A long-term recurrence-free survival of a patient with the mixed adeno-neuroendocrine bile duct carcinoma: A case report and review of the literature
| Autor: | Wataru Izumo, Masahiro Shiihara, Yutaro Matsunaga, Ryota Higuchi, Shuichiro Uemura, Takehisa Yazawa, Masakazu Yamamoto, Toru Furukawa |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Case Report NEN neuroendocrine neoplasm Neuroendocrine tumors Bile Duct Carcinoma Gastroenterology 03 medical and health sciences 0302 clinical medicine Internal medicine Biopsy medicine Carcinoma MANEC mixed adeno-neuroendocrine carcinoma Mixed adeno-neuroendocrine carcinoma NETs neuroendocrine tumors medicine.diagnostic_test business.industry Bile duct MANEC medicine.disease Pancreaticoduodenectomy Distal Bile Duct Carcinoma CT computed tomography NEC neuroendocrine carcinoma Long term survival medicine.anatomical_structure ERC endoscopic retrograde cholangiography 030220 oncology & carcinogenesis Adenocarcinoma 030211 gastroenterology & hepatology Surgery business MRI magnetic resonance imaging |
| Zdroj: | International Journal of Surgery Case Reports |
| ISSN: | 2210-2612 |
| DOI: | 10.1016/j.ijscr.2017.07.052 |
| Popis: | Highlights • Mixed adeno-neuroendocrine carcinoma arising primarily in the bile duct is very rare neoplasm. • The patient with mixed adeno-neuroendocrine carcinoma in the bile duct indicates a poor prognosis. • On imaging studies, a hypervascular tumor is suspicious of mixed adeno-neuroendocrine carcinoma. • Curative resection is the only way to obtain the long-term prognosis, even if these patients have lymph node metastasis. Introduction Neuroendocrine tumors arising primarily in the bile duct are rare. And among these tumors, mixed adeno-neuroendocrine carcinoma (MANEC) is quite uncommon. We report a patient with MANEC who achieved long-term recurrence-free survival. And our case report includes analysis previous case reports. Presentation of case A 66-year-old man underwent investigation for persistent anorexia and fatigue. Laboratory tests showed that the values of hepatobiliary enzymes were increased. On CT, a 10 mm × 8 mm hypervascular tumor was observed in the distal bile duct and the proximal bile duct was markedly dilated. Endoscopic retrograde cholangiography (ERC) also showed a stenosis with a long diameter of 10 mm. Examination of a biopsy specimen obtained from the narrow site of the bile duct at the time of ERC revealed tubular adenocarcinoma. Therefore, pylorus-preserving pancreaticoduodenectomy was performed under a preoperative diagnosis of distal bile duct carcinoma. Postoperative pathologic examination revealed alveolar structures and a mixture of moderately differentiated adenocarcinoma with synaptophysin-positive and chromogranin-A-positive neuroendocrine carcinoma. Therefore, the final diagnosis was MANEC, pT3, pN1, M0, pStage II B (TNM classification of the UICC). Curative resection was achieved and there has been no recurrence after 30 months. Discussion In the previous reports, only five patients (14.7%) survived for 24 months or longer. Median survival was longer (14 months) in the curative resection group and shorter (6 months) in the non-curative resection group. Conclusion Curative resection is essential to achieve long-term survival in patients with bile duct MANEC, even if these patients have lymph node metastasis. |
| Databáze: | OpenAIRE |
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