological advances in the diagnosis and classification of neuroendocrine tumors in general, as well as significant advances in imaging for neuroendocrine neoplasms, all of which are important for their treatment. This article presents a multiple disciplinary definition and proposed guidelines for diagnosing a neuroendocrine tumor/neuroendocrine carcinomas as being primary to the liver.
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Affiliation(s)
- Michael Torbenson
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, 55906, USA.
| | | | | | - Patrick J Navin
- Department of Nuclear Medicine, Mayo Clinic Rochester, MN, 55906, USA
| | - Patrick Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic Rochester, MN, 55906, USA
| | - Lori A Erickson
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, MN, 55906, USA
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8
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Li Y, Hua R, He J, Zhang H. Clinicopathological Features and Prognosis Analysis of Primary Bile Duct and Ampullary Neuroendocrine Neoplasms: A Population-Based Study from 1975 to 2016. Curr Oncol 2022; 30:449-461. [PMID: 36661685 PMCID: PMC9858302 DOI: 10.3390/curroncol30010036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 12/24/2022] [Accepted: 12/27/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The main purpose of this study is to analyze the clinicopathological features and prognosis factors of bile duct and ampullary neuroendocrine neoplasms (NENs). METHODS The relevant data were collected from the SEER database from 1975 to 2016. The Kaplan-Meier curve and Cox model were used for survival analysis. The nomogram was drawn to predict the survival rate. The calibration, discrimination and clinical utility of the nomogram were evaluated by calibration curve, the concordance index (C-index) and decision curve analysis (DCA). RESULTS A total of 340 cases were included in our research. According to Kaplan-Meier analysis, 1-year, 3-year and 5-year of overall survival (OS) were 77.3%, 61.9% and 58.4%, while 1-year, 3-year and 5-year of the disease-specific survival (DSS) were 82.7%, 69.3% and 66.9%, respectively. The multivariable analysis results showed that age, histological grade, SEER stage and surgery were independent predictors for either OS or DSS. The calibration curve and the C-index value indicated that the nomogram was well calibrated and had good discrimination. DCA showed that the model had ideal net benefits. CONCLUSIONS The age, histological grade, SEER stage and surgery were identified as independent prognostic variables for OS and DSS. After verification, nomogram has good predictive ability and clinical application value.
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Affiliation(s)
- Yijun Li
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
| | - Rui Hua
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
| | - Jianjun He
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
| | - Huimin Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, China
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9
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Jiang S, Yang F, Zhang L, Sang X, Lu X, Zheng Y, Xu Y. A prognostic nomogram based on log odds of positive lymph nodes to predict the overall survival in biliary neuroendocrine neoplasms (NENs) patients after surgery. J Endocrinol Invest 2022; 45:2341-2351. [PMID: 35908009 DOI: 10.1007/s40618-022-01874-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/17/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND The prognosis of biliary neuroendocrine neoplasms (NENs) patients is affected by the status of metastatic lymph nodes. The purpose of this study was to explore the prognostic value of the log odds of positive lymph nodes (LODDS) and develop a novel nomogram to predict the overall survival (OS) in biliary NENs patients. METHODS A total of 125 patients with histologically confirmed biliary NENs were selected from the Surveillance, Epidemiology and End Results (SEER) database and further divided into training and validation cohorts. The discrimination and calibration of the nomogram were evaluated using the concordance index (C-index), the area under the time-dependent receiver operating characteristic curve (time-dependent AUC), and calibration plots. The net benefits and clinical utility of the nomogram were quantified and compared with those of the SEER staging system using decision curve analysis (DCA), net reclassification index (NRI), and integrated discrimination improvement (IDI). The risk stratifications of the nomogram and the SEER staging system were compared. RESULTS LODDS showed the highest accuracy in predicting OS for biliary NENs. The C-index (0.789 for the training cohort and 0.890 for the validation cohort) and the time-dependent AUC (> 0.7) indicated the satisfactory discriminative ability of the nomogram. The calibration plots showed a high degree of consistency. The DCA, NRI, and IDI indicated that the nomogram performed significantly better than the SEER staging system. CONCLUSION A novel LODDS-incorporated nomogram was developed and validated to assist clinicians in evaluating the prognosis of biliary NENs patients.
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Affiliation(s)
- S Jiang
- Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - F Yang
- Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - L Zhang
- Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - X Sang
- Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - X Lu
- Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Y Zheng
- Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Y Xu
- Department of Liver Surgery, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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10
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Gopan A, Sen Sarma M, Har B, Singh RK, Agrawal V, Yachha SK. An unusual cause of obstructive jaundice in childhood: Intra-choledochal malignant neuroendocrine tumour. J Paediatr Child Health 2022; 58:1895-1898. [PMID: 35716114 DOI: 10.1111/jpc.16060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 04/20/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Abstract
The extrahepatic biliary apparatus is a rare site for neuroendocrine tumours. A 13-year-old child presented with cholestatic symptoms of jaundice and pruritus with soft hepatomegaly and mild ascites. Magnetic resonance imaging and endoscopic ultrasound revealed a mid-common bile duct mass, and dilated intrahepatic biliary system. An en-bloc resection of the extrahepatic biliary apparatus, showed malignant cells disposed in lobules in a desmoplastic stroma with intramural invasion, staining positive for cytokeratin, chromogranin, synaptophysin and negative for CD56. At 3 months post-resection, whole body positron emission tomography scan was normal with no recurrence at 24 months.
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Affiliation(s)
- Amrit Gopan
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Moinak Sen Sarma
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Bappaditya Har
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajneesh K Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Vinita Agrawal
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Surender K Yachha
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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11
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Rare Case of Neuroendocrine Tumor of Common Bile Duct Identified With Somatostatin Receptor But Not With Glucose Transporter Imaging. Clin Nucl Med 2022; 47:e715-e717. [PMID: 35961371 DOI: 10.1097/rlu.0000000000004342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Neuroendocrine tumors (NETs) are heterogeneous group of tumors arising from enterochromaffin cells. Neuroendocrine tumors are most commonly found in bowel and pancreatic tissue. Because of paucity of enterochromaffin cells in biliary tract, NETs of bile duct are very rare. Most of the neoplasms in the extrahepatic bile duct are adenocarcinomas; only 0.2% to 0.3% of NETs arise from the bile duct. Cases reported in the literature of biliary carcinoid are diagnosed postoperatively on histopathologic evaluation. We hereby demonstrate a rare presentation of CBD NET identified preoperatively on somatostatin receptor but not on glucose transporter imaging, confirmed by histopathology and immunohistochemistry to be grade 2 NET (Ki-67, 20%).
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12
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Zheng BH, Zhang C, Wan WZ, Sun WT, Cheng X, Ni XJ, Ni XL, Suo T, Liu H, Shen S, Liu HB. The clinical and prognostic factors for biliary neuroendocrine neoplasm: a study based on the SEER database. BMC Surg 2022; 22:253. [PMID: 35768809 PMCID: PMC9245279 DOI: 10.1186/s12893-022-01689-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 06/06/2022] [Indexed: 12/15/2022] Open
Abstract
Background In this study, we aimed at elucidating the postoperative survival and prognostic factors in patients with biliary neuroendocrine neoplasm (NEN). Methods Cases of biliary system NEN and adenocarcinoma from 1975 to 2016 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. A propensity score matching (PSM) method was used to adjust baseline differences in clinicopathological characteristics in our analysis. The Kaplan–Meier analysis was carried out for survival analysis. Results A total of 233 patients with biliary system NEN were enrolled in this study, of which 119 patients’ lesions located in gallbladder, while the others’ located in bile duct. The postoperative overall survival of bile duct NEN is significantly longer than that of gallbladder NEN (P < 0.001). For gallbladder NENs, surgery method (P = 0.020) and lymph node metastasis (P = 0.018) were identified as independent prognostic factors. In terms of ampulla of vater (AOV) NENs, age (P = 0.017) and lymph node metastasis (P = 0.006) were identified as independent prognostic factors, while grade (P = 0.002) and lymph node metastasis (P = 0.036) were identified as independent prognostic factors for extrahepatic bile duct (EBD) NENs. PSM analysis indicated that patients with biliary duct NENs have a better postoperative prognosis than biliary duct adenocarcinoma. Conclusions Patients with NEN have better overall survival than patients with adenocarcinoma. Gallbladder NEN has an adverse prognosis than that of biliary tract NEN. The pathological subtype, differentiation, lymph node metastasis, surgery method, and lymph node resection could affect the postoperative prognosis of the gallbladder and biliary tract NEN. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01689-7.
