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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] [What about the content of this article? (0)] [Affiliation(s)] [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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