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Mixed adenoneuroendocrine carcinoma of the ampulla of Vater: a case report and literature review
- Source :
- Clinical journal of gastroenterology. 13(1)
- Publication Year :
- 2018
-
Abstract
- Mixed adenoneuroendocrine carcinoma (MANEC) is defined as a tumor composed of both adenocarcinoma and neuroendocrine components. Here, we report the case of a 75-year-old woman with ampullary MANEC. She visited a physician with the chief complaint of dark urine and was diagnosed with advanced jaundice. Subsequently, she was referred to our hospital. Contrast-enhanced computed tomography scan revealed a neoplastic lesion measuring approximately 2 cm with a contrast effect at the duodenal papilla. Upper endoscopy showed a non-exposed tumor at the duodenal papilla. After biliary drainage, a subtotal stomach-preserving pancreaticoduodenectomy was performed. Histopathological examination revealed that the tumor components were composed of circular-to-oval atypical cells admixed with tubular adenocarcinoma tissue. These atypical cells were immunohistochemically positive for synaptophysin and diagnosed as neuroendocrine carcinoma with a Ki-67 labeling index of 63%. The patient was diagnosed with MANEC with a neuroendocrine carcinoma component of approximately 40%. The neuroendocrine carcinoma component had metastasized to the posterior pancreatic lymph nodes. Despite starting adjuvant chemotherapy with S-1, computed tomography revealed the presence of multiple liver metastases within 4 months after surgery. MANEC with neuroendocrine carcinoma is well known to have an extremely poor prognosis. Therefore, establishing a multidisciplinary therapy including chemotherapy is crucial.
- Subjects :
- medicine.medical_specialty
Ampulla of Vater
medicine.medical_treatment
Common Bile Duct Neoplasms
Adenocarcinoma
Pancreaticoduodenectomy
Surgical oncology
Internal medicine
medicine
Humans
Aged
Cholangiopancreatography, Endoscopic Retrograde
biology
business.industry
Gastroenterology
General Medicine
Hepatology
medicine.disease
Carcinoma, Neuroendocrine
Major duodenal papilla
Jaundice, Obstructive
medicine.anatomical_structure
Mixed Tumor, Malignant
Tubular Adenocarcinoma
Synaptophysin
biology.protein
Female
Radiology
business
Tomography, X-Ray Computed
Subjects
Details
- ISSN :
- 18657265
- Volume :
- 13
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Clinical journal of gastroenterology
- Accession number :
- edsair.doi.dedup.....234aeb70b32ed175e503c320c0900229