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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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Horita Y, Mihara Y, Mizuide M, Noda SE, Kawasaki T, Yasuda M, Kato S, Ryozawa S, Hamaguchi T. Bile Duct Mixed Neuroendocrine-nonendocrine Neoplasm with a Complete Response to Chemoradiotherapy. Intern Med 2024; 63:1243-1246. [PMID: 37779059 PMCID: PMC11116019 DOI: 10.2169/internalmedicine.2555-23] [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: 07/03/2023] [Accepted: 08/16/2023] [Indexed: 10/03/2023] Open
Abstract
The incidence of neuroendocrine carcinomas arising from the bile duct is low, and that of mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) is even lower; therefore, there is no standard treatment for MiNENs. Choosing the appropriate treatment in clinical practice is difficult. We herein report a case of unresectable extrahepatic bile duct MiNEN in a 66-year-old man who received curative chemoradiotherapy and achieved a complete response, remaining recurrence-free for 2.5 years. We consider the findings of this case to be valuable in selecting a treatment strategy for unresectable bile duct MiNENs.
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Affiliation(s)
- Yosuke Horita
- Department of Medical Oncology, Saitama Medical University International Medical Center, Japan
| | - Yoshiaki Mihara
- Department of Medical Oncology, Saitama Medical University International Medical Center, Japan
| | - Masafumi Mizuide
- Department of Gastroenterology, Saitama Medical University International Medical Center, Japan
| | - Shin-Ei Noda
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Japan
| | - Tomonori Kawasaki
- Department of Pathology, Saitama Medical University International Medical Center, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University International Medical Center, Japan
| | - Shingo Kato
- Department of Radiation Oncology, Saitama Medical University International Medical Center, Japan
| | - Shomei Ryozawa
- Department of Gastroenterology, Saitama Medical University International Medical Center, Japan
| | - Tetsuya Hamaguchi
- Department of Medical Oncology, Saitama Medical University International Medical Center, Japan
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3
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Nagi T, Suarez ZK, Haider MA, Vallejo C, Hernandez O, Doukides T. Acute Cholangitis Masquerading Biliary Neuroendocrine Carcinoma: A Rare Twist to a Typical Presentation. ACG Case Rep J 2023; 10:e01228. [PMID: 38111783 PMCID: PMC10727641 DOI: 10.14309/crj.0000000000001228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/09/2023] [Indexed: 12/20/2023] Open
Abstract
Biliary neuroendocrine carcinoma (BNEC) develops in the biliary tract and is characterized by the presence of neuroendocrine cells and account for less than 1% of all malignancies. We present a patient with no significant risk factors of BNEC who presented with abdominal pain and jaundice. An endoscopic ultrasound with endoscopic retrograde cholangiopancreatography was concerning for neoplasm and less likely Mirizzi syndrome. Pathology revealed well-differentiated grade 3 large-cell neuroendocrine carcinoma of the common bile duct. BNEC has a poor prognosis with a reported 5-year survival rate of less than 20%, which is worse than other biliary tract malignancies such as cholangiocarcinoma. Additional cases and further studies of multimodal treatment are required in the future to improve prognosis. Providers should be aware of the risk factors of BNEC and consider the diagnosis when evaluating patients with the symptoms above.