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Affiliation(s)
- Bo-Hao Zheng
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China.,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China
| | - Cheng Zhang
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China.,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China
| | - Wen-Ze Wan
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China.,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China
| | - Wen-Tao Sun
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China.,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China
| | - Xi Cheng
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China.,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China
| | - Xiao-Jian Ni
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China.,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China
| | - Xiao-Ling Ni
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China.,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China
| | - Tao Suo
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China.,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China
| | - Han Liu
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China.,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China
| | - Sheng Shen
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. .,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. .,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. .,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China. .,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China.
| | - Hou-Bao Liu
- Department of General Surgery, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. .,Biliary Tract Disease Center, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. .,Biliary Tract Disease Institute, Fudan University, 180 Fenglin Road, Shanghai, 200032, China. .,Cancer Center, Zhongshan Hospital, 180 Fenglin Road, 200032, Shanghai, China. .,Shanghai Engineering Research Center of Biliary Tract Minimal Invasive Surgery and Materials, Shanghai, China. .,Department of General Surgery, Biliary Tract Disease Institute, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
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13
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Zhang B, Li S, Sun Z, Chen X, Qi B, Zhang Q, Zhang G, Shang D. Challenges in treatment of a patient suffering from neuroendocrine tumor G1 of the hilar bile duct: a case report. BMC Gastroenterol 2022; 22:13. [PMID: 34998372 PMCID: PMC8742925 DOI: 10.1186/s12876-021-02019-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background Neuroendocrine tumors (NETs) arise from neuroendocrine cells and are extremely rare in the biliary tract. Currently, there are no guidelines for the diagnosis and treatment of biliary NETs. We presented a case with NETs G1 of the hilar bile duct and the challenges for her treatment. Case presentation A 24-year-old woman was presented to our department with painless jaundice and pruritus, and the preoperative diagnosis was Bismuth type II hilar cholangiocarcinoma. She underwent Roux-en-Y hepaticojejunostomy with excision of the extrahepatic biliary tree and radical lymphadenectomy. Unexpectedly, postoperative pathological and immunohistochemical examination indicated a perihilar bile duct NETs G1 with the microscopic invasion of the resected right hepatic duct. Then the patient received 3 cycles of adjuvant chemotherapy (Gemcitabine and tegafur-gimeracil-oteracil potassium capsule). At present, this patient has been following up for 24 months without recurrence or disease progression. Conclusion We know little of biliary NETs because of its rarity. There are currently no guidelines for the diagnosis and treatment of biliary NETs. We reported a case of perihilar bile duct NETs G1 with R1 resection, as far as we know this is the first report. More information about biliary NETs should be registered.
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Affiliation(s)
- Biao Zhang
- Department of General Surgery, Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, China.,Institute of Integrative Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Shuang Li
- Department of General Surgery, Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, China.,Institute of Integrative Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Zhen Sun
- Department of General Surgery, Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, China.,Department of General Surgery, The Second Hospital of Jilin University, Changchun, 130022, Jilin, China
| | - Xu Chen
- Department of General Surgery, Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, China.,Institute of Integrative Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Bing Qi
- Department of General Surgery, Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, China.,Institute of Integrative Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Qingkai Zhang
- Department of General Surgery, Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, China.,Institute of Integrative Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Guixin Zhang
- Department of General Surgery, Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, China.,Institute of Integrative Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China
| | - Dong Shang
- Department of General Surgery, Clinical Laboratory of Integrative Medicine, The First Affiliated Hospital of Dalian Medical University, Dalian, 116011, Liaoning, China. .,Institute of Integrative Medicine, Dalian Medical University, Dalian, 116044, Liaoning, China.
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14
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Endo S, Ishikawa T, Azumi M, Imai M, Nozawa Y, Iwanaga A, Sano T, Honma T, Ogawa H, Tsubono T, Nemoto T, Takeda K, Nishikura K, Yoshida T. Gallbladder primary neuroendocrine carcinoma liver metastasis that was difficult to differentially diagnose from gallbladder cancer liver metastasis and hepatocellular carcinoma. KANZO 2021; 62:639-646. [DOI: 10.2957/kanzo.62.639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Affiliation(s)
- Saori Endo
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital
| | - Toru Ishikawa
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital
| | - Motoi Azumi
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital
| | - Michitaka Imai
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital
| | - Yujiro Nozawa
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital
| | - Akito Iwanaga
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital
| | - Tomoe Sano
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital
| | - Terasu Honma
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital
| | | | | | - Takeo Nemoto
- Department of Radiology, Saiseikai Niigata Hospital
| | - Keiko Takeda
- Department of Radiology, Saiseikai Niigata Hospital
| | | | - Toshiaki Yoshida
- Department of Gastroenterology and Hepatology, Saiseikai Niigata Hospital
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15
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Shim JR, Kim JR, Park Y, Seo HI. Small-cell neuroendocrine carcinoma arising from an extra-hepatic bile duct: a case report. Gastroenterol Rep (Oxf) 2021; 9:380-382. [PMID: 34567573 PMCID: PMC8460092 DOI: 10.1093/gastro/goaa051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Jae Ryong Shim
- Division of HBP Surgery and Transplantation, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Jae Ri Kim
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Gudeok-ro, Seo-gu, Busan, Korea
| | - Youngmok Park
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Gudeok-ro, Seo-gu, Busan, Korea
| | - Hyung-Il Seo
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Gudeok-ro, Seo-gu, Busan, Korea
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16
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Zhou S, Jiang S, Chen W, Yin H, Dong L, Zhao H, Han S, He X. Biliary Neuroendocrine Neoplasms: Analysis of Prognostic Factors and Development and Validation of a Nomogram. Front Oncol 2021; 11:654439. [PMID: 34350109 PMCID: PMC8327779 DOI: 10.3389/fonc.2021.654439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 07/05/2021] [Indexed: 12/26/2022] Open
Abstract
Background For this study, we explored the prognostic profiles of biliary neuroendocrine neoplasms (NENs) patients and identified factors related to prognosis. Further, we developed and validated an effective nomogram to predict the overall survival (OS) of individual patients with biliary NENs. Methods We included a total of 446 biliary NENs patients from the SEER database. We used Kaplan-Meier curves to determine survival time. We employed univariate and multivariate Cox analyses to estimate hazard ratios to identify prognostic factors. We constructed a predictive nomogram based on the results of the multivariate analyses. In addition, we included 28 biliary NENs cases from our center as an external validation cohort. Results The median survival time of biliary NENs from the SEER database was 31 months, and the value of gallbladder NENs (23 months) was significantly shorter than that of the bile duct (45 months) and ampulla of Vater (33.5 months, p=0.023). Multivariate Cox analyses indicated that age, tumor size, pathological classification, SEER stage, and surgery were independent variables associated with survival. The constructed prognostic nomogram demonstrated good calibration and discrimination C-index values of 0.783 and 0.795 in the training and validation dataset, respectively. Conclusion Age, tumor size, pathological classification, SEER stage, and surgery were predictors for the survival of biliary NENs. We developed a nomogram that could determine the 3-year and 5-year OS rates. Through validation of our central database, the novel nomogram is a useful tool for clinicians in estimating individual survival among biliary NENs patients.
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Affiliation(s)
- Shengnan Zhou
- General Surgery Department, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Shitao Jiang
- Liver Surgery Department, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Weijie Chen
- General Surgery Department, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Haixin Yin
- General Surgery Department, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Liangbo Dong
- General Surgery Department, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Hao Zhao
- General Surgery Department, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Shaoqi Han
- General Surgery Department, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, Beijing, China
| | - Xiaodong He
- General Surgery Department, Peking Union Medical College Hospital, China Academy of Medical Science & Peking Union Medical College, Beijing, China
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17
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Luchini C, Pelosi G, Scarpa A, Mattiolo P, Marchiori D, Maragliano R, Sessa F, Uccella S. Neuroendocrine neoplasms of the biliary tree, liver and pancreas: a pathological approach. Pathologica 2021; 113:28-38. [PMID: 33686308 PMCID: PMC8138696 DOI: 10.32074/1591-951x-231] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 12/14/2022] Open
Abstract
Neuroendocrine neoplasms of the pancreatobiliary tract and liver are a heterogeneous group that encompass a spectrum of entities with distinct morphological, biological and clinical features. Although in the various anatomical sub-sites of this region they show specific characteristics, these tumors, as a whole, share several etiological and clinical aspects. This review systematically addresses NENs arising in the extrahepatic bile ducts, gallbladder, liver and pancreas, with the principal aim of pinpointing essential diagnostic and classification issues. In addition, the section on hepatic NENs has been expanded to include metastatic disease of unknown primary site.
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Affiliation(s)
- Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Italy
| | - Giuseppe Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, Italy.,Inter-Hospital Pathology Division, IRCCS MultiMedica, Milan, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Italy.,ARC-NET Research Centre, University of Verona, Italy
| | - Paola Mattiolo
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Italy
| | - Deborah Marchiori
- Department of Medicine and Surgery, Unit of Pathology, University of Insubria, Varese, Italy
| | - Roberta Maragliano
- Department of Medicine and Surgery, Unit of Pathology, University of Insubria, Varese, Italy
| | - Fausto Sessa
- Department of Medicine and Surgery, Unit of Pathology, University of Insubria, Varese, Italy
| | - Silvia Uccella
- Department of Medicine and Surgery, Unit of Pathology, University of Insubria, Varese, Italy
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18
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Miri SR, Movaghar ER, Safaei M, Sharifi A. Neuroendocrine tumor of the common bile duct: A case report of extremely rare cause for obstructive jaundice. Int J Surg Case Rep 2020; 77:303-306. [PMID: 33197772 PMCID: PMC7677652 DOI: 10.1016/j.ijscr.2020.11.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 12/22/2022] Open
Abstract
Common Bile Duct is extremely rare site for primary Neuroendocrine tumors. WHO classification categorized neuroendocrine neoplasms of digestive tract into three subtypes: well differentiated neuroendocrine tumor, poorly differentiated neuroendocrine carcinoma and mixed adenoneuroendocrine carcinoma. The etiology of developing NET in the bile duct tissues is unknown but it is related to chronic inflammation with subsequent metaplasia. Surgical resection is the mainstay of the treatment. Postoperative chemotherapy using cisplatin and etoposide showed promising results.
