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Marak JR, Kumar T, Dwivedi S, Khurana R. Neuroendocrine tumor of the gall bladder: A rare case report with review of literature. Radiol Case Rep 2023; 18:3912-3916. [PMID: 37663573 PMCID: PMC10473970 DOI: 10.1016/j.radcr.2023.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 07/10/2023] [Accepted: 08/03/2023] [Indexed: 09/05/2023] Open
Abstract
Neuroendocrine tumor of the gall bladder is an extremely rare malignancy, accounting for only 0.2% of all neuroendocrine tumors. Gall Bladder-Neuroendocrine Tumors (GB-NETs) are mainly diagnosed on histological examination of GB samples after cholecystectomy or after any biliary pathology surgery since it is very difficult to diagnose based on imaging. The overall outcome of gallbladder NET is worse than the adenocarcinoma of the gallbladder. No focused approach towards its treatment is available in literature due to its rarity. We share our experience of gall bladder NET in a 37-year-old female who was successfully managed at our institution.
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Affiliation(s)
- James R. Marak
- Department of Radiodiagnosis, Dr. RMLIMS, Lucknow, Uttar Pradesh, 226010, India
| | - Tushant Kumar
- Department of Radiodiagnosis, Dr. RMLIMS, Lucknow, Uttar Pradesh, 226010, India
| | - Shivam Dwivedi
- Department of Radiodiagnosis, Dr. RMLIMS, Lucknow, Uttar Pradesh, 226010, India
| | - Rohini Khurana
- Department of Radiation Oncology, Dr. RMLIMS, Lucknow, Uttar Pradesh, 226010, India
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2
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Jiang M, Zhang Y. Clinical features and outcomes analysis of Gallbladder neuroendocrine carcinoma. J Cancer Res Ther 2023; 19:910-916. [PMID: 37675716 DOI: 10.4103/jcrt.jcrt_1959_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Purpose Gallbladder neuroendocrine carcinoma (GB-NEC) is an uncommon and highly malignant tumor. This research aimed to investigate the clinical characteristics and prognostic factors of GB-NEC. Materials and Methods Our survey of case reports from January 2000 to May 2022 screened a total of 84 patients with complete data who received surgical resection for gallbladder NEC. Log-rank generated survival curves using the Kaplan-Meier method for univariate survival analysis. To identify GB-NEC independent prognostic indicators for overall survival (OS), univariate and multivariate Cox proportional hazard analyses were conducted. Results These patients consisted of 25 men and 59 women, with an average age of 60 (range 29-85). Patients under 60 years old made up 44% of the population, while patients over 60 made up 56%. Fifty-three tumors were advanced pathologic TNM stage III and IV. After surgery, 44 patients underwent chemotherapy or radiotherapy. The median OS of 84 patients with GB-NEC was 16.8 months. In univariate and multivariate analysis, tumor size (diameter ≥5 cm), TNM tumor stage, and the receipt of postoperative adjuvant chemotherapy are independent factors influencing the prognosis of patients with GB-NEC. Conclusion Tumor size (diameter ≥5 cm) and TNM tumor stage were independently related to a shorter OS. An enhanced OS was independently linked to receiving postoperative adjuvant chemotherapy.
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Affiliation(s)
- Man Jiang
- Department of Geriatric Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
| | - Yijing Zhang
- Department of Geriatric Gastroenterology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong Province, China
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3
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Noh BG, Seo HI, Park YM, Kim S, Hong SB, Lee SJ. Complete resection of large-cell neuroendocrine and hepatocellular carcinoma of the liver: A case report. World J Clin Cases 2022; 10:8277-8283. [PMID: 36159537 PMCID: PMC9403669 DOI: 10.12998/wjcc.v10.i23.8277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/07/2022] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Combined tumors comprising large-cell neuroendocrine carcinoma and hepatocellular carcinoma have been rarely reported in the literature.
CASE SUMMARY We report a case of a 73-year-old woman with chronic hepatitis B suspected to have a malignant hepatic mass (segment 3; size, 4.5 cm) and lymph node metastasis based on computed tomography and magnetic resonance imaging. Despite being Child-Pugh class A, esophageal varices were present. She underwent left lateral sectionectomy and lymph node dissection. Pathological examination revealed a collision tumor consisting of large-cell neuroendocrine (90%) and hepatocellular (10%) carcinomas. The combined carcinoma had metastasized to one of the three lymph nodes excised. The patient recovered without any postoperative complications and was discharged in good condition on postoperative day 13. Adjuvant chemotherapy was not performed. No recurrence occurred during a follow-up period of 24 mo.
CONCLUSION To improve the therapeutic management of combined tumors in the liver, it is necessary to discuss each clinical experience and consider an appropriate method for the preoperative diagnosis and treatment.
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Affiliation(s)
- Byeong Gwan Noh
- Division of HBP Surgery and Transplantation, Department of Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Hyung-Il Seo
- Division of HBP Surgery and Transplantation, Department of Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Young Mok Park
- Division of HBP Surgery and Transplantation, Department of Surgery, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Suk Kim
- Department of Radiology, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Seung Baek Hong
- Department of Radiology, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - So Jeong Lee
- Department of Pathology, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
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4
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Ren X, Jiang H, Sun K, Qin X, Qu Y, Xia T, Chen Y. Mixed neuroendocrine-non-neuroendocrine neoplasm of the gallbladder: case report and literature review. Diagn Pathol 2022; 17:51. [PMID: 35715834 PMCID: PMC9206291 DOI: 10.1186/s13000-022-01231-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 05/18/2022] [Indexed: 11/30/2022] Open
Abstract
Background Mixed neuroendocrine–non-neuroendocrine neoplasms (MiNENs) of the gallbladder are rare malignancies. Here we presented two cases and reviewed the related literature. Case presentation Our two patients were postoperatively diagnosed with gallbladder MiNENs, which pathologically consisted of a large cell neuroendocrine carcinoma and papillary adenocarcinoma. After cholecystectomy, one patient had a survival time of 30 months, while the other remained alive through 12 months of follow-up. In the literature, a total of 72 cases of gallbladder MiNENs were identified, and with our two patients included, we calculated a male-to-female ratio of 0.22 and a mean age of 64.5 years for the 74 reported cases. About one-half of these patients were found to have gallstones and presented with abdominal pain or discomfort in a relatively early stage. The preoperative diagnosis of these 74 cases mainly relied on abdominal ultrasound, contrast-enhanced computed tomography (CT) scanning, and magnetic resonance imaging or positron emission tomography/CT. However, the final diagnosis was established based upon the pathological evidence and expression of synaptophysin (Syn) and/or chromogranin A identified by immunohistochemical staining or neurosecretory granules detected by electron microscopy. Fifty-eight patients (78.4%) underwent various operations including simple cholecystectomy (n = 14), en bloc cholecystectomy (n = 9), standard or non-standard radical cholecystectomy (n = 25), or extended radical cholecystectomy (n = 6). The mean size of the resected gallbladder masses was 50.8 ± 36.1 mm (n = 63) with regional lymph node metastasis in 37 patients (52.1%), liver invasion or staging greater than T3 in 33 patients (45.8%), and hepatic metastasis in 26 patients (35.1%). The postoperative median survival time was 36 ± 11.42 months (95% confidence interval, 13.62 to 58.38 months). The log-rank analysis did not find that postoperative adjuvant chemotherapy contributed to a longer survival time relative to that among the patients who did not receive chemotherapy (numbers of patients, 15 versus 43; survival times, 36 months versus 30 months, p > 0.05). Conclusions Our two cases and the cases in the literature suggest that MiNENs of the gallbladder predominantly occur in women; are associated with early lymph node metastasis, local hepatic invasion, and hepatic metastasis; and can be managed by various surgeries as well as chemotherapy combined with somatostatin analogs.
