Preoperative diagnosis of well‐differentiated neuroendocrine tumor in common hepatic duct by brush cytology: A case report

Abstract

The biological behavior of neuroendocrine tumors (NETs) is heterogeneous and differs from that of cholangiocarcinoma, which is the most common malignant tumor of the biliary tree. However, the preoperative diagnosis of NET in the biliary tree is extremely difficult and to our knowledge, diagnosis by brush cytology has not previously been reported. Herein, we first reported a case of biliary NET preoperatively diagnosed by brush cytology in a 33‐year‐old female patient. Imaging study revealed a 2.6‐cm mass in the common hepatic duct. The brush cytology was characterized by loosely cohesive plasmacytoid tumor cells and scattered clusters of thin vascular septa. The tumor cells showed abundant cytoplasm and severe nuclear size variation but mitosis was not observed. Immunohistochemical staining of the cell block (CB) showed strong positivity for both synaptophysin and chromogranin A and a Ki‐67 labeling index of 3.5%. The surgically resected bile duct mass was pathologically confirmed as NET, G2 with lymphovascular and perineural invasion of the tumor cells. The patient showed no evidence of tumor recurrence 10 months after operation without adjuvant chemotherapy. Suspicion of this rare tumor and immunohistochemical staining of the CB are important for the preoperative diagnosis of NET in the biliary tree.

Challenges in treatment of a patient suffering from neuroendocrine tumor G1 of the hilar bile duct: a case report

“…However, Wang HH et al [9] reported that the positivity of CA19-9 was only 15.0%, CA72-4 was 7.5%, CEA was 17.5%, and AFP was 15.0% in primary hepatic neuroendocrine tumors. Furthermore, serum tumor markers are normal in most EBNET G1/G2, but they tend to be higher than normal levels in EBNET G3 or extrahepatic biliary neuroendocrine carcinomas [10][11][12][13][14]. Our patient with the hilar bile duct NETs G1 had serum tumor markers were within normal limits.…”

“…Sano et al [15] rstly reported a case of well-differentiated EBNET diagnosed successfully by EUS-guided ne-needle aspiration biopsy. Besides that, biliary brush cytology has been widely used in the preoperative diagnosis of biliary diseases, that cytology of bile and bile duct brush specimens were also helpful for preoperative diagnosis of NET [10,16].…”

A rare cause of biliary obstruction – intraductal neuroendocrine tumor of the right hepatic biliary duct: a case report

“…NETs of the biliary ducts are generally well-differentiated, slow-growing tumors with rare metastatic spread and have a favorable prognosis with a high-rate survival, mostly in cases in which curative surgical resection is possible [11][12][13][14][15]. Our patient also had a well-differentiated biliary tract NET-G2.…”

Challenges in treatment of a patient suffering from neuroendocrine tumor G1 of the hilar bile duct: a case report

“…However, Wang et al [ 9 ] reported that the positivity of CA19-9 was only 15.0%, CA72-4 was 7.5%, CEA was 17.5%, and AFP was 15.0% in primary hepatic neuroendocrine tumors. Furthermore, serum tumor markers are normal in most EBNET G1/G2, but they tend to be higher than normal levels in EBNET G3 or extrahepatic biliary neuroendocrine carcinomas [ 10 – 14 ]. Our patient with the hilar bile duct NETs G1 had serum tumor markers within normal limits.…”

“…Sano et al [ 15 ] reported a case of well-differentiated EBNET diagnosed successfully by EUS-guided fine-needle aspiration biopsy. Besides, biliary brush cytology has been widely used in the preoperative diagnosis of biliary diseases, and the cytology of bile and bile duct brush specimens were also helpful for preoperative diagnosis of biliary NET [ 10 , 16 ]. We regretted that the patient did not have bile juice cytology and step biopsy before surgery.…”