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Affiliation(s)
- Talwinder Nagi
- Department of Internal Medicine, Florida Atlantic University, Schmidt College of Medicine, Boca Raton, FL
| | - Zoilo K. Suarez
- Department of Internal Medicine, Florida Atlantic University, Schmidt College of Medicine, Boca Raton, FL
| | - Muhammad Adnan Haider
- Department of Internal Medicine, Florida Atlantic University, Schmidt College of Medicine, Boca Raton, FL
| | - Charles Vallejo
- Department of Internal Medicine, Florida Atlantic University, Schmidt College of Medicine, Boca Raton, FL
| | - Oscar Hernandez
- Department of Internal Medicine, Florida Atlantic University, Schmidt College of Medicine, Boca Raton, FL
| | - Theodore Doukides
- Department of Gastroenterology, Florida Atlantic University, Schmidt College of Medicine, Boca Raton, FL
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4
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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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5
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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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6
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Kiya Y, Nagakawa Y, Takishita C, Osakabe H, Nishino H, Akashi M, Yamaguchi H, Nagao T, Oono R, Katsumata K, Tsuchida A. Neuroendocrine carcinoma of the common bile duct associated with congenital bile duct dilatation: a case report. BMC Gastroenterol 2021; 21:257. [PMID: 34118881 PMCID: PMC8196520 DOI: 10.1186/s12876-021-01777-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/20/2021] [Indexed: 01/03/2023] Open
Abstract
Background Cholangiocarcinoma is frequently observed in patients with congenital bile duct dilatation (CBDD). Most cholangiocarcinomas are adenocarcinomas. Other types, especially neuroendocrine carcinomas (NECs), are rare. To the best of our knowledge, this is the third reported case of an NEC of the common bile duct associated with CBDD and the first to receive adjuvant chemotherapy for advanced disease. Case presentation
A 29-year-old woman presented with upper abdominal pain. Preoperative imaging indicated marked dilatation of the common bile duct and a tumor in the middle portion of the common bile duct. She was suspected of having distal cholangiocarcinoma associated with CBDD and underwent pylorus-preserving pancreaticoduodenectomy. Pathological and immunohistological findings led to a final diagnosis of large-cell NEC (pT3aN1M0 pStageIIB). The postoperative course was uneventful, and she was administered cisplatin and irinotecan every 4 weeks (four cycles) as adjuvant chemotherapy. She has remained recurrence-free for 16 months. Conclusions NEC might be a differential diagnosis in cases of cholangial tumor associated with congenital bile duct dilatation. This presentation is rare and valuable, and to establish better treatment for NEC, further reports are necessary.
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Affiliation(s)
- Yoshitaka Kiya
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku- ku, Tokyo, 160-0023, Japan.
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku- ku, Tokyo, 160-0023, Japan
| | - Chie Takishita
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku- ku, Tokyo, 160-0023, Japan
| | - Hiroaki Osakabe
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku- ku, Tokyo, 160-0023, Japan
| | - Hitoe Nishino
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku- ku, Tokyo, 160-0023, Japan
| | - Masanori Akashi
- Department of Surgery, Kurume University School of Medicine, 67 Asahicho, 830-0011, Kurume, Fukuoka, Japan
| | - Hiroshi Yamaguchi
- Department of Pathology, Saitama Medical University, 38 Morohongo, Moroyama-machi, Iruma-gun, Saitama, 350-0495, Japan
| | - Toshitaka Nagao
- Department of Anatomical Pathology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo, 160- 0023, Japan
| | - Ryo Oono
- Department of Digestive Surgery, Nitobe Memorial Nakano General Hospital, 4-59-16 Chuo, Nakano-ku, Tokyo, 164-8607, Japan
| | - Kenji Katsumata
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku- ku, Tokyo, 160-0023, Japan
| | - Akihiko Tsuchida
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku- ku, Tokyo, 160-0023, Japan
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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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8
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Kamiya M, Yamamoto N, Kamioka Y, Inoue H, Yotsumoto H, Murakawa M, Aoyama T, Washimi K, Kawachi K, Oshima T, Ueno M, Yukawa N, Rino Y, Masuda M, Morinaga S. Rapidly progressed neuroendocrine carcinoma in the extrahepatic bile duct: a case report and review of the literature. Surg Case Rep 2020; 6:191. [PMID: 32748005 PMCID: PMC7399003 DOI: 10.1186/s40792-020-00945-3] [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: 06/12/2020] [Accepted: 07/15/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Neuroendocrine carcinoma (NEC) originating from the extrahepatic bile duct (EHBD) is very rare but is known for its aggressiveness and poor prognosis. We herein report a case of rapidly progressed NEC in the extrahepatic bile duct. CASE PRESENTATION An 84-year-old man was referred to our facility with obstructive jaundice and abdominal pain. Imaging studies revealed an irregular filling defect in the middle bile duct by endoscopic retrograde cholangiopancreatography and an enhanced wall thickening from the middle to distal portion by enhanced computed tomography. The patient was initially diagnosed with extrahepatic cholangiocarcinoma by a bile duct biopsy and underwent pancreatoduodenectomy with lymph node dissection. The pathological findings showed an NEC with an adenosquamous carcinoma component in the extrahepatic bile duct with lymph node metastases. The patient experienced multiple liver metastases 1 month after surgery and died 3 months after surgery. Due to the rapid progression of his disease, his general condition deteriorated, and he was unable to receive any additional treatments, such as chemotherapy. CONCLUSION As shown in our case, NEC of the EHBD has an extremely poor prognosis and can sometimes progress rapidly. Multimodality treatment should be considered, even in cases of locoregional disease.