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Affiliation(s)
- Xu Ren
- Digestive Hospital of Heilongjiang Provincial Hospital Affiliated to Harbin University of Technology, No. 405, Guogeli Street, Harbin, 150001, Heilongjiang, China.
| | - Hong Jiang
- Department of Pathology, Heilongjiang Provincial Hospital Affiliated to Harbin University of Technology, Harbin, 150001, Heilongjiang Province, China
| | - Kan Sun
- Department of General Surgery, Heilongjiang Provincial Hospital Affiliated to Harbin University of Technology, Harbin, 150001, Heilongjiang Province, China
| | - Xufu Qin
- Department of Gastroenterology, Heilongjiang Provincial Hospital Affiliated to Harbin University of Technology, Harbin, 150001, Heilongjiang Province, China
| | - Yongping Qu
- Digestive Endoscopy Center, Heilongjiang Provincial Hospital of Harbin Institute of Technology, Harbin, 150001, Heilongjiang Province, China
| | - Tian Xia
- Digestive Hospital of Heilongjiang Provincial Hospital Affiliated to Harbin University of Technology, No. 405, Guogeli Street, Harbin, 150001, Heilongjiang, China
| | - Yan Chen
- Hospital Information Center of Heilongjiang Province Affiliated to Harbin Institute of Technology, Harbin, 150001, Heilongjiang Province, China
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5
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Hsiao TH, Wu CC, Tseng HH, Chen JH. Synchronous but separate neuroendocrine tumor and high-grade dysplasia/adenoma of the gall bladder: A case report. World J Clin Cases 2022; 10:2322-2329. [PMID: 35321155 PMCID: PMC8895191 DOI: 10.12998/wjcc.v10.i7.2322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/22/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gall bladder neuroendocrine tumors (GB-NETs) are rare, accounting for less than 0.5% of all NETs. They usually lack specific symptoms and are difficult to diagnose preoperatively. In most cases, GB-NETs are incidentally found after cholecystectomy for large polyps or cholelithiasis, causing acute or chronic cholecystitis. The coexistence of GB-NET and GB adenocarcinoma is very rare.
CASE SUMMARY We report a case of synchronous but separate GB-NET and adenoma with high-grade dysplasia in a patient who had undergone surgery for a progressively growing GB polypoid lesion. To the best of our knowledge, simultaneous separation of NETs and cancer in the GB has not been reported.
CONCLUSION Coexistent GB carcinoid tumor and adenocarcinoma is rare. A surveillance program is needed for these large GB polyps.
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Affiliation(s)
- Tsung-Hsien Hsiao
- Division of Gastroenterology and Hepatology, Taipei Tzu Chi Hospital, New Taipei City 231, Taiwan
| | - Chao-Chuan Wu
- Department of Surgery, Taipei Tzu Chi Hospital, New Taipei City 231, Taiwan
| | - Hui-Hwa Tseng
- Department of Pathology, Taipei Tzu Chi Hospital, New Taipei City 231, Taiwan
| | - Jiann-Hwa Chen
- Division of Gastroenterology and Hepatology; Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
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6
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Wang W, Yang CX, Yu XZ, Zhang SL, Wang J, Wang J. Clinicopathological characteristics and prognostic factors of patients with primary gallbladder neuroendocrine carcinomas. J Dig Dis 2022; 23:166-173. [PMID: 35187836 DOI: 10.1111/1751-2980.13088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 01/30/2022] [Accepted: 02/14/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVES Primary gallbladder neuroendocrine carcinomas (GB-NEC) are malignant neoplasms that remained to be studied. In this study we aimed to summarize their clinicopathological characteristics, effective treatment and prognostic factors for patients with GB-NEC. METHODS Patients with GB-NEC admitted to Shanghai Jiao Tong University Affiliated Sixth People's Hospital and Renji Hospital, School of Medicine, Shanghai Jiao Tong University from October 2012 to August 2020 were enrolled. Clinicopathological characteristics of our patients and those reported in previous studies were recorded. The Kaplan-Meier method and univariate and multivariate Cox regression analyses were used for survival analysis. RESULTS Altogether 15 patients from our hospitals and 47 patients from previous studies were included. A total of 55 patients who underwent surgical resection, including R0 and non-R0 resection, had significantly longer overall survival compared with the other seven patients. A univariate analysis indicated that patients aged 60 years or older, with jaundice, carcinoid syndrome, non-R0 resection, and advanced stage were associated with worse survival. A multivariate analysis showed that patients aged 60 years or older, carcinoid syndrome and non-R0 resection, but not lymphadenectomy and adjuvant chemotherapy, were independently related to reduced survival. CONCLUSIONS R0 resection should be the first-line treatment for GB-NEC. Older age, carcinoid syndrome and non-R0 resection are independently associated with reduced survival after surgical resection.
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Affiliation(s)
- Wei Wang
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chuan Xin Yang
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xin Zhe Yu
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shi Lei Zhang
- Department of Pathology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Wang
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jian Wang
- Department of Hepatobiliary and Pancreatic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China.,Department of Biliary-Pancreatic Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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7
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Do MY, Jang SI, Kang HP, Kim EJ, Lee KJ, Park GE, Lee SJ, Lee DK, Woo SM, Cho JH. Comparison of the Clinical Features and Outcomes of Gallbladder Neuroendocrine Carcinoma with Those of Adenocarcinoma: A Propensity Score-Matched Analysis. Cancers (Basel) 2021; 13:cancers13184713. [PMID: 34572940 PMCID: PMC8471353 DOI: 10.3390/cancers13184713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/16/2021] [Accepted: 09/18/2021] [Indexed: 12/14/2022] Open
Abstract
Simple Summary Neuroendocrine neoplasms (NENs) of the gallbladder (GB) are extremely rare. We aimed to compare the clinical features of GB-NENs with those of adenocarcinomas (ADCs) of the GB. Among 21 patients with GB-NENs, 20 were diagnosed with poorly differentiated small-cell neuroendocrine carcinoma (NEC), and 1 patient had large-cell NEC. At initial presentation, all patients had advanced stages of cancer, with extensive local extension and/or distant metastasis. Nine patients with GB-NEC who underwent surgical resection had a significantly better progression-free survival (PFS) than those who did not undergo surgery. After a propensity score matching with a 1:1 ratio using the American Joint Committee on Cancer (AJCC) stage, age, sex, and operation status, there was no difference in the overall survival or PFS between AJCC stage-matched patients with GB-NEC or GB-ADC. In conclusion, GB-NEC is difficult to diagnose early and has a prognosis similar to that of GB-ADC. Abstract Neuroendocrine neoplasms (NENs) of the gallbladder (GB) are extremely rare. We aimed to compare the clinical features, disease progression, management, and prognosis of patients with GB-NENs with those of patients with GB-adenocarcinomas (ADCs). A total of 21 patients with GB-NENs and 206 patients with GB-ADCs, treated at three tertiary medical centers between January 2010 and December 2020, were enrolled. Of the 21 patients with GB-NENs, 20 were diagnosed with poorly differentiated small-cell neuroendocrine carcinomas (NECs), and 1 patient had large-cell NEC. All patients presented with advanced stages of cancer with extensive local extension and/or distant metastasis and non-specific symptoms. Tumor-node-metastasis stage IIIB and IV (A/B) tumors were found in 6 and 15 (1/14) patients, respectively. Nine patients with GB-NEC who underwent surgical resection had a significantly better progression-free survival (PFS) than those who did not undergo surgery. After a propensity score matching with a 1:1 ratio using the American Joint Committee on Cancer stage, age, sex, and operation status, 19 pairs of patients were included. Compared with stage-matched patients with GB-ADC, patients with GB-NEC had similar overall survival and PFS. However, as GB-NEC is rarely diagnosed early, further studies investigating methods for the early diagnosis and improvement in the survival of patients with GB-NEC are needed.
