Repeat liver resection for pure large cell neuroendocrine carcinoma of the gallbladder: a favorable outcome

Ahmad Abutaka,Madiha Soofi,Irfan Helmy,Mohamed Ben Gashir,Ahmed Elaffandi,Walid Elmoghazy,Ibnouf Sulieman,Moamena El-Matbouly,Hatem Khalaf

doi:10.1186/s12957-019-1666-9

Abstract

BackgroundThe pure large cell type is a rare variant of primary neuroendocrine carcinoma of the gallbladder. Few reports have mentioned extended survival. Although a multimodal treatment has been described in the treatment of such rare disease, redo liver resection has not yet been mentioned.Case reportA 67-year-old lady was found to have poorly differentiated, high grade, pure large cell neuroendocrine tumor of the gallbladder after cholecystectomy for gallstones. After the diagnosis, staging workup showed a lesion in segment IVB/V of the liver, and chromogranin was elevated (982 mcg/L). The patient underwent central inferior hepatectomy and wedge excision of a lesion in segment III (discovered intra-operatively), with hilar lymphadenectomy. Three months after the first liver resection, she developed a new liver lesion II/III and underwent left lateral liver resection. The patient remained disease-free for 4 months following the second liver resection but then developed recurrent liver disease and was started on chemotherapy. Further progression led to multi-organ failure and death at 26 months from initial diagnosis.ConclusionThis is the first reported repeat liver resection in such a rare disease that has led to extended overall survival. We suggest that a group of selected patients with this rare malignancy, and liver-limited disease, may benefit from repeated liver resection.

Highlights

ConclusionThis is the first reported repeat liver resection in such a rare disease that has led to extended overall survival
large cell neuroendocrine carcinoma (LCNEC) of the gallbladder (GB) has rarely been reported in the literature [1]
Further imaging included a positron emission tomography scan (PET) that showed a hepatic lesion in segment IVB/V and magnetic resonance imaging (MRI) that confirmed the existence of the same liver lesion in segment IVB/V measuring 28 × 27 × 30 mm (Fig. 2) with no evidence of disease elsewhere

Summary

Conclusion

Redo liver resection has hardly been described in LCNEC of the gallbladder. This is the first reported repeat liver resection in such a rare disease that has led to extended overall survival. We can only speculate that a group of selected patients with such rare disease may benefit from a repeated liver surgery in the absence of extrahepatic disease

Introduction

Discussion