An Early Relapsed Case of Large Cell Endocrine Carcinoma in the Lower Bile Duct after Surgery

Abstract

日臨外会誌 80( 8 ) ，1525-1530，2019 ANEARLYRELAPSEDCASEOFLARGECELLENDOCRINECARCINOMAINTHELOWER BILEDUCTAFTERSURGERY YutaSHIBASAKI 1) 2) ,JunkoTAKITA 1) 2) ,NorihiroHAGA 1) 2) andKenSHIRABE 2) DepartmentofSurgery,NHOUtsunomiyaHospital 1) DepartmentofSurgery,GunmaUniversity 2) A62-year-oldwomanwasadmittedforepigastricpainandjaundice.Abdominalenhancedcomputed tomography (CT) showed a high-density tumor in the lower bile duct and a dilated common bile duct. Afterbiopsy,wesuspectedadenocarcinomainthelowerbileductandperformedpancreatoduodenectomy. Tumorcellswithahighnuclear-cytoplasmic(N/C)ratioandnestedpatternwereconfirmedbyhistologicalexamination.ImmunostainingfindingswerepositiveforchromograninAandsynaptophysin.TheKi-67indexwas＞90%.Consequently,wediagnosedlargecellneuroendocrinecarcinoma(LCNEC)inthe lowerbileduct.Asadjuvantchemotherapy,cisplatinandirinotecanwereadministered.However,three monthsaftersurgery,arecurrencewasobservedinthelymphnodes.Tenmonthsaftersurgery,thepatientdiedduetorecurrenceinthelymphnodes,multiplelivermetastases,andperitonealdissemination. LCNECinthebileductisextremelyrareandappearstobehighlyaggressivewithearlyrecurrenceand metastases.