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Affiliation(s)
- Min-Young Do
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (M.-Y.D.); (S.-I.J.); (D.-K.L.)
| | - Sung-Ill Jang
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (M.-Y.D.); (S.-I.J.); (D.-K.L.)
| | - Hua-Pyong Kang
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, Korea; (H.-P.K.); (E.-J.K.)
| | - Eui-Joo Kim
- Department of Internal Medicine, Gachon University Gil Medical Center, Incheon 21565, Korea; (H.-P.K.); (E.-J.K.)
| | - Kyong-Joo Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Korea;
| | - Go-Eun Park
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 06273, Korea; (G.-E.P.); (S.-J.L.)
| | - Su-Jee Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 06273, Korea; (G.-E.P.); (S.-J.L.)
| | - Dong-Ki Lee
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (M.-Y.D.); (S.-I.J.); (D.-K.L.)
| | - Sang-Myung Woo
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang 10408, Korea
- Correspondence: (S.-M.W.); (J.-H.C.)
| | - Jae-Hee Cho
- Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06273, Korea; (M.-Y.D.); (S.-I.J.); (D.-K.L.)
- Correspondence: (S.-M.W.); (J.-H.C.)
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8
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Dhali A, Ray S, Dhali GK. Primary Small Cell Neuroendocrine Tumour of Gallbladder Presenting as Pyrexia of Unknown Origin. Cureus 2021; 13:e15874. [PMID: 34327099 PMCID: PMC8302456 DOI: 10.7759/cureus.15874] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2021] [Indexed: 12/22/2022] Open
Abstract
Herein, we report a case of primary small cell neuroendocrine tumor (NET) of the gallbladder in a 45-year-old female who presented with complaints of fever accompanied by abdominal pain on the right upper quadrant for one month. Contrast-enhanced computed tomography abdomen showed a large gallbladder mass. It was infiltrating the segments IVa, IVb, and V of the liver. Ultrasound-guided fine-needle-aspiration-cytology was performed. Based on preoperative pathological and immunohistochemical investigations, it was diagnosed to be a primary small cell NET of the gallbladder. The patient underwent radical cholecystectomy after three cycles of cisplatin-based neoadjuvant chemotherapy. She had an uneventful recovery and received adjuvant chemo-radiotherapy. The patient was well at the 18-month follow-up.
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Affiliation(s)
- Arkadeep Dhali
- Department of Gastrointestinal Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, Kolkata, IND
| | - Sukanta Ray
- Department of Gastrointestinal Surgery, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, Kolkata, IND
| | - Gopal Krishna Dhali
- Department of Gastroenterology, School of Digestive and Liver Diseases, Institute of Postgraduate Medical Education and Research, Kolkata, IND
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9
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Wang P, Chen J, Jiang Y, Jia C, Pang J, Wang S, Chang X. Neuroendocrine Neoplasms of the Gallbladder: A Clinicopathological Analysis of 13 Patients and a Review of the Literature. Gastroenterol Res Pract 2021; 2021:5592525. [PMID: 34122537 PMCID: PMC8166508 DOI: 10.1155/2021/5592525] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/10/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) are rare gallbladder neuroendocrine neoplasms (GB-NENs). This study is aimed at investigating the clinicopathological features of GB-NENs and identifying prognostic factors related to overall survival (OS) of GB-MiNENs. METHODS The clinical data and pathological features of 13 patients with GB-NENs in our hospital were retrospectively reviewed. Additionally, 41 GB-MiNENs cases reported in English literature were reviewed and survival analysis was performed. RESULTS The mean age of thirteen patients (6 males and 7 females) with GB-NENs was 57.2 years (range: 35-75 years). Two patients were diagnosed with NET grade 1 (G1), two patients with NEC (large cell/small cell = 1/1), and nine patients with MiNENs. Of these 9 patients with MiNENs, 8 had composite tumors and 1 had amphicrine carcinoma. Microscopically, the adenocarcinoma component was located in the surface mucosa, and the neuroendocrine component was in the area of deep invasion, liver infiltration, and lymph node metastasis. Total analysis of 41 GB-MiNENs showed that patients were mainly elderly women (female/male ratio, 2.4 : 1.0; median age, 60 years). Kaplan-Meier's analysis demonstrated that liver metastasis and TNM stage III-IV were associated with decreased OS (P < 0.05), whereas age, sex, tumor size, grade of the neuroendocrine component, lymph node metastasis, and adjuvant chemotherapy were not significantly prognostic indicators of OS. Multivariate analysis identified liver metastasis (hazard ratio = 4.262, 95%confidence interval = 1.066-17.044, P = 0.040) as an independent unfavorable prognostic factor. CONCLUSIONS GB-MiNENs were the most common type of GB-NENs in our case series, and neuroendocrine components exhibited more aggressive lymph node metastasis and local invasion than adenocarcinoma. Liver metastasis was a poor prognostic indicator in GB-MiNENs patients.
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Affiliation(s)
- Pengyan Wang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tsinghua University, Beijing 100730, China
| | - Jingci Chen
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tsinghua University, Beijing 100730, China
| | - Ying Jiang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tsinghua University, Beijing 100730, China
| | - Congwei Jia
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tsinghua University, Beijing 100730, China
| | - Junyi Pang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tsinghua University, Beijing 100730, China
| | - Shan Wang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tsinghua University, Beijing 100730, China
| | - Xiaoyan Chang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tsinghua University, Beijing 100730, China
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10
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Costa AC, Cavalcanti CLC, Coelho HGB, Leão LHA, Soares DTC, Santa-Cruz F, Paz AR, Ferraz ÁAB. Rare Mixed Adenoneuroendocrine Carcinoma of the Gallbladder: Case Report and Review of Literature. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929511. [PMID: 33945521 PMCID: PMC8105744 DOI: 10.12659/ajcr.929511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Patient: Female, 58-year-old Final Diagnosis: Mixed adenoneuroendocrine carcinoma of the gallbladder Symptoms: Abdominal pain • asthenia Medication: — Clinical Procedure: — Specialty: Surgery
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Affiliation(s)
- Adriano C Costa
- Surgical Oncology Division, Hospital Napoleão Laureano, João Pessoa, PB, Brazil.,Oncology Division, Hospital das Clínicas at Federal University of Pernambuco (HC/UFPE), Recife, PE, Brazil
| | - Camilla L C Cavalcanti
- General Surgery Division, Hospital das Clínicas at Federal University of Pernambuco (HC/UFPE), Recife, PE, Brazil
| | | | | | | | | | - Alexandre R Paz
- Pathology Division, Napoleão Laureano Hospital, João Pessoa, PB, Brazil
| | - Álvaro A B Ferraz
- General Surgery Division, Hospital das Clínicas at Federal University of Pernambuco (HC/UFPE), Recife, PE, Brazil.,Department of Surgery, Federal University of Pernambuco (UFPE), Recife, PE, Brazil
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11
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Chu H, Shi Y, Liu J, Huang D, Zhang J, Dou C. Update in clinical management for gallbladder neuroendocrine carcinoma. Medicine (Baltimore) 2021; 100:e25449. [PMID: 33832150 PMCID: PMC8036038 DOI: 10.1097/md.0000000000025449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/10/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Gallbladder neuroendocrine carcinoma (GB-NEC) is rare and there are few reports at present. We sought to review the current knowledge of GB-NEC and provide recommendations for clinical management. METHODS A systemic literature research was conducted in the websites of Pubmed, Medline, Web of Science, CNKI, Wanfang Data using the keywords including gallbladder combined with neuroendocrine carcinoma or neuroendocrine tumor or neuroendocrine neoplasm. Two reviewers independently screened the articles by reading the title, abstract and full-text. RESULTS In computed tomography (CT) and magnetic resonance imaging (MRI) examination, a well-defined margin, gallbladder replacing type with larger hepatic and lymphatic metastases could be helpful for differential diagnosis of GB-NEC and gallbladder adenocarcinoma (GB-ADC). Older age, unmarried status, large tumor size (>5 cm), positive margins, and distant Surveillance, Epidemiology and End result (SEER) stage are independently associated with poor survival. Surgical resection remains as the preferred and primary treatment. The potential survival benefit of lymphadenectomy for patients remains controversial. Platinum-based postoperative adjuvant chemotherapy may improve the survival. The efficacy of other treatments including immunotherapy, targeted therapy and somatostatin analogue needs further investigation. CONCLUSION Typical imaging features could be helpful for preoperative diagnosis. Age, margin status, tumor size, marital status, histopathologic subtype and SEER stage may be independent predictors for the survival. Remarkable advances regarding the treatment for GB-NEC have been achieved in recent years. Further studies are needed to investigate the survival benefit of lymphadenectomy for patients with GB-NEC.
