J Korean Soc Radiol.  2013 Sep;69(3):207-211. 10.3348/jksr.2013.69.3.207.

Imaging Findings of Neuroendocrine Neoplasm in Biliary Duct with Liver Metastasis

• Oh JH
• Chung DJ
• Hahn ST
• Lee JM

• KMID: 2208803
• DOI: http://doi.org/10.3348/jksr.2013.69.3.207

Abstract

A 64-year-old man was transferred to our hospital because of indigestion and jaundice. The initial abdominal CT and MRI revealed a 2.0 cm enhancing mass in the proximal common bile duct (CBD) with several enlarged lymph nodes. The mass was presumed to be a cholangiocarcinoma, and a CBD segmental resection and choledochojejunostomy was performed. However, the final diagnosis was that of a mixed endocrine-exocrine carcinoma, a high-grade neuroendocrine neoplasm. Seven months after the operation, a follow-up abdominal CT study revealed multiple small arterial enhancing nodules in both hepatic lobes. A sono-guided liver biopsy confirmed these as metastastic mixed endocrine-exocrine carcinoma. This case is unique in that the imaging study regarding the neuroendocrine neoplasm of biliary duct has not been previously reported.

MeSH Terms

Biopsy
Cholangiocarcinoma
Choledochostomy
Common Bile Duct
Dyspepsia
Follow-Up Studies
Humans
Jaundice
Liver
Lymph Nodes
Middle Aged
Neoplasm Metastasis

Figure

• 

  Fig. 1 A 64-year-old man with jaundice. A, B. On contrast-enhanced axial and coronal CT show a size of about 2.0 cm, circumscribed, oval, mass (long arrows on A, B) in the proximal common bile duct (CBD) with extrahepatic bile duct obstruction. The mass shows about 100 Hounsfield unit net enhancement at late arterial phase. A enlarged lymph node (short arrow on A) is seen around the paraaortic space. C. On the tubography, there is a small expansile intraductal filling defect (arrows) in the proximal CBD, with moderate dilatation of intrahepatic ducts. D. Photomicrograph of mixed endocrine-exocrine carcinoma shows the CBD epithelium and tumor cells (Hematoxyline and Eosin stain, × 100). E. There is positive expression chromogranin A100 (× 100). F, G. On contrast-enhanced abdominal CT, there are multiple variable sized, ill defined small arterial enhancing nodules in the both hepatic lobes (arrows). The masses show subtle washout at the portal phase (not present).

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