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A 66-year-old man with unresectable extrahepatic bile duct MiNEN received curative chemoradiotherapy and achieved a complete response. The patient remained recurrence-free for 2.5 years, suggesting clinically valuable implications for treatment strategy selection in unresectable bile duct MiNENs.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/bile-duct-mixed-neuroendocrine-nonendocrine-neoplasm-with-a-complete-response-to-chemoradiotherapy/383187/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/bile-duct-mixed-neuroendocrine-nonendocrine-neoplasm-with-a-complete-response-to-chemoradiotherapy/383187.png","ImageObject",300,407,{"name":92,"@type":93},"kopisore","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-03","2026-09-24",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",12,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"Why is there no standard treatment for bile duct MiNEN?","Question",{"text":113,"@type":114},"The incidence of bile duct neuroendocrine carcinomas is low, and bile duct mixed neuroendocrine-nonendocrine neoplasms are even rarer, so no standard treatment strategy has been established for unresectable cases.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"What treatment led to the complete response in this case?",{"text":118,"@type":114},"The patient with unresectable extrahepatic bile duct MiNEN received curative chemoradiotherapy.",{"name":120,"@type":111,"acceptedAnswer":121},"How long did the patient remain recurrence-free after treatment?",{"text":122,"@type":114},"After achieving a complete response, the patient remained recurrence-free for 2.5 years.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},383187,1790823327,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":52},962090880963,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","doi: 10.2169/internalmedicine.2555-23  \nIntern Med 63: 1243-1246, 2024  \n[http://internmed.jp](http://internmed.jp)  \n【CASE REPORT】  \n\n| Bile Duct Mixed Neuroendocrine-nonendocrine Neoplasm with a Complete Response to Chemoradiotherapy |  |\n| --- | --- |\n| Yosuke Horita 1, Yoshiaki Mihara 1, Masafumi Mizuide 2, Shin-ei Noda 3, Tomonori Kawasaki 4, Masanori Yasuda 4, Shingo Kato 3, Shomei Ryozawa 2 and Tetsuya Hamaguchi 1 |  |\n| Abstract:\u003Cbr>The incidence of neuroendocrine carcinomas arising from the bile duct is low, and that of mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) is even lower; therefore, there is no standard treatment for MiNENs. Choosing the appropriate treatment in clinical practice is difficult. We herein report a case of unresectable extrahepatic bile duct MiNEN in a 66-year-old man who received curative chemoradiotherapy and achieved a complete response, remaining recurrence-free for 2.5 years. We consider the findings of this case to be valuable in selecting a treatment strategy for unresectable bile duct MiNENs.\u003Cbr>Key words: bile duct cancer, neuroendocrine cancer, mixed neuroendocrine-nonendocrine neoplasm (MiNEN), chemoradiotherapy\u003Cbr>(Intern Med 63: 1243-1246, 2024)\u003Cbr>(DOI: 10.2169/internalmedicine.2555-23) |  |\n| \u003Cbr>Introduction\u003Cbr>Histologically, biliary tract cancers are primarily adenocarcinomas. Neuroendocrine tumors of the bile duct are rare. Indeed, according to Modlin et al., primary bile duct tumors comprise only 31 (0.33%) of the 9,421 gastrointestinal carcinoid tumors (1) .\u003Cbr>Chemotherapy is the standard treatment for unresectable biliary tract cancers (2); however, the treatment strategy differs for neuroendocrine carcinomas. According to the NCCN guidelines for neuroendocrine and adrenal tumors, treatment strategies for poorly differentiated neuroendocrine carcinomas/large- or small-cell carcinomas are similar to those for small-cell lung cancer, and chemoradiotherapy is an option when the disease is locoregional and unresectable (3) . In contrast, according to the NCCN guidelines for unresectable but non-metastatic cholangiocarcinoma, chemoradiotherapy is considered a non-standard optional treatment (2) .\u003Cbr>Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) are defined as combinations of neuroendocrine and non-neuroendocrine tumors, with both types of tumors | present in more than 30% of cases (4) . No standard treatment strategy has been established for unresectable MiNEN. There is no consensus on whether treatment should follow the guidelines for neuroendocrine or non-neuroendocrine cancers, and each case differs.\u003Cbr>As mentioned earlier, the frequency of neuroendocrine carcinomas arising from the bile duct is very low, and only a few reports have discussed the use of chemoradiotherapy for treatment (5, 6) . To our knowledge, no cases of curative chemoradiotherapy for neuroendocrine extrahepatic bile duct carcinomas have yet been reported.\u003Cbr>We herein report a patient who received curative chemoradiotherapy for unresectable extrahepatic bile duct MiNEN and achieved a complete response.\u003Cbr>\u003Cbr>Case Report\u003Cbr>A 66-year-old Japanese man experienced epicardial and back pain for 3 months prior to receiving a diagnosis. He was referred to our hospital by a local doctor on suspicion of liver dysfunction based on blood sampling and the presence of a hilar bile duct tumor on contrast-enhanced ab- |\n\n1 Department of Medical Oncology, Saitama Medical University International Medical Center, Japan, 2 Department of Gastroenterology, Saitama Medical University International Medical Center, Japan, 3 Department of Radiation Oncology, Saitama Medical University International Medical Center, Japan and 4 Department of Pathology, Saitama Medical University International Medical Center, Japan  \nReceived: July 3, 2023; Accepted: August 16, 2023; Advance Publication by J-STAGE: September 29, 2023  \nCorrespondence to Yosuke Horita, [york01@saitama-med.ac.jp](york01@saitama-med.ac.jp)  \n","cbCaiosBD5AqMtw3","https://ap.wps.com/l/cbCaiosBD5AqMtw3","pdf",2107564,"English","# Abstract\n# Introduction\n# Case Report","[{\"question\":\"Why is there no standard treatment for bile duct MiNEN?\",\"answer\":\"The incidence of bile duct neuroendocrine carcinomas is low, and bile duct mixed neuroendocrine-nonendocrine neoplasms are even rarer, so no standard treatment strategy has been established for unresectable cases.\"},{\"question\":\"What treatment led to the complete response in this case?\",\"answer\":\"The patient with unresectable extrahepatic bile duct MiNEN received curative chemoradiotherapy.\"},{\"question\":\"How long did the patient remain recurrence-free after treatment?\",\"answer\":\"After achieving a complete response, the patient remained recurrence-free for 2.5 years.\"}]","Bile Duct Mixed Neuroendocrine-nonendocrine Neoplasm with a Complete Response to Chemoradiotherapy | PDF",1790255072]