Open AccessIntraductal papillary neoplasm of the bile duct accompanying biliary mixed adenoneuroendocrine carcinoma
Author(s) -
Ichiro Onishi,
Hirohisa Kitagawa,
Kenichi Harada,
Syogo Maruzen,
Shuichi Sakai,
Isamu Makino,
Hironori Hayashi,
Hisatoshi Nakagawara,
Hidehiro Tajima,
Hiroyuki Takamura,
Takashi Tani,
Masato Kayahara,
Hiroko Ikeda,
Tetsuo Ohta,
Yasuni Nakanuma
Publication year - 2013
Publication title -
world journal of gastroenterology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.427
H-Index - 155
eISSN - 2219-2840
pISSN - 1007-9327
DOI - 10.3748/wjg.v19.i20.3161
Subject(s) - bile duct , papillary tumor , medicine , papillary adenocarcinoma , intraductal papillary mucinous neoplasm , pathology , major duodenal papilla , jaundice , adenocarcinoma , neuroendocrine tumors , gastroenterology , pancreaticoduodenectomy , common bile duct , pancreas , cancer
We present the first case of an intraductal papillary neoplasm of the bile duct (IPNB) accompanying a mixed adenoneuroendocrine carcinoma (MANEC). A 74-year-old woman presented with fever of unknown cause. Laboratory data revealed jaundice and liver injury. Contrast-enhanced computed tomography revealed a 20 mm polypoid tumor in the dilated distal bile duct, which exhibited early enhancement and papillary growth. Upper gastrointestinal endoscopy revealed mucus production from the papilla of Vater, characterized by its protruding and dilated orifice. Endoscopic ultrasonography visualized the polypoid tumor in the distal bile duct, but no invasive region was suggested by diagnostic imaging. Therefore, the initial diagnosis was IPNB. After endoscopic nasobiliary drainage, a pylorus-preserving pancreaticoduodenectomy was performed. Pathological examination of the resected bile duct revealed papillary proliferation of biliary-type cells with nuclear atypia, indicating pancreaticobiliary-type IPNB. In addition, solid portions comprised of tumor cells with characteristic salt-and-pepper nuclei were evident. Immunohistochemistry revealed expression of the neuroendocrine marker synaptophysin in this solid component, diagnosing it as a neuroendocrine tumor (NET). Furthermore, the MIB-1 proliferation index of NET was higher than that of IPNB, and microinvasion of the NET component was found, indicating neuroendocrine carcinoma (NET G3). This unique case of MANEC, comprising IPNB and NET, provides insight into the pathogenesis of biliary NET.