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Affiliation(s)
- Hongwu Chu
- Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou
- Qingdao University, Qingdao
| | - Ying Shi
- Obstetrics and Gynecology, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Junwei Liu
- Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou
| | - Dongsheng Huang
- Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou
| | - Jungang Zhang
- Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou
| | - Changwei Dou
- Hepatobiliary and Pancreatic Surgery, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou
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12
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Alawad M, Gupta R, Haseeb MA, Brunicardi FC. Clinicopathologic and Molecular Features of Mixed Neuroendocrine Non-Neuroendocrine Neoplasms of the Gallbladder. Gastroenterology Res 2020; 13:269-278. [PMID: 33447306 PMCID: PMC7781272 DOI: 10.14740/gr1323] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/23/2020] [Indexed: 12/17/2022] Open
Abstract
Neuroendocrine neoplasms of the gallbladder are rare, comprising 0.5% of all neuroendocrine cancers and about 2% of gallbladder cancers. These neoplasms can also be found along with other malignant neoplasms of epithelial origin, mostly adenocarcinomas. Herein, we describe an unusual finding of a three-component mixed neuroendocrine non-neuroendocrine neoplasm (MiNEN) of the gallbladder. We also review the literature on 29 similar cases and summarize key features. We report on a 62-year-old woman who presented with right upper quadrant pain with a positive Murphy’s sign. A clinical diagnosis of neoplasia was entertained and she underwent cholecystectomy. Gross examination of the specimen revealed a 5-cm exophytic mass at the gallbladder fundus. Histopathologic examination of the mass showed an infiltrating squamous cell carcinoma, an adjacent neuroendocrine carcinoma (each of these two components composed more than 30% of the neoplasm), and a superficial adenocarcinoma (composing 10% of the neoplasm). Gallbladder MiNENs present with similar symptoms and in the same age group as do carcinomas; however, their prognosis is often poor. Specific management and treatment guidelines have not been established since MiNENs are very rare.
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Affiliation(s)
- Mouyed Alawad
- Department of Pathology, State University of New York, Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - Raavi Gupta
- Department of Pathology, State University of New York, Downstate Health Sciences University, Brooklyn, NY 11203, USA.,Department of Cell Biology, State University of New York, Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - M A Haseeb
- Department of Pathology, State University of New York, Downstate Health Sciences University, Brooklyn, NY 11203, USA.,Department of Cell Biology, State University of New York, Downstate Health Sciences University, Brooklyn, NY 11203, USA
| | - F Charles Brunicardi
- Department of Surgery, State University of New York, Downstate Health Sciences University, Brooklyn, NY 11203, USA
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Wen LJ, Chen JH, Xu HJ, Yu Q, Deng Y, Liu K. The clinical profiles, management, and prognostic factors of biliary mixed neuroendocrine nonneuroendocrine neoplasms: A systematic review of the literature. Medicine (Baltimore) 2020; 99:e23271. [PMID: 33327249 PMCID: PMC7738038 DOI: 10.1097/md.0000000000023271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Mixed neuroendocrine nonneuroendocrine neoplasms (MiNENs) originating from the biliary system (gallbladder, biliary tract, or ampulla of Vater) are extremely rare and have not been discussed in detail or systematically. We aimed to present the demographics, clinicopathological characteristics, management, and prognostic factors of biliary MiNENs. METHODS A systematic search of electronic biomedical databases (Web of Science, PUBMED, and Embase) was performed to identify eligible studies. Survival was analyzed with the Kaplan-Meier method. Log-rank tests were used to evaluate the differences between groups, and the effects of various clinical and histopathological features on prognosis were analyzed by univariate and multivariate Cox regression. RESULTS Fifty-three publications (patients, n = 67) were included. The median overall survival time was 21.0 months. Fifty-one patients (76.1%) underwent radical surgery and median survival for 41 months (P < .001). Twenty-two patients who received adjuvant radiochemotherapy treatment after radical surgery had a median survival for 43 months (P = .076). Radical resection (P < .001), Ki-67 index (P = .011), tumor stage (P < .001), neuroendocrine (NEC) grade (P = .011), and non-NEC grade (P = .017) were independent statistically significant prognostic factors according to univariate analysis; radical resection (P = .010) and small morphological subtype (P = .036) were independent statistically significant prognostic factors associated with higher overall survival according to multivariate analysis, and radical resection (P = .005) and age < 65 years (P = .026) were associated with higher recurrence free survival time. CONCLUSION Radical resection is essential for long-term survival. Aggressive multimodality therapy with adjuvant radiochemotherapy and biotherapy may improve survival of biliary MiNENs. Further randomized controlled trials are needed to determine the standard treatment.
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Affiliation(s)
- Li-Jia Wen
- Department of Hepatopancreatobiliary Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province
| | - Jun-Hong Chen
- College of Clinical Medicine, Jilin University, Changchun
| | - Hong-Ji Xu
- Department of Hepatopancreatobiliary Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province
| | - Qiong Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun 130021, Jilin Province, China
| | - Yu Deng
- Department of Hepatopancreatobiliary Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province
| | - Kai Liu
- Department of Hepatopancreatobiliary Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province
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Machairas N, Paspala A, Frountzas M, Tsilimigras DI, Moris D, Ntomi V, Tsapralis D, Schizas D. Mixed Adenoneuroendocrine Carcinoma (MANEC) of the Gallbladder: A Systematic Review of Outcomes Following Surgical Management. In Vivo 2020; 33:1721-1726. [PMID: 31662496 DOI: 10.21873/invivo.11662] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 08/04/2019] [Accepted: 08/05/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND/AIM Mixed adenoneuroendocrine carcinomas (MANEC) are uncommon tumors exhibiting both adenocarcinomatous and neuroendocrine differentiation. They most commonly arise in the colon, appendix, rectum or stomach, however, a limited number of MANECs have been reported to originate in the gallbladder (gMANEC). The aim of our systematic review was to accumulate the existing data on gMANEC with special attention to the clinicopathological characteristics, surgical approach, recurrence and survival rates of patients diagnosed with this rare malignancy. MATERIALS AND METHODS A comprehensive search of the literature was undertaken. RESULTS A total of 15 studies (14 case reports and 1 case series), which comprised 19 patients who successfully underwent surgical treatment for gMANEC were included in our systematic review. During a median follow-up of 8 months (range=2-48 months) the overall survival was 87% and the recurrence rate was 21%. CONCLUSION Achievement of complete surgical resection is the mainstay of the therapeutic management. Additionally, the stage of the disease and the histopathological mapping of these tumors affect decision-making for adjuvant chemotherapy and seem to define the prognostic course of each patient.
