Tachibana Mitsuhiro, Kamimura Kazuyasu, Tsukamoto Kei, Tsutsumi Yutaka
Department of Diagnostic Pathology, Shimada City General Medical Center, Shimada, JPN.
Department of Surgery, Shimada City General Medical Center, Shimada, JPN.
Cureus. 2021 Jun 24;13(6):e15882. doi: 10.7759/cureus.15882.
In the biliary tree, only three cases of neuroendocrine tumor (NET) synchronous with adenocarcinoma have been reported so far. We experienced a case of NET, grade 2 (G2), of the common bile duct associated with adenocarcinoma of the ampulla of Vater (AoV). A Japanese man at his 60's visited a local doctor, and obstructive jaundice was pointed out. Under the clinical diagnosis of carcinoma of the AoV, 20 x 20 mm, T3aN0M0 stage IIB, pylorus-preserving pancreaticoduodenectomy was performed. Dynamic computed tomography in an artery-dominant phase and microscopic examination revealed that the mass consisted of two different components; hypovascular, 2.5 cm-sized, exophytic adenocarcinoma in the AoV and hypervascular, 1.5 cm-sized, polypoid NET (G2) in the lower part of the common bile duct. The NET diffusely expressed neuroendocrine markers, including somatostatin receptor-2 (SSTR2), and adenocarcinoma cells arising from tubular adenoma focally expressed the neuroendocrine markers. Both malignancies were positive for caudal-type homeobox-2 (CDX2). It is presumed that NET occurred from intestinal-type adenoma/adenocarcinoma.
在胆道系统中，迄今为止仅报道了3例神经内分泌肿瘤（NET）与腺癌同步发生的病例。我们遇到了1例胆总管2级（G2）NET，其与Vater壶腹（AoV）腺癌相关。一名60多岁的日本男性前往当地医生处就诊，被诊断为梗阻性黄疸。在临床诊断为AoV癌（大小为20×20 mm，T3aN0M0，IIB期）后，实施了保留幽门的胰十二指肠切除术。动脉期动态计算机断层扫描及显微镜检查显示，肿块由两种不同成分组成；AoV处有一个2.5 cm大小的低血供外生性腺癌，胆总管下段有一个1.5 cm大小的高血供息肉样NET（G2）。NET弥漫性表达神经内分泌标志物，包括生长抑素受体-2（SSTR2），管状腺瘤来源的腺癌细胞局灶性表达神经内分泌标志物。两种恶性肿瘤尾型同源盒-2（CDX2）均呈阳性。推测NET起源于肠型腺瘤/腺癌。
