title: 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.
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.
authors: Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan. bonchi.tasuke@gmail.com.
authors: Kiichiro
authors: K
authors: Kaji
authors: Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan.
authors: Jun
authors: J
authors: Seishima
authors: Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan.
authors: Masatoshi
authors: M
authors: Yamato
authors: Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan.
authors: Masaki
authors: M
authors: Miyazawa
authors: Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan.
authors: Takuya
authors: T
authors: Komura
authors: Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan.
authors: Yohei
authors: Y
authors: Marukawa
authors: Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan.
authors: Hajime
authors: H
authors: Ohta
authors: Department of Clinical Laboratory, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan.
authors: Satomi
authors: S
authors: Kasashima
authors: Department of Clinical Laboratory, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan.
authors: Atsuhiro
authors: A
authors: Kawashima
authors: Department of Internal Medicine (Gastroenterology), Toyama Prefectural Central Hospital, Toyama, Japan.
authors: Masaaki
authors: M
authors: Yano
authors: Department of Gastroenterology, National Hospital Organization Kanazawa Medical Center, Kanazawa, Japan.
authors: Masashi
authors: M
authors: Unoura
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018278:Carcinoma, Neuroendocrine / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D018279:Carcinoma, Signet Ring Cell / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration / Q000379:methods*; D006801:Humans; D008297:Male; D018198:Mixed Tumor, Malignant / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D064847:Multimodal Imaging; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
keywords: EUS-FNA; MANEC; Mixed adenoneuroendocrine carcinoma; Pancreas; Signet-ring cell