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Affiliation(s)
- Nikolaos Machairas
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Anna Paspala
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Maximos Frountzas
- Laboratory of Experimental Surgery and Surgical Research "N. S. Christeas", National and Kapodistrian University of Athens, Athens, Greece
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner Medical Center, Columbus, OH, U.S.A
| | - Dimitrios Moris
- Department of Surgery, Duke University Medical Center, Durham, NC, U.S.A
| | - Vasileia Ntomi
- 3rd Department of Surgery, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | | | - Dimitrios Schizas
- 1st Department of Surgery, National and Kapodistrian University of Athens, Laikon Hospital, Athens, Greece
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Sciarra A, Missiaglia E, Trimech M, Melloul E, Brouland JP, Sempoux C, La Rosa S. Gallbladder Mixed Neuroendocrine-Non-neuroendocrine Neoplasm (MiNEN) Arising in Intracholecystic Papillary Neoplasm: Clinicopathologic and Molecular Analysis of a Case and Review of the Literature. Endocr Pathol 2020; 31:84-93. [PMID: 31981075 DOI: 10.1007/s12022-020-09605-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) of the gallbladder are generally composed of adenocarcinoma and neuroendocrine carcinoma (NEC). Rare cases associated with intracholecystic papillary neoplasm (ICPN) have been reported. Although recent molecular data suggest that the different components of digestive MiNENs originate from a common precursor stem cell, this aspect has been poorly investigated in gallbladder MiNENs. We describe the clinicopathologic and molecular features of a MiNEN composed of ICPN, adenocarcinoma, and NEC. A 66-year-old woman presented with severe abdominal pain. She underwent radical cholecystectomy and an intracholecystic mass was found. Histologically, it was composed of ICPN associated with adenocarcinoma and large cell neuroendocrine carcinoma (LCNEC). The three components were positive for DNA repair proteins and p53. EMA was positive in the ICPN and adenocarcinoma components, while it was negative in the LCNEC. Heterogeneous expression of Muc5AC, cytokeratin 20, and CDX2 was only observed in the ICPN component. Cytokeratin 7 was diffusely positive in both adenocarcinoma and LCNEC components, while it was heterogeneously expressed in the ICPN. The copy number variation analysis showed overlapping results between the adenocarcinoma and LCNEC components with some minor differences with the ICPN component. The three tumor components showed the same mutation profile including TP53 mutation c.700T > C (p. Tyr234His), without mutations in other 51 genes known to be frequently altered in cancer pathogenesis and growth. This finding may support the hypothesis of a monoclonal origin of the different tumor components. We have also performed a review of the literature on gallbladder MiNENs.
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Affiliation(s)
- Amedeo Sciarra
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, 25 rue du Bugnon, CH-1011, Lausanne, Switzerland
| | - Edoardo Missiaglia
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, 25 rue du Bugnon, CH-1011, Lausanne, Switzerland
| | - Mounir Trimech
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, 25 rue du Bugnon, CH-1011, Lausanne, Switzerland
| | - Emmanuel Melloul
- Department of Visceral Surgery, Lausanne University Hospital, 46 rue du Bugnon, 1011, Lausanne, Switzerland
| | - Jean-Philippe Brouland
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, 25 rue du Bugnon, CH-1011, Lausanne, Switzerland
| | - Christine Sempoux
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, 25 rue du Bugnon, CH-1011, Lausanne, Switzerland
| | - Stefano La Rosa
- Institute of Pathology, Lausanne University Hospital and University of Lausanne, 25 rue du Bugnon, CH-1011, Lausanne, Switzerland.
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16
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Hussain I, Sarvepalli D, Zafar H, Jehanzeb S, Ullah W. Neuroendocrine Tumor: A Rare, Aggressive Tumor of the Gallbladder. Cureus 2019; 11:e5571. [PMID: 31695990 PMCID: PMC6820688 DOI: 10.7759/cureus.5571] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
We report a case of rare and aggressive gallbladder neuroendocrine carcinoma (GB-NEC), diagnosed with the help of endoscopic ultrasound (EUS). A 65-year-old asymptomatic male, with a past medical history of hypertension, underwent abdominal ultrasound for the screening of an abdominal aortic aneurysm. He was found to have a mixed echogenicity area near the stomach, an incidental finding on abdominal ultrasound. The patient had an upper gastrointestinal (GI) endoscopy exam, which revealed an antral mass that was biopsied. The tissue specimen showed an epithelioid mesenchymal tumor of unclassified type and, eventually, the patient underwent partial gastrectomy. Surgical pathology reported a low-grade sub-serosal gastrointestinal stromal tumor (GIST) of the resected tissue specimen. He was later discharged and advised to follow up with abdominal computed tomography (CT) every year. Two years later, his abdominal CT revealed a new 3.7 cm x 2.0 cm mass in the posterior gallbladder fundus. Subsequently, the patient underwent laparoscopic cholecystectomy and the excisional biopsy reported a T3NXM1 neuroendocrine small cell carcinoma. Then, he received six cycles of systemic chemotherapy with carboplatin and etoposide, showing excellent response initially. However, a repeat CT abdomen/pelvis with contrast, on his eighth-month follow-up, demonstrated the interval development of an infiltrative mass in the pancreatic head. The gastroenterology team was then consulted, who performed sphincterotomy with temporary stent placement and celiac plexus neurolysis. Also, a transduodenal fine-needle aspiration (FNA) of the pancreatic mass was performed, which revealed metastatic small cell carcinoma. Based on these findings, the patient received an additional three cycles of carboplatin/etoposide chemotherapy, along with one cycle of immunotherapy. However, the patient had a poor response to chemotherapy, and he eventually chose hospice care.
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Affiliation(s)
| | | | - Hammad Zafar
- Internal Medicine, AdventHealth Orlando, Orlando, USA
| | | | - Waqas Ullah
- Internal Medicine, Abington Hospital - Jefferson Health, Abington, USA
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Skalický A, Vištejnová L, Dubová M, Malkus T, Skalický T, Troup O. Mixed neuroendocrine-non-neuroendocrine carcinoma of gallbladder: case report. World J Surg Oncol 2019; 17:55. [PMID: 30902091 PMCID: PMC6429764 DOI: 10.1186/s12957-019-1598-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 03/13/2019] [Indexed: 02/06/2023] Open
Abstract
Background Mixed neuroendocrine-non-neuroendocrine tumors (MINEN) of the gallbladder are extremely rare; indeed, the English expert literature reports a mere handful of case reports and case series on this topic. According to the WHO classification of 2010, MINEN are considered to be tumors consisting of two major components, neuroendocrine and non-neuroendocrine, each of which hosts at least 30% of the total cellular population. To date, the etiology and pathogenesis of MINEN have not been precisely determined and the non-specific symptoms generally result in late diagnosis (mainly in the terminal stages of the condition) and contribute to the generally poor prognosis. As far as the management of the disease is concerned, radical surgery plays a crucial role; however, the significance of surgical debulking and biological therapy applying somatostatin analogues has not yet been determined. Case presentation A 56-year-old female was referred to our department for a rapidly progressing tumor in the subhepatic area along with the infiltration of S5 and S6 liver segments. With regard to preoperative findings, the tumor appeared as operable, although, during the surgery, an extensive involvement of the hepatoduodenal ligament by the tumor through the lymph nodes was revealed. Due to acute perioperative bleeding from the necrotic tumor, we decided to perform modified resection. Histologically, the tumor was confirmed as MINEN of gallbladder, where the neuroendocrine component was dominant over the non-neuroendocrine component. Six weeks after the discharge, the patient underwent a follow-up CT revealing large recurrence of the disease. Thereafter, the patient was started on systemic therapy with etoposide and carboplatin in combination with somatostatin analogues. Thirteen months after the surgery, the patient is in good clinical condition, and while a recently performed PET/MRI scan revealed a hepatic lesion and hilar lymphadenopathy in full regression, there was a spread of small peritoneal and pleural metastases. The patient remains in the follow-up care. Conclusions The occurrence of mixed neuroendocrine-non-neuroendocrine neoplasms is extremely rare. Radical surgery remains the only potentially effective approach to the cure of this disease. The role of biological therapy and debulking in the management of the disease has not yet been precisely defined. In our experience, both of these methods have the potential to positively influence overall survival rates and the postoperational quality of life of patients.
