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Altiti M, Al-Sa'afin AJ, Al-Tawarah T, Suleihat A, Abulhaj S, Mahseeri M. Biliary tree neuroendocrine tumor, an incidental finding. Int J Surg Case Rep 2021; 82:105940. [PMID: 33964717 PMCID: PMC8114107 DOI: 10.1016/j.ijscr.2021.105940] [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: 03/26/2021] [Revised: 04/24/2021] [Accepted: 04/24/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction and importance Biliary tree neuroendocrine tumors (NET) are rare, with 100 cases in the literature, and have an excellent prognosis. Although they are rarely diagnosed before surgery, complete surgical excision offers optimal treatment. Case presentation We report a case of a 36-year-old female patient referred to the surgical team with obstructive jaundice for which she was investigated and found to have a common bile duct tumor showing proximal obstruction. Excision of the tumor with hepaticojejunostomy was done. Later on, the pathology report showed grade-1, well-differentiated neuroendocrine carcinoma, which was completely excised. No further intervention was provided to the patient. Clinical discussion Complete surgical resection with excision of the extrahepatic bile ducts and portal lymphadenectomy in addition to Roux-en-Y hepaticojejunostomy or even pancreaticoduodenectomy for distal CBD neuroendocrine tumors gives sufficient treatment in the majority of cases. No evidence of the advantage of chemo-radiotherapy as part of the treatment for this tumor. Conclusion Biliary tree neuroendocrine tumors are benign tumors, and it is usually difficult to ascertain the diagnosis preoperatively. However, complete surgical excision offers an optimal treatment with no evidence of chemotherapy or radiotherapy's role in the management. Biliary tree NETs have an excellent prognosis with a 10-year survival of 80% complete surgical excision offers optimal treatment for biliary tree NET Size of the tumor, presence of lymphovascular invasion, and Ki-67 assesses prognosis
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Affiliation(s)
- Monther Altiti
- General Surgery Department, School of Medicine, University of Jordan, Jordan
| | | | - Tayseer Al-Tawarah
- General Surgery Department, School of Medicine, University of Jordan, Jordan
| | - Ahmad Suleihat
- General Surgery Department, School of Medicine, University of Jordan, Jordan
| | - Saleh Abulhaj
- General Surgery Department, School of Medicine, Muta University, Jordan
| | - Mohamad Mahseeri
- General Surgery Department, School of Medicine, University of Jordan, Jordan.
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2
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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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3
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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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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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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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Buehner M, Raj T, Will M, Learn P, Graybill SD. Novel Neuroendocrine Tumor in Multiple Endocrine Neoplasia Type 1. Fed Pract 2017; 34:S62-S65. [PMID: 31089323 PMCID: PMC6375582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This case highlights the appropriate use of genetic testing and supports expanding the clinical diagnosis of multiple endocrine neoplasia type 1 to include neuroendocrine tumors of the extrahepatic bile duct.
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Affiliation(s)
- Michelle Buehner
- is a general surgery resident, is a pathology resident, and is an endocrinologist, all at Brooke Army Medical Center at Fort Sam Houston in San Antonio, Texas. is a pathologist at United States Air Force Academy in Colorado Springs, Colorado. is assistant professor of surgery at Uniformed Services University in Bethesda, Maryland
| | - Thomas Raj
- is a general surgery resident, is a pathology resident, and is an endocrinologist, all at Brooke Army Medical Center at Fort Sam Houston in San Antonio, Texas. is a pathologist at United States Air Force Academy in Colorado Springs, Colorado. is assistant professor of surgery at Uniformed Services University in Bethesda, Maryland
| | - Micah Will
- is a general surgery resident, is a pathology resident, and is an endocrinologist, all at Brooke Army Medical Center at Fort Sam Houston in San Antonio, Texas. is a pathologist at United States Air Force Academy in Colorado Springs, Colorado. is assistant professor of surgery at Uniformed Services University in Bethesda, Maryland
| | - Peter Learn
- is a general surgery resident, is a pathology resident, and is an endocrinologist, all at Brooke Army Medical Center at Fort Sam Houston in San Antonio, Texas. is a pathologist at United States Air Force Academy in Colorado Springs, Colorado. is assistant professor of surgery at Uniformed Services University in Bethesda, Maryland
| | - Sky D Graybill
- is a general surgery resident, is a pathology resident, and is an endocrinologist, all at Brooke Army Medical Center at Fort Sam Houston in San Antonio, Texas. is a pathologist at United States Air Force Academy in Colorado Springs, Colorado. is assistant professor of surgery at Uniformed Services University in Bethesda, Maryland
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