Abstract
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 slideshttp://www.diagnosticpathology.diagnomx.eu/vs/2731892837743787
Highlights
Neuroendocrine tumors are uncommon diseases which mostly occur in the gastrointestinal tract, pancreas and lung
There are considerable discrepancies about the predilection sites of the neuroendocrine tumors (NET) according to the database of various countries which may due to the different race [1,5]
The average onset age of Gallbladder neuroendocrine tumors (GB-NETs) is 64 years old with a female preponderance [7], which is very similar with primary colorectal neuroendocrine carcinoma (NEC) that is reported to have a median age of 60 years and a female to male ratio of 2:1 [8]
Summary
Neuroendocrine tumors are uncommon diseases which mostly occur in the gastrointestinal tract, pancreas and lung. CT scan suggested the size of the mass reduced dramatically and the enlarged lymph node in Figure 1 Radiological and pathological data of the case before chemotherapy. A. CT scan showed a gallbladder mass invading liver, head of pancreas with metastasis of peritoneum and enlarged lymphnodes in hepatic hilar. After 6 courses of treatment, her serum tumor markers remain normal and CT scan found that the tumor was limited to the gallbladder area with clear margin to the pancreatic head (Figure 2A). Postoperative pathological findings showed diffuse small round-shaped tumor cells in the gallbladder wall with marked interstitial fibrosis (Figure 2B). Scattered large, irregular and cribriform glandular composed of columnar neoplastic cells were found in the mucosa and muscularis layers of the gallbladder wall (Figure 2D) This moderately differentiated adenocarcinoma consisted about 40 percents of the whole tumor. A regularly followed up showed tumor biomarkers remain in normal range and CT scan found no evidence of recurrence after 7 months of the operation
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