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Affiliation(s)
- Adam Skalický
- Department of Surgery and Biomedical Center, Faculty of Medicine and University Hospital in Pilsen, Charles University in Prague, 304 60, Pilsen, Czech Republic.
| | - Lucie Vištejnová
- Biomedical Center, Faculty of Medicine in Pilsen, Charles University, 304 60, Pilsen, Czech Republic
| | - Magdaléna Dubová
- Šikl's Department of Pathology, Faculty of Medicine and University Hospital in Pilsen, Charles University, 305 99, Pilsen, Czech Republic
| | - Tomáš Malkus
- Department of Imaging Methods, University Hospital in Pilsen, 304 60, Pilsen, Czech Republic
| | - Tomáš Skalický
- Department of Surgery and Biomedical Center, Faculty of Medicine and University Hospital in Pilsen, Charles University in Prague, 304 60, Pilsen, Czech Republic
| | - Ondřej Troup
- Faculty of Medicine in Pilsen, Charles University, 301 00, Pilsen, Czech Republic
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18
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Czeczok TW, Schembri-Wismayer DJ, Smyrk TC, Truty MJ, Mounajjed T. Hepatic perihilar amphicrine cholangiocarcinoma: A case report. HUMAN PATHOLOGY: CASE REPORTS 2018. [DOI: 10.1016/j.ehpc.2018.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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19
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Soin S, Pannu BS, Myint PT, Dhillon AS. Large cell neuroendocrine carcinoma and adenocarcinoma of gallbladder with concomitant hepatitis C infection. BMJ Case Rep 2018; 2018:bcr-2018-225141. [PMID: 29954768 DOI: 10.1136/bcr-2018-225141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Neuroendocrinetumour (NET) of the gallbladder is an extremely rare tumour and with coexisting adenocarcinoma an even rarer occurrence. Mixed NETs have the tendency to invade the lymph nodes and the hepatic tissue from their high malignant potential, leading to poor prognosis. Survival rates of the patients with mixed NET can be improved with wide excision, adjuvant chemotherapy and radiation. We present a case of 62-year-old woman with history of hepatitis C infection, a risk factor for both hepatic and extrahepatic gastrointestinal malignancies. Patient underwent exploratory laparotomy with resection of the gallbladder and partial hepatectomy. Pathology showed high-grade larger cell neuroendocrine carcinoma 5×4×3 cm along with two separate lesions found out to be adenocarcinomas. In our patient, hepatitis C infection can be an inciting factor for the development of these carcinomas. We will discuss the presentation, treatment modalities and outcomes with this kind of coexisting tumours.
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Affiliation(s)
- Sarthak Soin
- Internal Medicine, Presence Saint Joseph Hospital Chicago, Chicago, Illinois, USA
| | - Bibek Singh Pannu
- Internal Medicine, Presence Saint Joseph Hospital Chicago, Chicago, Illinois, USA
| | - Phyo Thazin Myint
- Internal Medicine, Presence Saint Joseph Hospital Chicago, Chicago, Illinois, USA
| | - Amandeep Singh Dhillon
- Internal Medicine, Rosalind Franklin University of Medicine and Science Chicago Medical School, North Chicago, Illinois, USA
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20
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Il Kim D, Il Seo H, Lee JY, Kim HS, Han KT. Curative Resection of Combined Neuroendocrine Carcinoma and Adenocarcinoma of the Gallbladder. TUMORI JOURNAL 2018; 97:815-8. [DOI: 10.1177/030089161109700623] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Neuroendocrine carcinoma of the gallbladder has very rarely been reported as it accounts for only 0.5% of all neuroendocrine tumors. It has a very aggressive biological behavior. These tumors are usually diagnosed at an advanced stage and surgical management is therefore not an option. We performed a hepatopancreaticoduodenectomy along with adjuvant chemotherapy in a 48-year-old patient with a neuroendocrine carcinoma of the gallbladder. The patient has been followed up at the outpatient clinice for 18 months without there having been any recurrence. Patients with a locally invasive neuroendocrine carcinoma in the gallbladder may benefit from aggressive surgical treatment followed by adjuvant chemotherapy. The primary management in high-grade metastatic tumors is, however, mainly medical.
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Affiliation(s)
- Dong Il Kim
- Department of Surgery, School of Medicine, Pusan National University, Busan, Korea
| | - Hyung Il Seo
- Department of Surgery, School of Medicine, Pusan National University, Busan, Korea
| | - Jee Yeon Lee
- Department of Surgery, School of Medicine, Pusan National University, Busan, Korea
| | - Hyun Sung Kim
- Department of Surgery, School of Medicine, Pusan National University, Busan, Korea
| | - Koon Taek Han
- Department of Surgery, School of Medicine, Pusan National University, Busan, Korea
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21
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Hu HJ, Zhou RX, Tan YQ, Jing QY, Ma WJ, Yang Q, Wang JK, Wang SJ, Cheng NS, Li FY. Coexisting cancers: a mixture of neuroendocrine carcinoma and adenocarcinoma in the gallbladder: A case report. Medicine (Baltimore) 2016; 95:e5281. [PMID: 27858898 PMCID: PMC5591146 DOI: 10.1097/md.0000000000005281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Neuroendocrine carcinoma is rare with a proportion of less than 2% in gallbladder malignancies, cases of gallbladder neuroendocrine cell carcinoma coexisting with adenocarcinoma are exceptionally rare, and the prognosis is dismal. METHODS Herein, we presented an unusual case of poorly differentiated gallbladder neuroendocrine cell carcinoma coexisting with poorly differentiated adenocarcinoma who survived 20 months after the multimodal treatment (MT) of extended surgery and postoperative chemotherapy. RESULTS Our result indicated that for advanced gallbladder neuroendocrine cell carcinoma coexisting with adenocarcinoma, MT including extended surgical approach combined with postoperative chemotherapy may contribute to a relatively good survival outcome. CONCLUSION MT may contribute to a relatively good survival outcome for advanced gallbladder neuroendocrine cell carcinoma coexisting with gallbladder adenocarcinoma.
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Affiliation(s)
| | | | | | - Qiu-Yang Jing
- Department of Pathology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | | | | | | | | | | | - Fu-Yu Li
- Department of Biliary Surgery
- Correspondence: Fu-Yu Li, Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China (e-mail: )
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22
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González-Chávez MA, Villegas-Tovar E, González Hermosillo-Cornejo D, Gutierrez-Ocampo A, López-Rangel JA, Athié-Athié ADJ. [Neuroendocrine small-cell carcinoma of the gallbladder. An unexpected finding after diagnostic laparoscopy]. CIR CIR 2016; 85:168-174. [PMID: 26920213 DOI: 10.1016/j.circir.2015.12.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 11/10/2015] [Indexed: 12/26/2022]
Abstract
BACKGROUND Gallbladder cancer ranks fifth among oncological diseases affecting the gastrointestinal tract; nevertheless, it is the world's most common malignant tumor of the bile ducts. It is usually diagnosed after cholecystectomy and tends to have bad prognosis. Adenocarcinoma is the main histological finding, although other rare histologic types have been described among the actual literature. Poorly differentiated squamous-cell neuroendocrine gallbladder carcinoma is an extremely rare neoplasm. A poor prognosis is associated with this histological type. AIM The aim of this paper is to show that performing a systematic exploration of the entire peritoneal cavity in all laparoscopic surgeries can lead to find completely unexpected changes related to an unidentified disease. Also, a detailed review of our unexpected finding is made: The neuroendocrine small cell carcinoma of gallbladder. CLINICAL CASE We hereby report the case of a 40-year-old patient with a ruptured ectopic pregnancy that underwent emergency laparoscopic surgery, presenting the incidental finding of a small-cell carcinoma of the gallbladder. CONCLUSIONS Our surgical group advised that by introducing the laparoscope, the entire peritoneal cavity must be systematically reviewed, in search of differential diagnoses and unidentified pathologies. We must use the diagnostic and therapeutic qualities of laparoscopy. Bile duct endocrine tumors tend to remain silent until advanced stages, making the prognosis usually unfavorable, especially when they are unresectable. Endocrine neoplasias of the gallbladder, although uncommon, should be taken into account as possible diagnoses due to its therapeutic and prognostic implications.
