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Mixed adenoneuroendocrine carcinoma of the distal bile duct: A case report
- Source :
- International Journal of Surgery Case Reports
- Publication Year :
- 2017
- Publisher :
- Elsevier, 2017.
-
Abstract
- Highlights • Mixed adenoneuroendocrine carcinomas (MANECs) of the distal bile duct are extremely rare. • The treatment of MANECs of the bile duct remains controversial and the prognosis is poor. • Larger studies are required to establish standard treatment regimens of MANECs of the bile duct.<br />Introduction Mixed adenoneuroendocrine carcinomas (MANECs) of the distal bile duct are extremely rare, and only a few cases have been reported in the English literature. Presentation of case An 82-year-old man was referred to our hospital for increasing biliary enzymes. Abdominal computed tomography (CT) showed enlargement of the intrahepatic bile ducts and stenosis of the distal bile duct. Endoscopic retrograde cholangiopancreatography showed stenosis of the distal bile duct and a high-density signal at the same site on diffusion weighted imaging. PET-CT showed increased FDG accumulation (SUVmax: 4.5) at the distal bile duct stenosis. Biopsy specimens obtained by endoscopic ultrasonography-guided fine-needle aspiration revealed adenocarcinoma. The patient was diagnosed with adenocarcinoma of the distal bile duct and underwent subtotal stomach-preserving pancreaticoduodenectomy with regional lymph node dissection. The resected distal bile duct tumor was 18 × 14 × 12 mm in diameter. Hematoxylin and eosin staining revealed a composite carcinoma with adenocarcinoma and non-adenocarcinoma elements. The non-adenocarcinoma component stained positive for synaptophysin and chromogranin A. The Ki-67 labeling index was 37%. The non-adenocarcinoma component was therefore diagnosed as a neuroendocrine carcinoma. The two composite carcinoma was diagnosed as MANEC of the distal bile duct. The patient was treated with surgery alone and he remained disease-free for 7 months after the surgery. Discussion The treatment of MANECs of the bile duct remains controversial and the prognosis is poor. Conclusions There is no standard treatment for MANECs of the bile duct. Larger studies are required to establish standard treatment regimens.
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
H&E stain
Intrahepatic bile ducts
digestive system
Article
03 medical and health sciences
0302 clinical medicine
WHO, World Heath Organization
Mixed adenoneuroendocrine carcinoma
medicine
Carcinoma
IDUS, intraductal ultrasonography
Endoscopic retrograde cholangiopancreatography
medicine.diagnostic_test
business.industry
Bile duct
General surgery
medicine.disease
Pancreaticoduodenectomy
CT, computed tomography
Stenosis
MANEC, mixed adenoneuroendocrine carcinoma
medicine.anatomical_structure
030220 oncology & carcinogenesis
Adenocarcinoma
030211 gastroenterology & hepatology
Surgery
Radiology
Distal bile duct
business
ERCP, endoscopic retrograde cholangiopancreatography
Subjects
Details
- Language :
- English
- ISSN :
- 22102612
- Volume :
- 39
- Database :
- OpenAIRE
- Journal :
- International Journal of Surgery Case Reports
- Accession number :
- edsair.doi.dedup.....6483cfe103f4e7e9a2fe7772941577fc