Limits...
Successful treatment of gallbladder mixed adenoneuroendocrine carcinoma with neo-adjuvant chemotherapy.

Song W, Chen W, Zhang S, Peng J, He Y - Diagn Pathol (2012)

Bottom Line: 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, First Affiliated Hospital, Sun Yat-sen University, 58# Zhongshan Road 2, Guangzhou 510080, China.

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.

Show MeSH

Related in: MedlinePlus

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. B. Diffuse small round cells with scanty cytoplasm and round nucleus (HE×200). C. Strong positive cytoplasmic expression of Syn (IHC×400). D. Over 80 % tumor cells show positive expression of Ki-67 (IHC×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC3584922&req=5

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. B. Diffuse small round cells with scanty cytoplasm and round nucleus (HE×200). C. Strong positive cytoplasmic expression of Syn (IHC×400). D. Over 80 % tumor cells show positive expression of Ki-67 (IHC×200).

Mentions: A 55-year-old woman complained of mild epigastric discomfort was found to have a large impalpable mass in the gallbladder area with ultrasound examination. She was then admitted to the first affiliated hospital of Sun Yat-sen University. She had history of chronic cholecystitis for five years and no operation or other chronic diseases were found. Physical examination was negative. A slight impairment of liver function was found with AST 57 unit/L and ALT 68 unit/L (normal range<40) while albumin and bilirubin were within the normal range. Blood and urine analysis were normal. Her serum tumor markers CEA was 43 ug/L (normal range 0~5 ug/L), CA 125 465 U/ml (normal range 0~35 U/ml) and CA 19–9 100 U/ml (normal range 0~35 U/ml), all of which showed a significant elevation. Blood hormone test showed her serum CgA increased to 220 ng/ml (normal range17~34 U/L), while 5-HIAA, 5-HT and cortisol level were normal. Abdominal ultrasound examination revealed massive ascites together with a mass measuring 14 cm×8.4 cm in the gallbladder bed area closely adhering to the pancreatic head and liver. CT scan suggested that the gallbladder neoplasm invaded the neighboring liver, pancreatic head, peritoneum and omentum (Figure 1A). Lymph nodes enlargements were found in hepatic hilar region and liver segment 5 metastasis was suspected. PET/CT scan also demonstrated the results, without any other distant hyper-metabolic foci.


Successful treatment of gallbladder mixed adenoneuroendocrine carcinoma with neo-adjuvant chemotherapy.

Song W, Chen W, Zhang S, Peng J, He Y - Diagn Pathol (2012)

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. B. Diffuse small round cells with scanty cytoplasm and round nucleus (HE×200). C. Strong positive cytoplasmic expression of Syn (IHC×400). D. Over 80 % tumor cells show positive expression of Ki-67 (IHC×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3584922&req=5

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. B. Diffuse small round cells with scanty cytoplasm and round nucleus (HE×200). C. Strong positive cytoplasmic expression of Syn (IHC×400). D. Over 80 % tumor cells show positive expression of Ki-67 (IHC×200).
Mentions: A 55-year-old woman complained of mild epigastric discomfort was found to have a large impalpable mass in the gallbladder area with ultrasound examination. She was then admitted to the first affiliated hospital of Sun Yat-sen University. She had history of chronic cholecystitis for five years and no operation or other chronic diseases were found. Physical examination was negative. A slight impairment of liver function was found with AST 57 unit/L and ALT 68 unit/L (normal range<40) while albumin and bilirubin were within the normal range. Blood and urine analysis were normal. Her serum tumor markers CEA was 43 ug/L (normal range 0~5 ug/L), CA 125 465 U/ml (normal range 0~35 U/ml) and CA 19–9 100 U/ml (normal range 0~35 U/ml), all of which showed a significant elevation. Blood hormone test showed her serum CgA increased to 220 ng/ml (normal range17~34 U/L), while 5-HIAA, 5-HT and cortisol level were normal. Abdominal ultrasound examination revealed massive ascites together with a mass measuring 14 cm×8.4 cm in the gallbladder bed area closely adhering to the pancreatic head and liver. CT scan suggested that the gallbladder neoplasm invaded the neighboring liver, pancreatic head, peritoneum and omentum (Figure 1A). Lymph nodes enlargements were found in hepatic hilar region and liver segment 5 metastasis was suspected. PET/CT scan also demonstrated the results, without any other distant hyper-metabolic foci.

Bottom Line: 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.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, First Affiliated Hospital, Sun Yat-sen University, 58# Zhongshan Road 2, Guangzhou 510080, China.

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.

Show MeSH
Related in: MedlinePlus