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Affiliation(s)
- Mario Andrés González-Chávez
- Departamento de Cirugía General, Fundación Clínica Médica Sur, Ciudad de México, México; Facultad Mexicana de Medicina, Universidad La Salle, Ciudad de México, México.
| | - Eduardo Villegas-Tovar
- Departamento de Cirugía General, Fundación Clínica Médica Sur, Ciudad de México, México; Facultad Mexicana de Medicina, Universidad La Salle, Ciudad de México, México
| | | | - Alejandro Gutierrez-Ocampo
- Departamento de Cirugía General, Fundación Clínica Médica Sur, Ciudad de México, México; Facultad Mexicana de Medicina, Universidad La Salle, Ciudad de México, México
| | | | - Amado de Jesús Athié-Athié
- Departamento de Cirugía General, Fundación Clínica Médica Sur, Ciudad de México, México; Facultad Mexicana de Medicina, Universidad La Salle, Ciudad de México, México
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23
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Lee SW, Baek SY, Sung SH. Combined Undifferentiated and Neuroendocrine Carcinomas of the Gallbladder Appearing as Two Separate Lesions: A Case Report with Radiological-Pathological Correlation. J Radiol Case Rep 2015; 9:14-21. [PMID: 26622929 DOI: 10.3941/jrcr.v9i5.2165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
We report herein a rare case of incidentally detected combined undifferentiated and neuroendocrine carcinomas of the gallbladder. An incidental gallbladder malignancy was revealed on abdominal ultrasound and multi-detector computed tomography in a 54-year-old man. A short distance from the main polypoid hypoechoic mass at the fundus of the gallbladder, focal wall thickening was noted with prominently increased power Doppler flow. Extended cholecystectomy was performed, and histology confirmed the main polypoid mass as undifferentiated carcinoma and the separate nodule as neuroendocrine carcinoma. To our knowledge, this is the first report presenting two separate lesions of combined gallbladder carcinomas by radiological features.
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Affiliation(s)
- So Won Lee
- Department of Radiology, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Seung Yon Baek
- Department of Radiology, School of Medicine, Ewha Womans University, Seoul, South Korea
| | - Sun Hee Sung
- Department of Pathology, School of Medicine, Ewha Womans University, Seoul, South Korea
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24
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Zheng SL, Yip VS, Pedica F, Prachalias A, Quaglia A. Intrahepatic bile duct mixed adenoneuroendocrine carcinoma: a case report and review of the literature. Diagn Pathol 2015; 10:204. [PMID: 26589730 PMCID: PMC4654861 DOI: 10.1186/s13000-015-0439-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 11/12/2015] [Indexed: 12/16/2022] Open
Abstract
Background Mixed adeno-neuroendocrine carcinoma (MANEC) of the biliary tract is rare with only a few reported cases. Consequently, knowledge about their pathogenesis, histopathological characteristics and outcomes is sparce. Case presentation A 53-year old man presented with epigastric pain on a background of excessive alcohol consumption. Contrast-enhanced computed tomography imaging of the liver revealed a central enhancing mass located at the bifurcation of right anterior and posterior portal veins. Magnetic resonance imaging demonstrated intrahepatic biliary duct dilatation distal to the mass. The patient underwent a right lobe hepatectomy and excision of the extrahepatic biliary tree with formation of a hepaticojejunostomy. Histopathological finding of the specimen revealed an intraductal tumour with predominant neuroendocrine immunohistochemical phenotype and infiltration into nearby tissue. An element of glandular differentiation on immunohistochemistry confirmed the lesion as MANEC. Conclusions We present the first reported histopathological case of a MANEC arising from the intrahepatic bile ducts. This report aims to review what is known about primary neuroendocrine and mixed adeno-neuroendocrine carcinoma of the bile ducts, particularly in comparison to other types of biliary and hepatic tumours.
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Affiliation(s)
- Sean L Zheng
- Department of Hepato-Pancreato-Biliary Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
| | - Vincent S Yip
- Department of Hepato-Pancreato-Biliary Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Federica Pedica
- Liver Histopathology, Institute of Liver Studies, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Andreas Prachalias
- Department of Hepato-Pancreato-Biliary Surgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Alberto Quaglia
- Liver Histopathology, Institute of Liver Studies, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
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Santos Naharro J, Márquez Rojas J, Blanco Fernández G, Rodríguez García JM, Solórzano Peck G. Carcinoma neuroendocrino mixto de vesícula. Cir Esp 2014; 92:445-7. [DOI: 10.1016/j.ciresp.2012.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Revised: 01/15/2012] [Accepted: 02/15/2012] [Indexed: 12/13/2022]
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Tamura T, Takeuchi K. Small cell gall bladder carcinoma complicated by syndrome of inappropriate secretion of antidiuretic hormone (SIADH) treated with mozavaptan. BMJ Case Rep 2013; 2013:bcr-2013-010039. [PMID: 23761568 DOI: 10.1136/bcr-2013-010039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Small cell gall bladder carcinoma (Scc-GB) is a very rare entity. Although some cases present with endocrine manifestations, paraneoplastic hyponatraemia has been reported in only one previous case. Recently, the antidiuretic hormone (ADH) receptor antagonist mozavaptan has become available. Herein we report a case with Scc-GB complicated with syndrome of inappropriate secretion of antidiuretic hormone (SIADH) treated with mozavaptan. A 47-year-old woman was referred to our hospital for hyponatraemia. Physical examination revealed elevated serum ADH, a gall bladder mass. She was clinically diagnosed with Scc-GB with SIADH as a paraneoplastic syndrome. Mozavaptan was used for SIADH. Serum sodium was quickly normalised after mozavaptan treatment. Two months later, metastasis to the subcutis of the abdominal wall was observed. The metastatic nodule was resected, and small cell carcinoma (Scc) was identified pathologically. Mozavaptan was effective for improvement of hyponatraemia in this patient with Scc-GB complicated with SIADH.
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Affiliation(s)
- Tetsuo Tamura
- Gastroenterological Department, Toranomon Hospital, Tokyo, Japan.
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Harada K, Sato Y, Ikeda H, Hsu M, Igarashi S, Nakanuma Y. Notch1-Hes1 signalling axis in the tumourigenesis of biliary neuroendocrine tumours. J Clin Pathol 2013; 66:386-91. [PMID: 23423517 DOI: 10.1136/jclinpath-2012-201273] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
AIMS Biliary neuroendocrine tumours (NETs) are rare and mostly exist as a component of mixed adenoneuroendocrine carcinomas (MANECs). Although the NET component in biliary MANECs is generally more malignant and clinically more important to the prognosis than the ordinary adenocarcinomatous component, the histogenesis of biliary NET has not been clarified. In this study, the role of the Notch1-Hes1 signalling axis in the histogenesis of biliary NETs was examined. METHODS Immunohistochemistry for Notch1, its ligand Jagged1 and Hes1 was performed using surgical specimens from 11 patients with biliary MANEC. Moreover, after the knock-down of Notch1 mRNA expression in a cholangiocarcinoma cell line, the expression of chromogranin A (a neuroendocrine marker) and Ascl1 (a neuroendocrine-inducing molecule inhibited by activated Hes1) was examined by quantitative PCR. RESULTS Histological examination revealed that the adenocarcinomatous components were predominately located at the luminal surface of the MANEC and the majority of stromal invasion involved NET components. Ordinary adenocarcinomas and non-neoplastic biliary epithelium constantly expressed Notch1, Jagged1 and Hes1, but the expression of Notch1 and Hes1 was decreased or absent in NET components, suggesting interference with the Notch1-Hes1 signalling axis in biliary NET. Moreover, in the cholangiocarcinoma cell line in which the expression of Notch1 mRNA was knocked down, the mRNA expression of Ascl1 and chromogranin A was increased. CONCLUSIONS The Notch1-Hes1 signalling axis suppresses neuroendocrine differentiation and maintains tubular/acinar features in adenocarcinoma and non-neoplastic epithelium in the biliary tree. Moreover, a disruption of this signalling axis may be associated with the tumourigenesis of NETs in biliary MANEC.
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Affiliation(s)
- Kenichi Harada
- Department of Human Pathology, Kanazawa University Graduate School of Medicine, , Kanazawa, Ishikawa, Japan.
