Postoperative finding of gastric neuroendocrine tumor in a patient undergoing a mini gastric bypass: points to consider

Gastro-Intestinal Tract Cancers Following Bariatric Surgery: a Narrative Review

The association between obesity and malignancies has been identified epidemiologically. Meanwhile, the increasing global number of bariatric surgeries is reported annually; bariatric surgery's effect on different types of cancers is not well understood. Unfortunately, nonspecific presentations and difficulties regarding investigations make diagnosis challenging. The aim of this study is to compile available data about gastro-intestinal (GI) cancers, occurring after different bariatric surgeries. Although GI cancers are considered a rare complication of obesity surgery, they do exist, and diagnosis needs a high index of suspicion.

Extrahepatic biliary obstrution secondary to neuroendocrine tumor of the common hepatic duct

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Extra hepatic biliary obstruction can be frequently caused by tumors.

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Differentiation between cholangiocarcinoma and an unusual bile duct tumor such as a neuroendocrine tumor (NET) is very difficult preoperatively.

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Prognosis of NET of the extrahepatic bile duct is dependent on the grade of the tumor however is markedly better than cholangiocarcinoma.

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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.