Shohei Hirano, Koji Kubota, Akira Shimizu, Tsuyoshi Notake, Tomohiko Ikehara, Yudai Kuroiwa, Kenya Nakamura, Yuji Soejima
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引用次数: 0
摘要
一名 78 岁的男性患者以发烧为主诉来我院就诊。计算机断层扫描显示,胰腺头部肿瘤不明显,胆管和主胰管扩张。内镜下经毛细血管活检显示腺上皮为腺癌,准圆形细胞密集形成。病理结果显示,CK AE1/AE3 和 INSM-1 阳性,CD45 阴性,Ki67 指数约为 80%,诊断为胰头 3 级神经内分泌癌(NEC)。因此,患者接受了胰十二指肠切除术。术后病理结果显示,胰腺头部有小细胞神经内分泌癌(SCNEC),胆管周围有不典型腺管浸润性生长,表明存在分化良好的腺癌。腺癌包含原位病变和胆道上皮内瘤变(BilIN),与 SCNEC 相连。因此,诊断结果是NEC源于肝外胆管,并侵犯了胰头。肝外胆管 NEC 非常罕见,约占胃肠道神经内分泌肿瘤的 0.2-2%,其预后较差,与其他胃肠道 NEC 相似,即使进行了手术治疗也是如此。患者术后17个月仍在门诊治疗,未见复发。
[Neuroendocrine carcinoma of the extrahepatic bile duct:a case report].
A 78-year-old male patient came to our hospital with a chief complaint of fever. Computed tomography revealed an indistinct tumor in the pancreatic head, along with dilatation of the bile duct and main pancreatic duct. An endoscopic transpapillary biopsy demonstrated adenocarcinoma in the glandular epithelium and a dense formation of quasi-round cells. Pathology results indicated positive CK AE1/AE3 and INSM-1, negative CD45, and a Ki67 index of about 80%, leading to a diagnosis of neuroendocrine carcinoma (NEC) Grade 3 of the pancreatic head. Consequently, a pancreatoduodenectomy was performed. Postoperative pathology revealed small cell NEC (SCNEC) at the pancreatic head, with infiltrative growth of atypical gland ducts around the bile ducts, indicating the presence of a well-differentiated adenocarcinoma. The adenocarcinoma contained in situ lesions and biliary intraepithelial neoplasia (BilIN), with SCNEC being contiguous. Therefore, the diagnosis was NEC originating from the extrahepatic bile duct, which invaded the pancreatic head. NEC of the extrahepatic bile duct is rare, accounting for approximately 0.2-2% of gastrointestinal neuroendocrine tumors, and it has a poor prognosis, similar to other gastrointestinal NECs, even when surgical treatment is performed. The patient remained an outpatient without recurrence 17 months postoperatively.
期刊介绍:
The Journal of Gastroenterology, which is the official publication of the Japanese Society of Gastroenterology, publishes Original Articles (Alimentary Tract/Liver, Pancreas, and Biliary Tract), Review Articles, Letters to the Editors and other articles on all aspects of the field of gastroenterology. Significant contributions relating to basic research, theory, and practice are welcomed. These publications are designed to disseminate knowledge in this field to a worldwide audience, and accordingly, its editorial board has an international membership.