Introduction Neuroendocrine tumors (NET) of common bile duct are rare. There have been less than 100 cases reported worldwide. Presentation of case A 37-year-old female patient was referred to our center after six months of abdominal pain with no definite diagnosis. At initial presentation, she complained of increased abdominal pain, nausea, vomiting, oral intolerance to food and icteric sclera. Physical examination and laboratory tests were indicative of pancreatitis. At day four, she took retrograde cholangiopancreatography (ERCP) and a mid CBD stenosis or impacted stone was found. In order to locally investigate the lesion, Endoscopic Ultrasound (EUS) examination was performed which reported 16 × 12 mm isoechoic tumoral lesion at the middle of the CBD. In this regard we decided to perform ERCP-guided brushing biopsy of the lesion. The pathology report was highly suggestive for malignancy. She underwent resection of the mid portion of the CBD with Roux-en-Y hepaticojejunostomy, cholecystectomy and portahepatis lymph node dissection. The pathology report indicated that the CBD lesion was well-differentiated neuroendocrine tumor grade II. Discussion The exact etiology of developing NET in the bile duct tissues is not clear however cholelithiasis and congenital malformation of the biliary tract has been proposed to cause chronic inflammation with subsequent metaplasia which ultimately transforms into NET. Conclusion As there are very few cases of NETs of the CBD, no definite surgical or medical treatment is proposed. Currently, combination of radical surgical resection and lymph node dissection followed by chemotherapy is the treatment of choice.
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Affiliation(s)
- Seyed Rouhollah Miri
- Department of Oncosurgery, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Masoomeh Safaei
- Department of Pathology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirsina Sharifi
- Research Associate, Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran Iran
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19
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Repeat hepatectomy for liver metastases from bile duct neuroendocrine tumor: a case report. Surg Case Rep 2020; 6:204. [PMID: 32770496 PMCID: PMC7415062 DOI: 10.1186/s40792-020-00967-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 07/29/2020] [Indexed: 01/26/2023] Open
Abstract
Background Primary neuroendocrine tumor (NET) originating from the extrahepatic bile duct is rare, although liver metastasis from gastroenteropancreatic NET is frequently observed. We herein report a case who successfully underwent repeat hepatectomy for liver metastases from bile duct NET grade 2 (G2). Case presentation A 75-year-old man presented with jaundice and was suspected of perihilar cholangiocarcinoma by computed tomography (CT) and magnetic resonance imaging (MRI). He underwent extended left hepatectomy, extrahepatic bile duct resection, and hepaticojejunostomy. Pathological findings showed a NET G2 of the biliary tract arising from the common bile duct. Two years and 11 months after surgery, a liver metastasis was detected and hepatectomy was performed. During the surgery, another liver metastasis was detected, and limited liver resection for the two lesions was performed. Pathological findings showed four liver metastases of NET G2. Five years and 4 months after the first surgery (2 years and 5 months after the second hepatectomy), four liver metastases were detected. Thereafter, he received somatostatin analogues for 1 year. Although the size of tumors increased slightly, the number did not change. He underwent limited liver resections and was diagnosed with 7 liver metastases of NET G2. Finally, another hepatectomy (fourth hepatectomy) was performed and long-term survival without recurrence was obtained for as long as 8 years after the first surgery. Conclusions Repeat hepatectomy is a good option to obtain long-term survival for liver metastases from bile duct NET G2 in select patients.
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20
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Kaino M, Kaino S, Goma W, Hideura E, Hitosugi T, Harima Y, Urata Y, Nakamura Y. A case of mixed neuroendocrine non-neuroendocrine neoplasm of the distal bile duct with biliary intraepithelial neoplasia. Clin J Gastroenterol 2020; 14:297-303. [PMID: 32643120 DOI: 10.1007/s12328-020-01174-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 06/21/2020] [Indexed: 02/07/2023]
Abstract
A 72-year-old man with obstructive jaundice, diagnosed with distal biliary carcinoma, underwent pylorus-preserving pancreaticoduodenectomy. The patient was histopathologically and immunohistochemically diagnosed with mixed neuroendocrine non-neuroendocrine neoplasm. Pathological examination revealed that the well-differentiated adenocarcinoma components occupied the superficial portion of the bile duct and the neuroendocrine carcinoma components were located in the deeper portion of the bile duct. Pathological examination showed that a portion of the biliary intraepithelial neoplasia arose from the proximal bile duct and then extended to the gallbladder. The patient was administered tegafur/gimeracil/oteracil as adjuvant chemotherapy, and the lesion did not recur for 6 months postoperatively.
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Affiliation(s)
- Miyuki Kaino
- Department of Gastroenterology and Hepatology, Yamaguchi Rosai Hospital, 1315-4 Onoda, Sanyo-Onoda, Yamaguchi, 756-0095, Japan.
| | - Seiji Kaino
- Department of Gastroenterology and Hepatology, Yamaguchi Rosai Hospital, 1315-4 Onoda, Sanyo-Onoda, Yamaguchi, 756-0095, Japan.,Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi, 755-8505, Japan
| | - Wakana Goma
- Department of Gastroenterology and Hepatology, Yamaguchi Rosai Hospital, 1315-4 Onoda, Sanyo-Onoda, Yamaguchi, 756-0095, Japan
| | - Eizaburo Hideura
- Department of Gastroenterology and Hepatology, Yamaguchi Rosai Hospital, 1315-4 Onoda, Sanyo-Onoda, Yamaguchi, 756-0095, Japan
| | - Tomoki Hitosugi
- Department of Gastroenterology and Hepatology, Yamaguchi Rosai Hospital, 1315-4 Onoda, Sanyo-Onoda, Yamaguchi, 756-0095, Japan
| | - Yohei Harima
- Department of Gastroenterology and Hepatology, Yamaguchi Rosai Hospital, 1315-4 Onoda, Sanyo-Onoda, Yamaguchi, 756-0095, Japan
| | - Yohei Urata
- Department of Gastroenterology and Hepatology, Yamaguchi Rosai Hospital, 1315-4 Onoda, Sanyo-Onoda, Yamaguchi, 756-0095, Japan
| | - Yohei Nakamura
- Department of Gastroenterology and Hepatology, Yamaguchi Rosai Hospital, 1315-4 Onoda, Sanyo-Onoda, Yamaguchi, 756-0095, Japan
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21
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Maeda T, Yugawa K, Kinjo N, Kayashima H, Imai D, Kawata K, Ikeda S, Edahiro K, Takeishi K, Iguchi T, Harada N, Ninomiya M, Yamaguchi S, Konishi K, Tsutsui S, Matsuda H. Mixed adenoneuroendocrine carcinoma of the distal bile duct: a case report. Surg Case Rep 2020; 6:160. [PMID: 32632765 PMCID: PMC7338298 DOI: 10.1186/s40792-020-00921-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mixed adenoneuroendocrine carcinoma (MANEC) of the common bile duct (CBD) is very rare, with only 10 reported cases. Here, we report a case of MANEC of the distal bile duct (DBD) that was surgically resected under a diagnosis of cholangiocarcinoma (CCA). CASE PRESENTATION A 60-year-old male had epigastric pain and was admitted to our hospital for the treatment of a suspected CBD stone. Upon admission, laboratory findings revealed elevated hepatobiliary enzymes including serum aspartate aminotransferase, serum alanine aminotransferase, serum glutamyltransferase, and serum alkaline phosphatase. Both carcinoembryonic antigen and carbohydrate antigen 19-9 were negative. Computed tomography (CT) showed dilation of the CBD. Endoscopic retrograde cholangiopancreatography (ERCP) showed circumferential stenosis and a 5-mm elevated lesion in the DBD. Brush cytology showed atypical ductal cells, indicating adenocarcinoma (AC) of the DBD. Under a diagnosis of CCA of the DBD, a subtotal stomach-preserving pancreaticoduodenectomy was performed. Neither peritoneal dissemination nor lymph node metastasis was found. Microscopically, the lesion was seen to be composed of predominantly well-differentiated tubular AC in the superficial layer of the tumor, admixed with neuroendocrine carcinoma (NEC) in the deeper portion, indicating a diagnosis of MANEC of the DBD. After immunohistochemical staining, NEC components were positive for synaptophysin and CD56 and were for SSTR2, SSTR5, and mammalian target of rapamycin (mTOR). Three months postsurgery, postoperative adjuvant chemotherapy with S-1 was started. More than 3 years postsurgery, he is alive without recurrence. CONCLUSIONS MANEC is highly malignant, progresses rapidly, and has a poor prognosis. Preoperative diagnosis is difficult; therefore, identifying NEC components by immunohistochemical staining using resected specimens is important.
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Affiliation(s)
- Takashi Maeda
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan.
| | - Kyohei Yugawa
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Nao Kinjo
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Hiroto Kayashima
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Daisuke Imai
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Koto Kawata
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Shinichiro Ikeda
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Keitaro Edahiro
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Kazuki Takeishi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Tomohiro Iguchi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Noboru Harada
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Mizuki Ninomiya
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Shohei Yamaguchi
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Kozo Konishi
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Shinichi Tsutsui
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
| | - Hiroyuki Matsuda
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan
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22
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Abstract
Neuroendocrine neoplasms (NENs) of the gastrointestinal (GI) tract and pancreas are a rare and heterogeneous group of neoplasms characterized by common cellular features as well as unique site-specific traits. GI and pancreatic NENs are much rarer than the more common adenocarcinomas arising at these sites. However, the incidences of GI and pancreatic NENs have increased significantly, particularly in the stomach and common site, followed by rectum, appendix, colon, and stomach. Pancreatic NENs are also uncommon, with fewer than 1 per 100,000, accounting for 1% to 2% of all pancreatic neoplasms.
