# A Case of Distal Common Bile Duct Obstruction Due to a Neuroendocrine Tumor

## TL;DR

An elderly patient with a rare bile duct tumor experienced symptoms like jaundice and was treated with a stent, but the tumor was ultimately fatal.

## Contribution

This case highlights the clinical presentation and management of a rare neuroendocrine tumor in the biliary tract.

## Key findings

- A well-differentiated neuroendocrine tumor was diagnosed in the distal common bile duct of a 93-year-old patient.
- Endoscopic stenting provided palliation but did not lead to curative treatment in this case.
- Surgical excision is currently considered the only curative option for localized biliary neuroendocrine tumors.

## Abstract

Neuroendocrine tumors (NETs) are a rare subset of malignancies in the biliary tract that may have an aggressive and initially asymptomatic course. A 93-year-old female presented with four days of abdominal pain with associated nausea, jaundice, and brown-colored urine. A CT scan revealed a soft-tissue lesion measuring 1.9 x 1.5 x 1.9 cm within the distal-most aspect of the common bile duct and papilla with marked bile duct dilatation, pancreatic duct dilatation, and multiple hepatic lesions of varying sizes. The biliary stricture was palliated with a stent via endoscopic retrograde cholangiopancreatography. Biopsies taken from the biliary mass were consistent with a well-differentiated NET: World Health Organization, Grade 3. The patient was minimally symptomatic after stenting and was discharged home. She ultimately decided not to pursue further treatment and passed away two months after the initial presentation. Currently, surgical excision is considered the main and only curative treatment for localized NETs, although chemotherapy and radiation therapy may be suitable. Early detection and treatment of these rare NETs in the biliary tree can potentially result in curative treatment.