Biliary Mixed Neuroendocrine-Nonneuroendocrine Neoplasms: A Series of Four Cases with Review of Literature

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Introduction: Mixed Neuroendocrine-Nonneuroendocrine Neoplasms (MiNENs) are rare tumors comprising of both adenocarcinoma and neuroendocrine component, at least 30% of each in the lesion.

Aim(s): To report 4 biliary MiNENs, with a brief literature review.

Materials and methods: Case 1: 22 year old male with jaundice had distal bile duct MiNEN, and a single DOTA positive liver lesion. He underwent neoadjuvant 4 cycles FOLFOX followed by pancreaticoduodenectomy (PD). Case 2: 65 year old male came post-laparoscopic cholecystectomy with biopsy suspicious of adenocarcinoma. Patient underwent completion radical cholecystectomy which revealed an infiltrating GB MiNEN. Patient is on cisplatin + etoposide. Case 3: 51 year old male presented with endoscopic ampullectomy for periampullary lesion - MiNEN arising from distal bile duct. Patient was taken for PD, abandoned due to dense adhesions to major vessels. He was given 3 cycles of FOLFIRINOX followed by surgery followed by 2 cycles of cisplatin + etoposide, later changed to 4 cycles of gemcitabine + capecitabine due to poor response. He responded well, and is disease free at 14 months. Case 4: 35-year old lady with painless jaundice had a mid-bile duct stricture. Endoscopic Ultrasound guided Fine Needle Aspiration Cytology (EUS-FNA) revealed neuroendocrine differentiation. She underwent margin-negative extrahepatic bile duct resection that was a MiNEN. She was given 6 cycles of capecitabine + temozolomide, and is disease free at 2 years.

Conference: 15th Annual ENETSConcerence (2018)

Presenting Author: Pande P

Authors: Pande P, Desai G, Shah R, Palepu J,

Keywords: minen, biliary mixed neuroendocrine-nonneuroendocrine neoplasms,