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23
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Ito H, Wada Y, Takami Y, Ryu T, Ureshino H, Imamura H, Sasaki S, Ohno A, Hijioka M, Kaku T, Kawabe K, Kawauchi S, Saitsu H. A case of small cell neuroendocrine carcinoma of the ampulla of Vater. Surg Case Rep 2020; 6:150. [PMID: 32592083 PMCID: PMC7320127 DOI: 10.1186/s40792-020-00915-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/17/2020] [Indexed: 11/11/2022] Open
Abstract
Background Gastroenteric neuroendocrine carcinomas (NECs) account for 6.2% of gastroenteric neuroendocrine tumors (NETs), and only 1% or less of gastroenteric NETs occur in the ampulla of Vater (AoV). Clinical features of NEC of the AoV remain obscure. Case presentation A 65-year-old man visited a general practitioner because of jaundice, and an abdominal contrast-enhanced computed tomography scan revealed a tumor of 11 mm in diameter, which was enhanced in the arterial phase at the duodenal papilla, with dilation of the upstream bile duct. Gastrointestinal scope revealed an unexposed tumor of the AoV. Based on a biopsy of the site, a moderately differentiated tubular adenocarcinoma was suspected, and pancreatoduodenectomy was performed. Histopathological examination revealed dysplasia and highly proliferative small tumor cells, with solid and nodular formation at the AoV. Histological analysis showed a high mitotic count, and immunohistochemical staining revealed a Ki-67 index of 40–50% and cells positive for synaptophysin, chromogranin A, and p53. Small cell-type NEC was finally diagnosed. Four months post pancreatoduodenectomy, multiple liver metastases developed, and systemic chemotherapy was administered. Salvage liver resection for liver metastases was performed 14 months after the pancreatoduodenectomy. Unfortunately, multiple liver metastases developed 2 months after liver resection, and the patient died 18 months after the pancreatoduodenectomy. Conclusions Neuroendocrine carcinoma originating from the bile duct is very rare; therefore, in this article, we provide a review of the literature and a case report.
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Affiliation(s)
- Hiroharu Ito
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Yoshiyuki Wada
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan.
| | - Yuko Takami
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Tomoki Ryu
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Hiroki Ureshino
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Hajime Imamura
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Shin Sasaki
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan
| | - Akihisa Ohno
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Masayuki Hijioka
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Toyoma Kaku
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Ken Kawabe
- Department of Gastroenterology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Shigeto Kawauchi
- Department of Pathology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Hideki Saitsu
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyohama, Chuo-ku, Fukuoka, 810-8563, Japan
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24
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Shiihara M, Higuchi R, Furukawa T, Yazawa T, Uemura S, Izumo W, Yamamoto M. Comparison of Clinicopathological Features of Biliary Neuroendocrine Carcinoma with Adenocarcinoma. Dig Surg 2020; 38:30-37. [PMID: 32570243 DOI: 10.1159/000508443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 05/04/2020] [Indexed: 12/10/2022]
Abstract
OBJECTIVE This study aimed to demonstrate the clinical features and postoperative outcomes of extrahepatic bile duct (EHBD) neuroendocrine carcinoma (NEC) and compared with those of adenocarcinoma. METHODS We retrospectively analyzed patients with EHBD cancer operated in our institution between 1995 and 2015. RESULTS Of 475 patients, 468 had adenocarcinoma, while 7 had NEC/mixed adenoneuroendocrine carcinoma (MANEC) in this study. There were no notable preoperative and pathological features in patients with NEC/MANEC. However, patients with NEC/MANEC had a higher recurrence rate (51.8 vs. 100%, p = 0.016), poorer relapse-free survival (RFS) time (the median RFS time: 35 vs. 12 months, p = 0.006), and poorer overall survival (OS) time (the median OS time: 60 vs. 19 months, p = 0.078) than those with adenocarcinoma. Furthermore, patients with NEC/MANEC had higher rates of liver metastasis (11.9 vs. 85.7%, p < 0.001) than those with adenocarcinoma. In multivariable regression analysis, pathological type with NEC/MANEC was a risk factor for poorer RFS (p = 0.022, hazard ratio: 6.09). CONCLUSIONS Patients with NEC/MANEC have high malignant potential and poor outcomes. It is necessary to develop an effective approach and postoperative adjuvant treatment for patients with NEC/MANEC.
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Affiliation(s)
- Masahiro Shiihara
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.,Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan,
| | - Toru Furukawa
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takehisa Yazawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Shuichiro Uemura
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Wataru Izumo
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
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25
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Sassi A, Bacha D, Lahmar A, Talbi G, Ben Slama S, Gharbi L, Bouraoui S. Primary neuroendocrine tumour of the common hepatic duct: An unexpected Klatskin-like lesion. Arab J Gastroenterol 2020; 21:125-127. [PMID: 32423858 DOI: 10.1016/j.ajg.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 03/15/2018] [Accepted: 04/08/2020] [Indexed: 02/07/2023]
Abstract
The biliary system is an uncommon location for neuroendocrine tumours (NETs), and within this system, the common hepatic duct is an even more rare site for NETs. Clinical and radiological presentations are challenging because these tumours may be preoperatively confused with Klatskin-like lesions. Here we report a well-differentiated grade 2 NET arising from the common hepatic duct in a 64-year-old female. Curative surgery was performed, and no evidence of recurrent disease was observed at the 2-months follow-up.
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Affiliation(s)
- Asma Sassi
- Pathology Department, Mongi Slim Hospital, Tunis, Tunisia; Medicine Faculty of Tunis, Tunis El Manar University, Tunis, Tunisia.
| | - Dhouha Bacha
- Pathology Department, Mongi Slim Hospital, Tunis, Tunisia; Medicine Faculty of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Ahlem Lahmar
- Pathology Department, Mongi Slim Hospital, Tunis, Tunisia; Medicine Faculty of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Ghofrane Talbi
- Department of Surgery, Mongi Slim Hospital, Tunis, Tunisia; Medicine Faculty of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Sana Ben Slama
- Pathology Department, Mongi Slim Hospital, Tunis, Tunisia; Medicine Faculty of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Lasaad Gharbi
- Department of Surgery, Mongi Slim Hospital, Tunis, Tunisia; Medicine Faculty of Tunis, Tunis El Manar University, Tunis, Tunisia
| | - Saadia Bouraoui
- Pathology Department, Mongi Slim Hospital, Tunis, Tunisia; Medicine Faculty of Tunis, Tunis El Manar University, Tunis, Tunisia
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26
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Oleas R, Olmos J, Alcívar-Vásquez J, Robles-Medranda C. A rare cause of extrahepatic biliary tract stricture: a neuroendocrine carcinoma. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2020; 112:501-502. [PMID: 32379475 DOI: 10.17235/reed.2020.6491/2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The case was an 82-year-old Hispanic female who complained of painless jaundice and weight loss. Endoscopic retrograde cholangiopancreatography (ERCP) showed a distal common bile duct (CBD) stricture with dilatation of the intra and extra-hepatic bile ducts.
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Affiliation(s)
- Roberto Oleas
- Gastroenterology and Endoscopy Division , Instituto Ecuatoriano de Enfermedades Digestivas, Ecuador
| | - Juan Olmos
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas
| | - Juan Alcívar-Vásquez
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas
| | - Carlos Robles-Medranda
- Gastroenterology and Endoscopy Division, Instituto Ecuatoriano de Enfermedades Digestivas, Ecuador
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27
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Zhang L, Yang Z, Chen Q, Li M, Zhu X, Wan D, Xie H, Zheng S. Mixed adenoendocrine carcinoma in the extrahepatic biliary tract: A case report and literature review. Oncol Lett 2019; 18:1585-1596. [PMID: 31423226 PMCID: PMC6607098 DOI: 10.3892/ol.2019.10502] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 04/02/2019] [Indexed: 12/20/2022] Open
Abstract
Neuroendocrine neoplasm (NEN) comprises a group of tumors that exhibit neuroendocrine phenotypes. NEN is subclassified into neuroendocrine tumor (NET), neuroendocrine carcinoma (NEC) and mixed adenoendocrine carcinoma (MANEC), based on histopathological parameters. NEN in the extrahepatic biliary tract (EHBT) is uncommon. Little is known about its clinicopathological features and prognostic indicators. The present study presented a case of MANEC in the distal common bile duct (CBD) and reviewed previous cases of NENs in the EHBT to characterize the clinical settings of this disease entity and to identify influencing factors of survival outcomes. A 64-year-old Chinese woman presented with abdominal pain and jaundice. Imaging studies demonstrated malignant stenosis in the distal CBD. Bile duct brush cytology revealed small clusters of atypical cells. Following an initial diagnosis of distal cholangiocarcinoma (CCA), the patient underwent pancreaticoduodenectomy. Histological analysis combined with immunohistochemical investigation of the resected specimen revealed a collision tumor that was composed of poorly differentiated adenocarcinoma and NEC. Each histological component accounted for >30% of the tumor. The definitive diagnosis was a MANEC in the distal CBD. Multiple intrahepatic and pulmonary metastases were observed postoperatively over 8 months. The patient succumbed to the disease 12 months after surgery. In conclusion, NEN occurs infrequently in the EHBT, with NET being the predominant type. NEN in the EHBT is extremely challenging to diagnose preoperatively due to its tendency to mimic CCA. Patients with NEN in the EHBT exhibited extremely distinct oncology outcomes according to pathological types. Additionally, old age (>60 years) and the presence of tumor recurrence were associated with decreased survival of patients with NEN.