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Affiliation(s)
- Mariko Kamiya
- Department of Hepatobiliary and Pancreatic Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan.
| | - Naoto Yamamoto
- Department of Hepatobiliary and Pancreatic Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan
| | - Yuto Kamioka
- Department of Hepatobiliary and Pancreatic Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan
| | - Hirohide Inoue
- Department of Hepatobiliary and Pancreatic Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan
| | - Hirokazu Yotsumoto
- Department of Hepatobiliary and Pancreatic Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan
| | - Masaaki Murakawa
- Department of Hepatobiliary and Pancreatic Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan
| | - Toru Aoyama
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Kota Washimi
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Japan
| | - Kae Kawachi
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Japan
| | - Takashi Oshima
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Makoto Ueno
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Japan
| | - Norio Yukawa
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Soichiro Morinaga
- Department of Hepatobiliary and Pancreatic Surgery, Kanagawa Cancer Center, 1-1-2 Nakao, Asahi-Ku, Yokohama, 241-8515, Japan
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9
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Ishida M, Okano K, Sandoh K, Ito H, Ikeura T, Mitsuyama T, Miyoshi H, Shimatani M, Takaoka M, Okazaki K, Tsuta K. Neuroendocrine carcinoma diagnosis from bile duct cytological specimens: A retrospective single-center study. Diagn Cytopathol 2019; 48:154-158. [PMID: 31697402 DOI: 10.1002/dc.24334] [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: 08/06/2019] [Revised: 09/13/2019] [Accepted: 10/22/2019] [Indexed: 12/23/2022]
Abstract
Neuroendocrine carcinoma (NEC) in the extrahepatic bile duct is extremely rare and clinically aggressive. Cytological examination of bile and/or bile duct brushing specimens plays an important role in the diagnosis of carcinoma of the extrahepatic bile duct, but only a few articles have described the cytological features of NEC in this area. Thus, we retrospectively analyzed the cytological features of NEC in bile and/or bile duct brushing specimens. Patients with a histopathological diagnosis of NEC who underwent bile and/or bile duct brush cytological examination were enrolled in this study. The cytological features, including the background, arrangement, and shape of the neoplastic cells, and nuclear and cytoplasmic features were reviewed. Six patients with small cell NEC were enrolled, and two of them had pancreatic tumors directly invading the bile duct wall. The cytological specimens showed small and/or large neoplastic cell clusters with occasional single cells in all cases. The neoplastic cells had a high nuclear/cytoplasmic ratio and round-to-oval nuclei with powdery chromatin, inconspicuous nucleoli, and scant cytoplasm. Nuclear molding was a characteristic finding in all cases. One case had an adenocarcinoma component, which was also present in the cytological specimen. Cytological examination of bile and/or bile duct brushing specimens can be useful for the diagnosis of small cell NEC. This is an extremely rare but aggressive carcinoma, and its diagnosis by identifying characteristic cytological features may facilitate early detection and treatment.
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Affiliation(s)
- Mitsuaki Ishida
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Kimiaki Okano
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Kaori Sandoh
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Hiroko Ito
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Tsukasa Ikeura
- Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Toshiyuki Mitsuyama
- Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Hideaki Miyoshi
- Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Masaaki Shimatani
- Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Makoto Takaoka
- Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Kazuichi Okazaki
- Third Department of Internal Medicine, Kansai Medical University, Osaka, Japan
| | - Koji Tsuta
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
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10
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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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