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Clinical utility of endoscopic ultrasound-guided fine-needle aspiration in mixed adenoneuroendocrine carcinoma with signet-ring cells of the pancreas: a case report and review of the literature

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Abstract

A man in his 60s visited our hospital because of a pancreatic head tumor. Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) revealed that the tumor consisted of a neuroendocrine carcinoma (NEC) and adenocarcinoma, including signet-ring cell carcinoma, and that the ratio of these components was approximately 50:50. Therefore, he was diagnosed with mixed adenoneuroendocrine carcinoma (MANEC). Because of liver and lymph node metastases, systemic chemotherapy was initiated using a regimen for the NEC component based on an increase in neuron-specific enolase (NSE). Although the patient achieved stable disease after two chemotherapy cycles, the tumor increased in size after three cycles, which was associated with a gradual increase in carcinoembryonic antigen and a decrease in NSE level. An EUS-FNA reexamination revealed that the adenocarcinoma component accounted for 90 % of the tumor. Thus, an adenocarcinoma chemotherapy regimen was started, and a slight reduction in tumor size was observed. Here, we report an extremely rare and remarkable case of MANEC of the pancreas that demonstrates the effectiveness of EUS-FNA for helping to decide the chemotherapy regimen.

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Authors and Affiliations

  1. Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan

    Kiichiro Kaji, Jun Seishima, Masatoshi Yamato, Masaki Miyazawa, Takuya Komura, Yohei Marukawa, Hajime Ohta & Masashi Unoura

  2. Department of Clinical Laboratory, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan

    Satomi Kasashima & Atsuhiro Kawashima

  3. Department of Internal Medicine (Gastroenterology), Toyama Prefectural Central Hospital, Toyama, Japan

    Masaaki Yano

Authors
  1. Kiichiro Kaji
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  2. Jun Seishima
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  3. Masatoshi Yamato
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  4. Masaki Miyazawa
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  5. Takuya Komura
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  6. Yohei Marukawa
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  8. Satomi Kasashima
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  9. Atsuhiro Kawashima
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  11. Masashi Unoura
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Corresponding author

Correspondence to Kiichiro Kaji.

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Conflict of interest

Kiichiro Kaji, Jun Seishima, Masatoshi Yamato, Masaki Miyazawa, Takuya Komura, Yohei Marukawa, Hajime Ohta, Satomi Kasashima, Atsuhiro Kawashima, Masaaki Yano, and Masashi Unoura declare that they have no conflict of interest.

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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008(5).

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Informed consent was obtained from the patients for being included in the study.

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Kaji, K., Seishima, J., Yamato, M. et al. Clinical utility of endoscopic ultrasound-guided fine-needle aspiration in mixed adenoneuroendocrine carcinoma with signet-ring cells of the pancreas: a case report and review of the literature. Clin J Gastroenterol 9, 43–48 (2016). https://doi.org/10.1007/s12328-016-0625-z

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  • DOI: https://doi.org/10.1007/s12328-016-0625-z

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