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Affiliation(s)
- Liang Zhang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China.,Key Laboratory of Combined Multi-Organ Transplantation, National Health and Family Planning Commission (NHFPC), Hangzhou, Zhejiang 310000, P.R. China.,Key Laboratory of The Diagnosis and Treatment of Organ Transplantation, Chinese Academy of Medical Sciences (CAMS), Hangzhou, Zhejiang 310000, P.R. China
| | - Zhengtao Yang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China.,Key Laboratory of Combined Multi-Organ Transplantation, National Health and Family Planning Commission (NHFPC), Hangzhou, Zhejiang 310000, P.R. China.,Key Laboratory of The Diagnosis and Treatment of Organ Transplantation, Chinese Academy of Medical Sciences (CAMS), Hangzhou, Zhejiang 310000, P.R. China
| | - Qing Chen
- Department of Pathology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China
| | - Mengxia Li
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China.,Key Laboratory of Combined Multi-Organ Transplantation, National Health and Family Planning Commission (NHFPC), Hangzhou, Zhejiang 310000, P.R. China.,Key Laboratory of The Diagnosis and Treatment of Organ Transplantation, Chinese Academy of Medical Sciences (CAMS), Hangzhou, Zhejiang 310000, P.R. China
| | - Xiaolu Zhu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China.,Key Laboratory of Combined Multi-Organ Transplantation, National Health and Family Planning Commission (NHFPC), Hangzhou, Zhejiang 310000, P.R. China.,Key Laboratory of The Diagnosis and Treatment of Organ Transplantation, Chinese Academy of Medical Sciences (CAMS), Hangzhou, Zhejiang 310000, P.R. China
| | - Dalong Wan
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China.,Key Laboratory of Combined Multi-Organ Transplantation, National Health and Family Planning Commission (NHFPC), Hangzhou, Zhejiang 310000, P.R. China.,Key Laboratory of The Diagnosis and Treatment of Organ Transplantation, Chinese Academy of Medical Sciences (CAMS), Hangzhou, Zhejiang 310000, P.R. China
| | - Haiyang Xie
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China.,Key Laboratory of Combined Multi-Organ Transplantation, National Health and Family Planning Commission (NHFPC), Hangzhou, Zhejiang 310000, P.R. China.,Key Laboratory of The Diagnosis and Treatment of Organ Transplantation, Chinese Academy of Medical Sciences (CAMS), Hangzhou, Zhejiang 310000, P.R. China
| | - Shusen Zheng
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310000, P.R. China.,Key Laboratory of Combined Multi-Organ Transplantation, National Health and Family Planning Commission (NHFPC), Hangzhou, Zhejiang 310000, P.R. China.,Key Laboratory of The Diagnosis and Treatment of Organ Transplantation, Chinese Academy of Medical Sciences (CAMS), Hangzhou, Zhejiang 310000, P.R. China
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28
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Park JY, Jeon TJ. Large Cell Neuroendocrine Carcinoma of the Extrahepatic Bile Duct. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 72:318-321. [PMID: 30642152 DOI: 10.4166/kjg.2018.72.6.318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/24/2018] [Accepted: 06/02/2018] [Indexed: 11/03/2022]
Abstract
Primary neuroendocrine tumors originating from the extrahepatic bile duct are rare. Among these tumors, large cell neuroendocrine carcinomas (NECs) are extremely rare. A 59-year-old man was admitted to Sanggye Paik Hospital with jaundice that started 10 days previously. He had a history of laparoscopic cholecystectomy, which he had undergone 12 years previously due to chronic calculous cholecystitis. Laboratory data showed abnormally elevated levels of total bilirubin 15.3 mg/dL (normal 0.2-1.2 mg/dL), AST 200 IU (normal 0-40 IU), ALT 390 IU (normal 0-40 IU), and gamma-glutamyl transferase 1,288 U/L (normal 0-60 U/L). Serum CEA was normal, but CA 19-9 was elevated 5,863 U/mL (normal 0-37 U/mL). Abdominal CT revealed a 4.5 cm sized mass involving the common bile duct and liver hilum and dilatation of both intrahepatic ducts. Percutaneous transhepatic drainage in the left hepatic duct was performed for preoperative biliary drainage. The patient underwent radical common bile duct and Roux-en-Y hepaticojejunostomy for histopathological diagnosis and surgical excision. On histopathological examination, the tumor exhibited large cell NEC (mitotic index >20/10 high-power field, Ki-67 index >20%, CD56 [+], synaptophysin [+], chromogranin [+]). Adjuvant concurrent chemotherapy and radiotherapy were started because the tumor had invaded the proximal resection margin. No recurrence was detected at 10 months by follow-up CT.
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Affiliation(s)
- Ji Young Park
- Division of Gastroenterology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Tae Joo Jeon
- Division of Gastroenterology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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29
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Zhang HW, Kou K, Qi J, Xie EB, Wang M, Li Y, Lv GY, Wang GY. Mixed adenoneuroendocrine carcinoma of the extrahepatic bile duct: a case report. J Int Med Res 2019; 47:3421-3426. [PMID: 31154920 PMCID: PMC6683900 DOI: 10.1177/0300060519850391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background The concept of mixed adenoneuroendocrine carcinoma (MANEC) was introduced in the 2010 World Health Organization classification of digestive neuroendocrine neoplasms. Bile duct invasion by MANEC is exceptionally rare. We herein report a case of MANEC with invasion of multiple bile ducts. Case presentation: A 60-year-old man presented with a 7-day history of upper abdominal pain, and a mass in the cystic duct was suspected based on computed tomography findings. The patient underwent resection of the extrahepatic bile ducts with concomitant radical lymphadenectomy and Roux-en-Y cholangiojejunostomy. Large cell neuroendocrine carcinoma was detected in a component of the resected tumor. According to the pathological and immunohistochemical features of the tumor, the final histopathological diagnosis was a biliary MANEC, tumor stage T2N0M1 (Stage IIIC). The patient recovered uneventfully and was discharged from the hospital 10 days after surgery. Conclusions We have described a rare case of extrahepatic MANEC invading multiple bile ducts, with particular emphasis on the physician’s awareness of MANEC and its optimal treatment. MANEC arising from extrahepatic bile ducts is rare, and surgical resection is the most effective treatment method.
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Affiliation(s)
- Hai-Wen Zhang
- 1 Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Kai Kou
- 1 Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jun Qi
- 1 Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - En-Bo Xie
- 1 Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Meng Wang
- 1 Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yan Li
- 2 Department of Surgery, School of Medicine, University of Louisville, Louisville, KY, USA
| | - Guo-Yue Lv
- 1 Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Guang-Yi Wang
- 1 Department of Hepatobiliary and Pancreatic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
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30
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Rehfuss JP, Thomas RM. Extrahepatic Neuroendocrine Tumor Causing Biliary Obstruction. J Gastrointest Surg 2019; 23:1266-1268. [PMID: 30465186 DOI: 10.1007/s11605-018-4048-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Accepted: 11/05/2018] [Indexed: 01/31/2023]
Affiliation(s)
- Jonathan P Rehfuss
- Department of Surgery, College of Medicine, University of Florida, PO Box 100109, Gainesville, FL, 32610, USA
| | - Ryan M Thomas
- Department of Surgery, College of Medicine, University of Florida, PO Box 100109, Gainesville, FL, 32610, USA. .,North Florida/South Georgia Veterans Health System, Gainesville, USA.
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31
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Choi J, Lee KJ, Kim SH, Cho MY. Preoperative diagnosis of well-differentiated neuroendocrine tumor in common hepatic duct by brush cytology: A case report. Diagn Cytopathol 2019; 47:720-724. [PMID: 30884200 DOI: 10.1002/dc.24173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/22/2019] [Accepted: 02/26/2019] [Indexed: 01/25/2023]
Abstract
The biological behavior of neuroendocrine tumors (NETs) is heterogeneous and differs from that of cholangiocarcinoma, which is the most common malignant tumor of the biliary tree. However, the preoperative diagnosis of NET in the biliary tree is extremely difficult and to our knowledge, diagnosis by brush cytology has not previously been reported. Herein, we first reported a case of biliary NET preoperatively diagnosed by brush cytology in a 33-year-old female patient. Imaging study revealed a 2.6-cm mass in the common hepatic duct. The brush cytology was characterized by loosely cohesive plasmacytoid tumor cells and scattered clusters of thin vascular septa. The tumor cells showed abundant cytoplasm and severe nuclear size variation but mitosis was not observed. Immunohistochemical staining of the cell block (CB) showed strong positivity for both synaptophysin and chromogranin A and a Ki-67 labeling index of 3.5%. The surgically resected bile duct mass was pathologically confirmed as NET, G2 with lymphovascular and perineural invasion of the tumor cells. The patient showed no evidence of tumor recurrence 10 months after operation without adjuvant chemotherapy. Suspicion of this rare tumor and immunohistochemical staining of the CB are important for the preoperative diagnosis of NET in the biliary tree.
