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Case Reports
. 2014 Jan-Feb;99(1):40-4.
doi: 10.9738/INTSURG-D-13-00161.1.

Mixed adenoneuroendocrine carcinoma of the colon progressed rapidly after hepatic rupture: report of a case

Hiromitsu Ito  1 , Atsushi Kudo, Satoshi Matsumura, Daisuke Ban, Takumi Irie, Takanori Ochiai, Noriaki Nakamura, Shinji Tanaka, Minoru Tanabe
Affiliations
Case Reports

Mixed adenoneuroendocrine carcinoma of the colon progressed rapidly after hepatic rupture: report of a case

Hiromitsu Ito et al. Int Surg. 2014 Jan-Feb.

Abstract

The rupture of a metastatic mixed adenoneuroendocrine carcinoma (MANEC) has not been previously reported, although the neuroendocrine cell carcinoma is often associated with a high incidence of hepatic metastases. The patient was a 39-year-old male who presented with upper abdominal pain over 3 months. Computed tomography showed multiple tumors in both hepatic lobes, while lower gastrointestinal endoscopy revealed a tumor in the transverse colon. Histopathologic examination of the tumor revealed it to be a neuroendocrine cell carcinoma. After the resection of the primary tumor, hepatic metastases rapidly increased, and one of them in the left lateral segment was ruptured with significant hemorrhage. The rupture led us to undertake the emergency operation to stop the bleeding. Histology showed a high-grade large-cell neuroendocrine carcinoma associated with moderately differentiated tubular adenocarcinoma. The Ki-67 labeling index was 80% (G3). The diagnosis was mixed adenoneuroendocrine carcinoma according to the 2010 World Health Organization guidelines. Hepatic arterial infusion chemotherapy, systemic chemotherapy, and transcatheter arterial chemoembolization did not decrease the tumor progress, and the patient died on postoperative day 110. Reporting this highly malignant case, I hope all doctors can be interested in MANEC.

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Figures

Fig. 1
Fig. 1
(A) There was a semicircular tumor in the transverse colon. (B) Multiple hypovascular masses were noted in both hepatic lobes.
Fig. 2
Fig. 2
(A) Multiple hypovascular masses were noted in both hepatic lobes. The white arrow showed external fluid due to bleeding. (B) The tumor was necrotic and ruptured.
Fig. 3
Fig. 3
(A) The tumor was composed of high-grade large-cell endocrine cell carcinoma with moderately differentiated tubular adenocarcinoma. Colon: HE (×40). (B) Chromogranin A (+). Colon: chromogranin A (×40). (C) Synaptophysin (+). Colon: synaptophysin (×40). (D) The Ki-67 labeling index was high in both lesion (80%). Colon: Ki-67 (×40). (E) The tumor in the liver was also composed of high-grade large-cell endocrine cell carcinoma with moderately differentiated tubular adenocarcinoma. Liver: chromogranin A (×200).
See this image and copyright information in PMC

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