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Song W, Chen W, Zhang S, Peng J, He Y. Successful treatment of gallbladder mixed adenoneuroendocrine carcinoma with neo-adjuvant chemotherapy. Diagn Pathol 2012. [PMID: 23186166 PMCID: PMC3584922 DOI: 10.1186/1746-1596-7-163] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
UNLABELLED Mixed adenoneuroendocrine carcinoma (MANEC) carcinomas rarely occur in the gallbladder. Here we reported a case of giant gallbladder unresectable mass with local liver invasion and omentum metastasis, which proved to be neuroendocrine carcinoma (NEC) by biopsy, received successful radical operation after neo-adjuvant chemotherapy plus somatostatin treatment. The patient showed good response as the neoplasm diminished dramatically and showed clear margin after 6 courses of treatment. A radical operation including cholecystectomy, hepatic wedge resection of the gallbladder fossa segment and lymph node of group 8a and 8p resection was performed successfully. Postoperative histopathological examination revealed neuroendocrine carcinoma mixed with adenocarcinoma in the gallbladder wall. Followed up showed no evidence of recurrence after 7 months of the operation. We suggest that neo-adjuvant chemotherapy may be beneficial to gallbladder mixed neuroendocrine carcinomas in an advanced stage which could also be advantageous to NEC of other organs. VIRTUAL SLIDES http://www.diagnosticpathology.diagnomx.eu/vs/2731892837743787.
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Affiliation(s)
- Wu Song
- Department of Surgery, First Affiliated Hospital, Sun Yat-sen University, 58# Zhongshan Road 2, Guangzhou 510080, China
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Clinicopathologic study of mixed adenoneuroendocrine carcinomas of hepatobiliary organs. Virchows Arch 2012; 460:281-9. [PMID: 22358181 DOI: 10.1007/s00428-012-1212-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 12/21/2011] [Accepted: 02/08/2012] [Indexed: 12/15/2022]
Abstract
Neuroendocrine neoplasms in hepatobiliary organs are very rare, but several cases of mixed adenoneuroendocrine carcinoma (MANEC) have been reported. In this study, we characterized the neuroendocrine component of biliary MANEC. A total of 274 cases of biliary cancer including 17 intrahepatic cholangiocarcinomas (CCs), 15 hepatic hilar CCs without preceding hepatobiliary disease, 55 hepatic hilar CCs with hepatolithiasis, 49 gallbladder cancers, 53 extrahepatic CCs, and 85 hepatocellular carcinomas were examined for a neuroendocrine component using immunohistochemistry with neuroendocrine markers (chromogranin A and synaptophysin). In the MANEC cases, in addition to a close histological examination, the proliferative activity and the expression of somatostatin receptor 2A were also evaluated. In addition to an ordinary adenocarcinoma, a neuroendocrine component occupying more than 30% of the entire tumor was also found in 4% (2/55 cases) of hepatic hilar cholangiocarcinomas with hepatolithiasis, 10% (5/49 cases) of gallbladder cancers, and 4% (2/53 cases) of extrahepatic cholangiocarcinomas, but not in the intrahepatic cholangiocarcinomas, hilar cholangiocarcinomas without preceding hepatobiliary disease, and hepatocellular carcinomas. Two cases were positive for somatostatin receptor 2A. The adenocarcinoma components were predominately located at the surface of the tumors, and the majority of stromal and vascular invasion and lymph node metastasis involved neuroendocrine components, showing the features of neuroendocrine tumor G2 or neuroendocrine carcinomas (NECs). NEC components showed higher proliferative activity on Ki67 immunostaining, compared to the adenocarcinoma components. Biliary MANECs are found in hepatic hilar cholangiocarcinomas with hepatolithiasis, gallbladder cancers, and extrahepatic cholangiocarcinomas and show a characteristic histology. Since the neuroendocrine component in biliary MANEC defines the prognosis, it is important to identify it and consider the indications for adjunctive therapy with somatostatin analogues.
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Abstract
BACKGROUND Gallbladder neuroendocrine tumors (GB-NETs) represent only 0.5% of all NETs, and little is known about their biological behavior. We sought to provide an overview of the current state of knowledge about GB-NETs and provide a recommendation for management. STUDY A PubMed search was undertaken using the following criteria: primary gallbladder and carcinoid or NET. We also interrogated the SEER 9, 13 and 17 registries (1973 to 2005) and the Niigata registry (2003) to assess the epidemiology and clinicopathological characteristics. Finally, we compared the clinical presentation, management and prognosis of GB-NETs to that of gallbladder adenocarcinoma. RESULTS GB-NETs probably derive from either a multipotent stem cell or neuroendocrine cells in intestinal or gastric metaplasia of the gallbladder epithelium, which occurs consequent upon cholelithiasis/chronic inflammation. Clinically and at surgery, GB-NETs are indistinguishable from gallbladder cancer (GBC) and "carcinoid syndrome" is evident in only ∼1%.The median survival was only 9.8 months among 278 cases of GB-NETs reported in SEER. The 5 year survival rate for tumors classified as carcinoids/neuroendocrine carcinoma or small cell cancer (SCC) was 36.9 and 0%, respectively. Soga divided GB-NETs into typical and variant carcinoids with 5 year survival rates of 60.4% and 21.3% respectively. CONCLUSIONS GB-NETs have an aggressive behavior, and once diagnosed, extensive surgical management and careful NET follow up with CT scan is mandatory to facilitate early detection of recurrence. Since more aggressive surgical management for GBC has shown increased survival rates for these tumors, a similar strategy seems reasonable for GB-NETs. However, in high grade metastatic tumors, the primary management is mainly medical.
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31
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Two cases of small cell carcinoma of the gallbladder. Case Rep Med 2010; 2010. [PMID: 20953379 PMCID: PMC2952924 DOI: 10.1155/2010/453624] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2010] [Accepted: 09/27/2010] [Indexed: 12/13/2022] Open
Abstract
Small cell carcinoma of the gallbladder is a rare disease process with approximately 40 cases reported in the literature. It is most often found in elderly female population and is associated with cholelithiasis and cigarette smoking. A multidisciplinary approach to treatment with wide surgical resection and adjuvant chemotherapy is the current standard of care. Notwithstanding prompt medical intervention, it is a disease with a poor prognosis. The pathology is characterized by early metastases and extensive local invasion. Herein, we report two cases of small cell carcinoma addressed at our institution. In both cases, a radical resection was performed with subsequent referral to oncology for additional therapy.
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Oshiro H, Matsuo K, Mawatari H, Inayama Y, Yamanaka S, Nagahama K, Endo I, Shimada H, Nakajima A, Kubota K. Mucin-producing gallbladder adenocarcinoma with focal small cell and large cell neuroendocrine differentiation associated with pancreaticobiliary maljunction. Pathol Int 2009; 58:780-6. [PMID: 19067853 DOI: 10.1111/j.1440-1827.2008.02311.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Herein is reported a case of mucin-producing carcinoma of the gallbladder in a 55-year-old Japanese woman. Although the patient's status and laboratory data initially suggested biliary pancreatitis due to gallstone, radiography and endoscopy confirmed the presence of pancreaticobiliary maljunction and a gallbladder tumor with excessive mucin, in which the duodenal papilla and the common bile duct were impacted. Following surgery, the gallbladder tumor was histopathologically diagnosed as a mixed endocrine-exocrine carcinoma. The carcinoma predominantly consisted of papillary, but also contained some tubular adenocarcinomatous components. Additionally, small foci of small cell and large cell neuroendocrine carcinomatous components were observed. There was no evidence of lymph node metastasis, distant metastasis, or direct invasion outside the gallbladder. Thus, the final classification of pT2N0M0 stage II was given to this lesion, according to the Union Internationale Contre le Cancer guidelines. The postoperative course was uneventful, and the carcinoma had not recurred in the absence of chemoradiotherapy for a period of 20 months. Mucin-producing gallbladder carcinoma is a rare clinical condition that can occur in patients with pancreaticobiliary maljunction. Detailed investigation of this condition is important to develop and refine effective therapeutic strategies.
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Affiliation(s)
- Hisashi Oshiro
- Department of Pathology, Yokohama City University Hospital, Yokohama, Japan.
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Ahn JE, Byun JH, Ko MS, Park SH, Lee MG. Case report: neuroendocrine carcinoma of the gallbladder causing hyperinsulinaemic hypoglycaemia. Clin Radiol 2007; 62:391-4. [PMID: 17331836 DOI: 10.1016/j.crad.2006.11.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2006] [Revised: 11/18/2006] [Accepted: 11/24/2006] [Indexed: 01/12/2023]
Affiliation(s)
- J E Ahn
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Songpa-Gu, Seoul, Republic of Korea
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