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Affiliation(s)
- Jiwoon Choi
- Department of Pathology, Wonju Severance Christian Hospital, Yonsei University, Wonju, South Korea
| | - Kyong Joo Lee
- Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University, Wonju, South Korea
| | - Sung Hoon Kim
- Department of Surgery, Wonju Severance Christian Hospital, Yonsei University, Wonju, South Korea
| | - Mee-Yon Cho
- Department of Pathology, Wonju Severance Christian Hospital, Yonsei University, Wonju, South Korea
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32
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Chaouch MA, Dougaz MW, Ferjaoui W, Gouta EL, Nouira R, Bouasker I, Dziri C. A Case Report of a Primary Neuroendocrine Tumour of the Proximal Common Bile Duct. J Gastrointest Cancer 2019; 50:1048-1050. [PMID: 30737710 DOI: 10.1007/s12029-019-00208-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - Wael Ferjaoui
- Department of surgery B, Charles Nicolle Hospital, Tunis, Tunisia
| | - Esma Leila Gouta
- Department of surgery B, Charles Nicolle Hospital, Tunis, Tunisia
| | - Ramzi Nouira
- Department of surgery B, Charles Nicolle Hospital, Tunis, Tunisia
| | | | - Chadli Dziri
- Department of surgery B, Charles Nicolle Hospital, Tunis, Tunisia
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33
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Moraes AB, Treistman N, Studart MC, Chagas VLA, Brabo EP, Vieira Neto L. Gastrinoma of Cystic Duct: A Rare Association With Multiple Endocrine Neoplasia Type 1. J Clin Med Res 2018; 10:843-847. [PMID: 30344820 PMCID: PMC6188020 DOI: 10.14740/jocmr3541w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 08/14/2018] [Indexed: 11/29/2022] Open
Abstract
Neuroendocrine tumors (NETs) of cystic duct are extremely rare, accounting for less than 2% of NET cases. The association of biliary tree NET and multiple endocrine neoplasm type 1 (MEN1) are even more rare. In this report, we described a case of a 65-year-old woman who was referred to our neuroendocrine outpatient clinic to investigate MEN1 after an incidental diagnosis of gastrinoma. Her medical history initiated 7 years earlier with severe peptic disease not responsive to proton pump inhibitor therapy. Endoscopic study revealed erosive antral gastritis, erosive duodenitis, bulbar ulcer and pyloric deformity. During follow-up she presented with abdominal pain, chronic diarrhea and weight loss; an ultrasonography was performed and showed only a cholelithiasis. She underwent a video laparoscopic cholecystectomy and all her symptoms were solved. Histopathological study found a 1.0 cm well differentiated NET (Ki-67 labeling index < 2%) located in cystic duct infiltrating the entire wall and subserosa. The MEN1 investigation revealed a primary hyperparathyroidism with a brown tumor in right iliac bone; the patient was referred to a total parathyroidectomy with autotransplantation. No evidence of pituitary tumor was found. The patient remains asymptomatic 24 months after surgery. To conclude, this case highlights an unusual presentation of a cystic duct primary NET gastrinoma in a MEN1 context.
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Affiliation(s)
- Aline Barbosa Moraes
- Department of Internal Medicine and Endocrine Unit, Medical School and Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Natalia Treistman
- Department of Internal Medicine and Endocrine Unit, Medical School and Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana Coutinho Studart
- Pathology Department, Medical School and Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Vera Lucia Antunes Chagas
- Pathology Department, Medical School and Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Eloa Pereira Brabo
- Oncology Unit and Neuroendocrine Section, Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Leonardo Vieira Neto
- Department of Internal Medicine and Endocrine Unit, Medical School and Clementino Fraga Filho University Hospital, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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34
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Zhang L, Wan D, Bao L, Chen Q, Xie H, Xu S, Lin S. Neuroendocrine carcinoma in the extrahepatic biliary tract: A case report and literature review. Medicine (Baltimore) 2018; 97:e11487. [PMID: 30024526 PMCID: PMC6086531 DOI: 10.1097/md.0000000000011487] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
RATIONALE Neuroendocrine carcinoma (NEC) arising from the extrahepatic biliary tracts (EHBTs) is rare, and thus its management and prognosis remain poorly clarified. We herein describe a case of NEC in the perihilar EHBTs, and review the literature, together with a comparison between NECs in the perihilar and distal EHBTs, to elucidate the management strategy and oncological outcome of this rare entity. PATIENT CONCERNS A 62-year-old Chinese male was admitted with complaints of painless jaundice. Imaging studies revealed a 2-cm mass in the hepatic hilum, regional lymph node involvement, and severe stenosis at the junction of the common hepatic ducts. DIAGNOSES The histopathological examination of the resected specimen demonstrated small tumor cells with round hperchromatic nuclei and scant cytoplasm. A detailed immunohistochemical analysis showed that the tumor was strongly positive for synaptophysin, CD56 and chromogranin A, with a Ki-67 labeling index greater than 80%. These results led to a diagnosis of NEC in the perihilar bile duct. INTERVENTIONS The patient underwent surgical resection including a left hemihepatectomy, cholecystectomy, lymphadenectomy and Roux-en-Y hepaticojejunostomy. OUTCOMES During the two months of follow-up, repeated imaging studies indicated tumor recurrence in the liver. The patient died 6 months after surgery. LESSONS NEC in the EHBTs is extremely challenging to diagnose preoperatively because of mimicking other bile duct cancers. The prognosis of this disease entity is dismal, and most patients die within 2 years after diagnosis. Subtyping of NECs into perihilar NECs and distal NECs is beneficial for clinical applications, including guiding therapy selection and predicting survival.
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Affiliation(s)
- Liang Zhang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University
- NHFPC Key Laboratory of Combined Multi-Organ Transplantation
- Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS
| | - DaLong Wan
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University
- NHFPC Key Laboratory of Combined Multi-Organ Transplantation
- Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS
| | - Li Bao
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University
- NHFPC Key Laboratory of Combined Multi-Organ Transplantation
- Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS
| | - Qing Chen
- Department of Pathology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - HaiYang Xie
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University
- NHFPC Key Laboratory of Combined Multi-Organ Transplantation
- Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS
| | - ShiGuo Xu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University
- NHFPC Key Laboratory of Combined Multi-Organ Transplantation
- Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS
| | - ShengZhang Lin
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University
- NHFPC Key Laboratory of Combined Multi-Organ Transplantation
- Key Laboratory of the Diagnosis and Treatment of Organ Transplantation, CAMS
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Liu Z, Zhang DY, Lu Z, Zhang P, Sun WL, Ma X, Wu H, Wu BQ, Zhou S. Neuroendocrine tumor of the common bile duct: a case report and review of the literature. Onco Targets Ther 2018; 11:2295-2301. [PMID: 29731637 PMCID: PMC5923221 DOI: 10.2147/ott.s162934] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We report a rare case of neuroendocrine tumor (NET) in the common bile duct (CBD). The patient is a 56-year-old female who presented to our department with symptoms of fever but without jaundice. A preoperative examination showed a tumor in the CBD. The tumor volume was almost 5.5 × 4.5 × 4 cm3, which is the biggest NET in the CBD reported on PubMed. The imaging results (computed tomography [CT] and magnetic resonance imaging [MRI]) were not consistent with CBD adenocarcinoma. The tumor appeared to oppress the growth of the CBD rather than originate in the bile duct wall; combined with the low blood bilirubin index and lack of jaundice symptoms, the preoperative diagnosis was not clear. We performed a radical resection of the cholangiocarcinoma. The patient recovered well before going home. The pathology was NET (Grade 2). The patient showed no recurrence to date, without intravenous chemotherapy (8 months).
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Affiliation(s)
- Zhong Liu
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China
| | - Deng-Yong Zhang
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China
| | - Zheng Lu
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China
| | - Pei Zhang
- Department of Pharmacy, Bengbu Medical College, Bengbu, People's Republic of China
| | - Wan-Liang Sun
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China
| | - Xiang Ma
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China
| | - Hua Wu
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China
| | - Bin-Quan Wu
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China
| | - Shuo Zhou
- Department of General Surgery, The First Affiliated Hospital of Bengbu Medical College, Bengbu, People's Republic of China
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Zhao ZM, Wang J, Ugwuowo UC, Wang L, Townsend JP. Primary hepatic neuroendocrine carcinoma: report of two cases and literature review. BMC Clin Pathol 2018; 18:3. [PMID: 29507528 PMCID: PMC5831736 DOI: 10.1186/s12907-018-0070-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 02/16/2018] [Indexed: 12/16/2022] Open
Abstract
Background Primary hepatic neuroendocrine carcinoma (PHNEC) is extremely rare. The diagnosis of PHNEC remains challenging—partly due to its rarity, and partly due to its lack of unique clinical features. Available treatment options for PHNEC include surgical resection of the liver tumor(s), radiotherapy, liver transplant, transcatheter arterial chemoembolization (TACE), and administration of somatostatin analogues. Case presentation We report two male PHNEC cases and discuss the diagnosis and treatment options. Both cases presented with abdominal pain; case two also presented with symptoms of jaundice. The initial diagnosis for both cases was poorly differentiated grade 3 small-cell neuroendocrine carcinoma, based on imaging characteristics and the pathology of liver biopsies. Final diagnoses of PHNEC were arrived at by ruling out non-hepatic origins. Case one presented with a large tumor in the right liver lobe, and the patient was treated with TACE. Case two presented with tumors in both liver lobes, invasions into the left branch of hepatic portal vein, and metastasis in the hepatic hilar lymph node. This patient was ineligible for TACE and was allergic to the somatostatin analogue octreotide. This limited treatment options to supportive therapies such as albumin supplementation for liver protection. Patient one and two died at 61 and 109 days, respectively, following initial hospital admission. Conclusions We diagnosed both cases with poorly differentiated grade 3 small-cell PHNEC through imaging characteristics, immunohistochemical staining of liver biopsies, and examinations to eliminate non-hepatic origins. Neither TACE nor liver protection appeared to significantly extend survival time of the two patients, suggesting these treatments may be inadequate to improve survival of patients with poorly differentiated grade 3 small-cell PHNEC. The prognosis of poorly differentiated grade 3 small-cell PHNEC is poor due to limited and ineffective treatment options. Electronic supplementary material The online version of this article (10.1186/s12907-018-0070-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Zi-Ming Zhao
- 1The Jackson Laboratory for Genomic Medicine, 10 Discovery Drive, Farmington, CT 06032 USA.,2Department of Biostatistics, Yale University, New Haven, CT 06511 USA
| | - Jin Wang
- 3Division of Vascular Surgery, The Second Affiliated Hospital of Dalian Medical University, Dalian, Liaoning Province 116000 China.,4Division of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Dalian Medical University, 467 Zhongshan Road, Dalian, Liaoning Province 116000 China.,5Dalian Medical University, Dalian, Liaoning Province 116000 China
| | - Ugochukwu C Ugwuowo
- 6Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06520 USA
| | - Liming Wang
- 4Division of Hepatobiliary and Pancreatic Surgery, The Second Affiliated Hospital of Dalian Medical University, 467 Zhongshan Road, Dalian, Liaoning Province 116000 China.,8Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, The Second Affiliated Hospital of Dalian Medical University, 467 Zhongshan Road, Dalian, Liaoning 116027 China
| | - Jeffrey P Townsend
- 2Department of Biostatistics, Yale University, New Haven, CT 06511 USA.,Suite 200, 135 College St, New Haven, CT 06510 USA
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Abe T, Nirei A, Suzuki N, Todate Y, Azami A, Waragai M, Sato A, Takano Y, Nishino N, Sakuma H, Teranishi Y. Neuroendocrine tumor of the extrahepatic bile duct: A case report. Int J Surg Case Rep 2017; 40:6-9. [PMID: 28915429 PMCID: PMC5602749 DOI: 10.1016/j.ijscr.2017.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 09/01/2017] [Accepted: 09/02/2017] [Indexed: 11/25/2022] Open
Abstract
Neuroendocrine tumors of the extrahepatic bile ducts are extremely rare neoplasms. They most commonly occur in young females and usually present with painless jaundice. Preoperative diagnosis is difficult because the findings are similar to other biliary malignancies. Surgical resection is considered to be the only curative treatment.
