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Li BB, Zheng H, Lou YD, Zhang WW, Zheng S. Periampullary tumors in a patient with pancreatic divisum and neurofibromatosis type 1: a case report. Hered Cancer Clin Pract 2023; 21:18. [PMID: 37773168 PMCID: PMC10540396 DOI: 10.1186/s13053-023-00262-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION We present a case of a male patient with neurofibromatosis type 1 diagnosed with pancreatic divisum and several gastrointestinal tumors. A 55-year-old man was admitted to the hospital with recurrent chronic pancreatitis, indicating a large mass in the ampulla. In addition, genetic testing revealed two unique germline mutations in the neurofibromin (NF1) gene, and their potential interaction in promoting cancer was further investigated. CONCLUSION The first similar case was reported in 2020. The current case was distinct from other cases since an additional two NF1 mutations were found in the patient. In conjunction with prior case reports, our findings imply that genetic testing in patients diagnosed with neurofibromatosis type 1 could be helpful in the development of effective treatments.
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Affiliation(s)
- Bin-Bin Li
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
- Department of Medical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang, China
| | - Hui Zheng
- Department of Medical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang, China
| | - Yi-Dan Lou
- Department of Medical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang, China
- Zhejiang University School of Medicine, Hangzhou, China
| | - Wen-Wei Zhang
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China
- Department of Medical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang, China
| | - Song Zheng
- The Fourth School of Clinical Medicine, Zhejiang Chinese Medical University, Hangzhou, 310053, Zhejiang, China.
- Department of Medical Oncology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang, China.
- Department of Medical Oncology, Affiliated Hangzhou Cancer Hospital, Zhejiang University School of Medicine, Hangzhou, 310000, Zhejiang, China.
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Hangzhou, 310000, Zhejiang, China.
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Karlafti E, Charalampidou M, Fotiadou G, Abba Deka I, Raptou G, Kyriakidis F, Panidis S, Ioannidis A, Protopapas AA, Netta S, Paramythiotis D. Ampullary Large-Cell Neuroendocrine Carcinoma, a Diagnostic Challenge of a Rare Aggressive Neoplasm: A Case Report and Literature Review. Diagnostics (Basel) 2022; 12:1797. [PMID: 35892508 PMCID: PMC9332052 DOI: 10.3390/diagnostics12081797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 11/17/2022] Open
Abstract
Ampullary large-cell neuroendocrine carcinomas (LCNECs) are extremely rare, and available data are limited on case reports. They present with jaundice, non-specific abdominal pain, or weight loss, imitating adenocarcinoma. Their incidence increases due to the improved diagnostic techniques. However, preoperative diagnosis remains challenging. We report the case of a 70-year-old man with a history of metabolic syndrome, cholecystectomy, and right hemicolectomy, presenting with jaundice. Laboratory results showed increased liver biochemistry indicators and elevated CA 19-9. Esophagogastroduodenoscopy revealed an ulcerative tumor on the ampulla of Vater, and the biopsy revealed neuroendocrine carcinoma. Although computed tomography (CT) detected enlarged regional lymph nodes, the positron emission tomography (PET) showed a hyperactive lesion only in this area. Pylorus-preserving pancreatoduodenectomy with R0 resection was performed. Pathologic evaluation of the 3.1 × 1.9 cm tumor revealed an LCNEC with immunohistochemical positivity at Synaptophysin, EMA, CD56, and cytokeratin CK8/18. The Ki-67 index was 45%. Two out of the nine dissected lymph nodes were occupied by the neoplasm. The patient was discharged home free of symptoms, and adjuvant chemotherapy with carboplatin + etoposide was initiated. A comprehensive review of the reported cases showed that the preoperative biopsy result was different from the final diagnosis in few cases, regarding the subtypes. Conventional radiology cannot identify small masses, and other methods, such as endoscopy, magnetic resonance cholangiopancreatography (MRCP), and FDG-PET scan, might aid the diagnosis. Diagnosis is based on histology and immunohistochemical markers of the surgical specimens. The treatment of choice is pancreatoduodenectomy, followed by adjuvant chemotherapy. However, recurrence is frequent, and the prognosis remains poor.
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Affiliation(s)
- Eleni Karlafti
- Emergency Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 546 21 Thessaloniki, Greece
- First Propaedeutic Department of Internal Medicine, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 546 21 Thessaloniki, Greece;
| | - Maria Charalampidou
- First Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 546 21 Thessaloniki, Greece; (G.F.); (S.P.); (A.I.); (S.N.); (D.P.)
| | - Georgia Fotiadou
- First Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 546 21 Thessaloniki, Greece; (G.F.); (S.P.); (A.I.); (S.N.); (D.P.)
| | - Ioanna Abba Deka
- Pathology Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 546 21 Thessaloniki, Greece; (I.A.D.); (G.R.)
| | - Georgia Raptou
- Pathology Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 546 21 Thessaloniki, Greece; (I.A.D.); (G.R.)
| | | | - Stavros Panidis
- First Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 546 21 Thessaloniki, Greece; (G.F.); (S.P.); (A.I.); (S.N.); (D.P.)
| | - Aristeidis Ioannidis
- First Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 546 21 Thessaloniki, Greece; (G.F.); (S.P.); (A.I.); (S.N.); (D.P.)
| | - Adonis A. Protopapas
- First Propaedeutic Department of Internal Medicine, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 546 21 Thessaloniki, Greece;
| | - Smaro Netta
- First Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 546 21 Thessaloniki, Greece; (G.F.); (S.P.); (A.I.); (S.N.); (D.P.)
| | - Daniel Paramythiotis
- First Propaedeutic Surgical Department, University Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 546 21 Thessaloniki, Greece; (G.F.); (S.P.); (A.I.); (S.N.); (D.P.)
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