Introduction Neuroendocrine tumors (NETs) of the extrahepatic bile ducts are extremely rare neoplasms arising from endocrine cells and have variable malignant potential. They most commonly occur in young females and usually present with painless jaundice. Presentation of case Here we present the case of an asymptomatic 57-year-old woman with NET of the common bile duct that was incidentally discovered on abdominal ultrasound during a medical examination. She was admitted to our hospital with a diagnosis of hepatic hilar tumor. Computed tomography revealed the tumor surrounding the hepatic hilum and duodenum. Magnetic resonance cholangiopancreatography revealed a filling defect of the common bile duct with morphology suggestive of external compression. Endoscopic ultrasound confirmed a submucosal tumor of the duodenal bulb measuring 30 × 20 mm in size. The patient qualified for surgery with a preoperative diagnosis of submucosal tumor of the duodenal bulb. Intraoperative examination revealed that the tumor location involved the common bile duct and/or cystic duct with no signs of invasion to other organs or metastatic lymph nodes. Excision of the biliary ducts and tumor was followed by Roux-en-Y anastomosis. Histological results showed NET grade 1. Discussion Preoperative diagnosis of NETs is difficult because of their rarity. A definitive diagnosis is usually established intraoperatively or after histopathological evaluation. Conclusion For these tumors, surgical resection is currently the only treatment modality for achieving a potentially curative effect and prolonged disease-free survival.
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Affiliation(s)
- Tsuyoshi Abe
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama 963-8563, Japan.
| | - Azuma Nirei
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama 963-8563, Japan
| | - Nobuyasu Suzuki
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama 963-8563, Japan
| | - Yukitoshi Todate
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama 963-8563, Japan
| | - Ayaka Azami
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama 963-8563, Japan
| | - Mitsuru Waragai
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama 963-8563, Japan
| | - Atai Sato
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama 963-8563, Japan
| | - Yoshinao Takano
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama 963-8563, Japan
| | - Noriyuki Nishino
- Department of Gastroenterology, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama 963-8563, Japan
| | - Hideo Sakuma
- Department of Pathology, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama 963-8563, Japan
| | - Yasushi Teranishi
- Department of Surgery, Southern Tohoku Research Institute for Neuroscience, 7-115 Yatsuyamada, Koriyama 963-8563, Japan
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Hoepfner L, White JA. Primary extrahepatic bile duct neuroendocrine tumor with obstructive jaundice masquerading as a Klatskin tumor. J Surg Case Rep 2017; 2017:rjx104. [PMID: 28596824 PMCID: PMC5457964 DOI: 10.1093/jscr/rjx104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 05/17/2017] [Indexed: 12/12/2022] Open
Abstract
Neuroendocrine tumors (NETs) of the extrahepatic bile duct are extremely rare and reported infrequently in the literature. These tumors are difficult to diagnose preoperatively, and the prognosis is variable, often determined by extent of disease, tumor grade and resectability. This case report presents a 45-year-old male with history of biliary obstruction relieved by endobiliary stents with common hepatic duct stricture just above the cystic duct, thought to be a Klatskin’s cholangiocarcinoma. Final pathological examination was consistent with primary extrahepatic NET.
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Affiliation(s)
- Lauren Hoepfner
- University of Alabama School of Medicine, University of Alabama Birmingham, Birmingham, AL 35294, USA
| | - Jared A White
- Liver Transplant and Hepatobiliary Surgery, University of Alabama Birmingham, Birmingham, AL 35294, USA
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Lee KJ, Cho JH, Lee SH, Lee KH, Park BK, Lee JK, Woo SM, Ryu JK, Lee JK, Kim YS, Kim JW, Lee WJ. Clinicopathological characteristics of biliary neuroendocrine neoplasms: a multicenter study. Scand J Gastroenterol 2017; 52:437-441. [PMID: 27924650 DOI: 10.1080/00365521.2016.1261938] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES This study assessed the clinicopathological features, therapeutic approaches, and prognosis of patients with biliary neuroendocrine neoplasm (NENs). MATERIALS AND METHODS Multicenter retrospective study of patients with biliary tract NENs in the gallbladder, the extrahepatic bile duct, or the ampulla of Vater between 2005 and 2014. RESULTS Total of 43 patients were included in the study. The median age was 62 years (range: 29-84 years) and 58.1% of the patients were male. The tumors occurred in the gallbladder (n = 11), the extrahepatic bile duct (n = 5) or the ampulla of Vater (n = 27). The liver was the most common metastatic site. Based on the 2010 World Health Organization classification, more patients with gallbladder NENs (11/11 (100%)) had neuroendocrine carcinoma G3 than those with NENs in the ampulla of Vater (10/27 (37.1%)). The median progression free survival time (39.3 vs 5.1 months, p = 0.001) and median overall survival time (46.9 vs 7.9 months, p < 0.001) were significantly longer in patients with ampulla of Vater NENs than gallbladder NENs. A 2010 World Health Organization classification of neuroendocrine carcinoma G3 was independently related to poor overall survival (hazard ratio (HR), 27.1; 95% confidence intervals (CI), 2.81-260.68; p = 0.004). CONCLUSION The 2010 World Health Organization classification of neuroendocrine carcinoma G3 was the only factor related to poor prognosis in patients with biliary neuroendocrine neoplasms.
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Affiliation(s)
- Kyong Joo Lee
- a Department of Internal Medicine , Yonsei University Wonju College of Medicine , Wonju , South Korea
| | - Jae Hee Cho
- b Department of Internal Medicine , Gachon university, Gil Medical Center , Incheon , South Korea
| | - Sang Hyub Lee
- c Department of Internal Medicine and Liver Research Institute , Seoul National University College of Medicine , Seoul , South Korea
| | - Kwang Hyuk Lee
- d Department of Internal Medicine , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , South Korea
| | - Byung Kyu Park
- e National Health Insurance Corporation Ilsan Hospital , Goyang , South Korea
| | - Jun Kyu Lee
- f Department of Internal Medicine , Dongguk University Ilsan Hospital, Dongguk University , Goyang , South Korea
| | - Sang Myung Woo
- g Center for Liver Cancer, National Cancer Center , Goyang , South Korea
| | - Ji Kon Ryu
- c Department of Internal Medicine and Liver Research Institute , Seoul National University College of Medicine , Seoul , South Korea
| | - Jong Kyun Lee
- d Department of Internal Medicine , Samsung Medical Center, Sungkyunkwan University School of Medicine , Seoul , South Korea
| | - Yeon Suk Kim
- b Department of Internal Medicine , Gachon university, Gil Medical Center , Incheon , South Korea
| | - Jae Woo Kim
- a Department of Internal Medicine , Yonsei University Wonju College of Medicine , Wonju , South Korea
| | - Woo Jin Lee
- g Center for Liver Cancer, National Cancer Center , Goyang , South Korea
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40
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Kim JY, Hong SM. Recent Updates on Neuroendocrine Tumors From the Gastrointestinal and Pancreatobiliary Tracts. Arch Pathol Lab Med 2017; 140:437-48. [PMID: 27128301 DOI: 10.5858/arpa.2015-0314-ra] [Citation(s) in RCA: 92] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
CONTEXT -Gastrointestinal (GI) and pancreatobiliary tracts contain a variety of neuroendocrine cells that constitute a diffuse endocrine system. Neuroendocrine tumors (NETs) from these organs are heterogeneous tumors with diverse clinical behaviors. Recent improvements in the understanding of NETs from the GI and pancreatobiliary tracts have led to more-refined definitions of the clinicopathologic characteristics of these tumors. Under the 2010 World Health Organization classification scheme, NETs are classified as grade (G) 1 NETs, G2 NETs, neuroendocrine carcinomas, and mixed adenoneuroendocrine carcinomas. Histologic grades are dependent on mitotic counts and the Ki-67 labeling index. Several new issues arose after implementation of the 2010 World Health Organization classification scheme, such as issues with well-differentiated NETs with G3 Ki-67 labeling index and the evaluation of mitotic counts and Ki-67 labeling. Hereditary syndromes, including multiple endocrine neoplasia type 1 syndrome, von Hippel-Lindau syndrome, neurofibromatosis 1, and tuberous sclerosis, are related to NETs of the GI and pancreatobiliary tracts. Several prognostic markers of GI and pancreatobiliary tract NETs have been introduced, but many of them require further validation. OBJECTIVE -To understand clinicopathologic characteristics of NETs from the GI and pancreatobiliary tracts. DATA SOURCES -PubMed (US National Library of Medicine) reports were reviewed. CONCLUSIONS -In this review, we briefly summarize recent developments and issues related to NETs of the GI and pancreatobiliary tracts.
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Affiliation(s)
| | - Seung-Mo Hong
- From the Department of Pathology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea (Dr Kim); and the Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Dr Hong)
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Extrahepatic biliary obstrution secondary to neuroendocrine tumor of the common hepatic duct. Int J Surg Case Rep 2016; 30:46-49. [PMID: 27902955 PMCID: PMC5133469 DOI: 10.1016/j.ijscr.2016.11.043] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 11/21/2016] [Accepted: 11/21/2016] [Indexed: 12/18/2022] Open
Abstract
Extra hepatic biliary obstruction can be frequently caused by tumors. Differentiation between cholangiocarcinoma and an unusual bile duct tumor such as a neuroendocrine tumor (NET) is very difficult preoperatively. Prognosis of NET of the extrahepatic bile duct is dependent on the grade of the tumor however is markedly better than cholangiocarcinoma. Unusual biliary tumors can not be diferentiated preoperatively from cholangiocarcinoma.
Introduction Primary neuroendocrine tumors (NET) of the extrahepatic biliary tree are a rare entity with less than 100 reported cases in the literature. Presentation of case Here, we report a case of NET of the extrahepatic bile duct in a 64-year-old male patient presenting with painless jaundice, direct hyperbilirubinemia, and mildly elevated transaminases. Diagnostic workup with an ultrasound revealed dilation of the intrahepatic biliary ducts, without cholelithiasis or choledocholithiasis. Additional cross sectional imaging identified a stricture at the confluence of the common hepatic and cystic duct junction. Given lack of additional findings presumptive diagnosis of localized klatskin’s tumor was made. The patient subsequently underwent resection of the common bile duct and roux-en-y hepaticojejunostomy reconstruction. Final pathologic diagnosis showed G2 well-differentiated NET of the extrahepatic bile duct, measuring 1.3 × 1.1 × 1 cm. Discussion When a patient is evaluated for a primary bile duct neoplasm, differentiation between cholangiocarcinoma and an unusual bile duct tumor, such as a NET is very difficult before surgical resection and histologic review. Conclusion NET of the extrahepatic biliary tree are a rare entity. Typical presentation is with painless jaundice and other symptoms related to obstruction of the biliary tree and the diagnosis is usually made post-operatively.
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Huang YQ. Current progress in diagnosis and therapy of neuroendocrine neoplasms of the digestive system. Shijie Huaren Xiaohua Zazhi 2016; 24:2625-2636. [DOI: 10.11569/wcjd.v24.i17.2625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Neuroendocrine neoplasms (NENs) are a group of heterogeneous, biologically diverse, rare malignancies originated from the peptidergic neurons and neuroendocrine cells. In recent years, the incidence of NENs has been increasing gradually. They typically arise in the pancreas and gastrointestinal tract. Chromogranin A (CgA) has long been used as an important broad-spectrum marker for the identification of NENs. The diagnosis is based on histopathology demonstrating neuroendocrine features such as positive staining for chromogranin A and specific hormones such as gastrin, proinsulin, vasoactive intestinal peptide (VIP) and glucagon. In addition, radiological modalities including computed tomography (CT), positron emission tomography and computed tomography (PET/CT), magnetic resonance imaging (MRI), ultrasound (US), endoscopic ultrasound (EUS), and somatostatin receptor scintigraphy (SRS) can help establish a diagnosis. Surgery is still one of the cornerstones in the management of NENs. This article reviews the current progress in the diagnosis and therapy of NENs of the digestive system, including the pathological features and clinical diagnostic modalities for primary esophageal, gastric, duodenal, small intestinal, appendiceal, colonic, rectal, hepatic, gallbladder, extrahepatic bile duct, and pancreatic NENs, according to a revised system of classification, nomenclature and grading of NENs proposed by the fourth edition of "World Health Organization (WHO) classification of tumours of the digestive system" in 2010, and consensus of diagnosis and treatment of gastroenteropancreatic NENs (GEP-NENs) proposed by the Chinese Society of Clinical Oncology (CSCO) in 2013.
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Hosoda K, Kobayashi A, Shimizu A, Kitagawa N, Ito T, Yamada A, Miyagawa SI. Neuroendocrine tumor of the common bile duct. Surgery 2016; 160:525-6. [PMID: 26873297 DOI: 10.1016/j.surg.2016.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 01/05/2016] [Accepted: 01/05/2016] [Indexed: 12/22/2022]
Affiliation(s)
- Kiyotaka Hosoda
- First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akira Kobayashi
- First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan.
| | - Akira Shimizu
- First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Noriyuki Kitagawa
- First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuya Ito
- Department of Gastroenterology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Akira Yamada
- Department of Radiology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shin-Ichi Miyagawa
- First Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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Pape UF, Maasberg S, Jann H, Pschowski R, Krüger S, Prasad V, Denecke T, Wiedenmann B, Pascher A. Management of follow-up of neuroendocrine neoplasias. Best Pract Res Clin Endocrinol Metab 2016; 30:129-40. [PMID: 26971849 DOI: 10.1016/j.beem.2016.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neuroendocrine neoplasias (NEN) comprise heterogeneous epithelial neoplasms with a large variety of clinical presentations, treatment options and outcomes. Since potentially all NEN bear malignant potential it is important for long-term clinical management and improvement of outcome to decide on successful and oncologically and economically meaningful follow-up strategies. Evidence-based outcome data validating specific follow-up strategies are, however, not available to date and thus outcome data, known prognostic factors and clinical experience guide the decisions on follow-up regimens. The review summarizes general recommendations as well as specific considerations based on tumor entities, clinicopathological tumor characteristics and clinical experience. Follow-up shall serve the patient to improve outcome, benefit from more effective therapies and suffer less from unnecessary and/or toxic therapeutic interventions and finally preserve or gain a good quality of life.
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Affiliation(s)
- Ulrich-Frank Pape
- Medical Department, Division of Hepatology and Gastroenterology, Charité Campus Mitte and Virchow Klinikum, Charité University Medicine Berlin, Germany.
| | - Sebastian Maasberg
- Medical Department, Division of Hepatology and Gastroenterology, Charité Campus Mitte and Virchow Klinikum, Charité University Medicine Berlin, Germany
| | - Henning Jann
- Medical Department, Division of Hepatology and Gastroenterology, Charité Campus Mitte and Virchow Klinikum, Charité University Medicine Berlin, Germany
| | - René Pschowski
- Medical Department, Division of Hepatology and Gastroenterology, Charité Campus Mitte and Virchow Klinikum, Charité University Medicine Berlin, Germany
| | - Sandrine Krüger
- Medical Department, Division of Hepatology and Gastroenterology, Charité Campus Mitte and Virchow Klinikum, Charité University Medicine Berlin, Germany
| | - Vikas Prasad
- Department of Nuclear Medicine, Charité Campus Mitte and Virchow Klinikum, Charité University Medicine Berlin, Germany
| | - Timm Denecke
- Department of Radiology, Charité Campus Mitte and Virchow Klinikum, Charité University Medicine Berlin, Germany
| | - Bertram Wiedenmann
- Medical Department, Division of Hepatology and Gastroenterology, Charité Campus Mitte and Virchow Klinikum, Charité University Medicine Berlin, Germany
| | - Andreas Pascher
- Department of General, Visceral- and Transplantation Surgery, Charité Campus Mitte und, Virchow Klinikum, Charité University Medicine Berlin, Germany
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Zheng SL, Yip VS, Pedica F, Prachalias A, Quaglia A. Intrahepatic bile duct mixed adenoneuroendocrine carcinoma: a case report and review of the literature. Diagn Pathol 2015; 10:204. [PMID: 26589730 PMCID: PMC4654861 DOI: 10.1186/s13000-015-0439-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/12/2015] [Indexed: 12/16/2022] Open
Abstract
Background Mixed adeno-neuroendocrine carcinoma (MANEC) of the biliary tract is rare with only a few reported cases. Consequently, knowledge about their pathogenesis, histopathological characteristics and outcomes is sparce. Case presentation A 53-year old man presented with epigastric pain on a background of excessive alcohol consumption. Contrast-enhanced computed tomography imaging of the liver revealed a central enhancing mass located at the bifurcation of right anterior and posterior portal veins. Magnetic resonance imaging demonstrated intrahepatic biliary duct dilatation distal to the mass. The patient underwent a right lobe hepatectomy and excision of the extrahepatic biliary tree with formation of a hepaticojejunostomy. Histopathological finding of the specimen revealed an intraductal tumour with predominant neuroendocrine immunohistochemical phenotype and infiltration into nearby tissue. An element of glandular differentiation on immunohistochemistry confirmed the lesion as MANEC. Conclusions We present the first reported histopathological case of a MANEC arising from the intrahepatic bile ducts. This report aims to review what is known about primary neuroendocrine and mixed adeno-neuroendocrine carcinoma of the bile ducts, particularly in comparison to other types of biliary and hepatic tumours.
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Affiliation(s)
- Sean L Zheng
- Department of Hepato-Pancreato-Biliary Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - Vincent S Yip
- Department of Hepato-Pancreato-Biliary Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Federica Pedica
- Liver Histopathology, Institute of Liver Studies, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Andreas Prachalias
- Department of Hepato-Pancreato-Biliary Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Alberto Quaglia
- Liver Histopathology, Institute of Liver Studies, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
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