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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.

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Related in: MedlinePlus

Radiological and pathological data of the case after chemotherapy. A. The mass decreased and was limited to the gallbladder fossa with clear margin. B. Small round-shaped tumor cells in gallbladder wall with marked interstitial fibrosis (HE×200). C. Positive expression of CgA in the cytoplasma of the tumor cells (IHC×200). D. Scattered large and cribriform glands infiltrate the mucous and muscularis layers (HE×200).
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Figure 2: Radiological and pathological data of the case after chemotherapy. A. The mass decreased and was limited to the gallbladder fossa with clear margin. B. Small round-shaped tumor cells in gallbladder wall with marked interstitial fibrosis (HE×200). C. Positive expression of CgA in the cytoplasma of the tumor cells (IHC×200). D. Scattered large and cribriform glands infiltrate the mucous and muscularis layers (HE×200).

Mentions: Considering the tumor is unresectable at this stage, neo-adjuvant chemotherapy and somatostatin treatments were adopted based on multi-disciplinary team (MDT) based discussion. The chemotherapy regiment is combination of Carboplatin 300 mg/m2, VP16 100 mg/m2, Paclitaxel 180 mg/m2 combined with Octreotide 30 mg/month. The patient showed good response to the chemotherapy and the abdominal ascites was relieved after two courses of treatment. She presented mild anorexia and hair loss as the side effects of chemotherapy, which was alleviated after the supportive and nutritional therapy. After 4 courses of treatment, her serum tumor markers including CEA, CA125 and CA19-9 decreased to normal range. CT scan suggested the size of the mass reduced dramatically and the enlarged lymph node in hepatic hilar region can not be detected any more. Liver lesion in the fifth segment was found to be not metastasis but a hepatic cyst. PET/CT scan indicated a hyper-metabolic nodule in the gallbladder area, with no other lesion all around the body. 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). Two enlarged lymph nodes were found in the hepatodudenal ligament. Considering the satisfying effect of the neo-adjuvant chemotherapy, we decided to perform radical operation on this patient based on MDT discussion.


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 after chemotherapy. A. The mass decreased and was limited to the gallbladder fossa with clear margin. B. Small round-shaped tumor cells in gallbladder wall with marked interstitial fibrosis (HE×200). C. Positive expression of CgA in the cytoplasma of the tumor cells (IHC×200). D. Scattered large and cribriform glands infiltrate the mucous and muscularis layers (HE×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 2: Radiological and pathological data of the case after chemotherapy. A. The mass decreased and was limited to the gallbladder fossa with clear margin. B. Small round-shaped tumor cells in gallbladder wall with marked interstitial fibrosis (HE×200). C. Positive expression of CgA in the cytoplasma of the tumor cells (IHC×200). D. Scattered large and cribriform glands infiltrate the mucous and muscularis layers (HE×200).
Mentions: Considering the tumor is unresectable at this stage, neo-adjuvant chemotherapy and somatostatin treatments were adopted based on multi-disciplinary team (MDT) based discussion. The chemotherapy regiment is combination of Carboplatin 300 mg/m2, VP16 100 mg/m2, Paclitaxel 180 mg/m2 combined with Octreotide 30 mg/month. The patient showed good response to the chemotherapy and the abdominal ascites was relieved after two courses of treatment. She presented mild anorexia and hair loss as the side effects of chemotherapy, which was alleviated after the supportive and nutritional therapy. After 4 courses of treatment, her serum tumor markers including CEA, CA125 and CA19-9 decreased to normal range. CT scan suggested the size of the mass reduced dramatically and the enlarged lymph node in hepatic hilar region can not be detected any more. Liver lesion in the fifth segment was found to be not metastasis but a hepatic cyst. PET/CT scan indicated a hyper-metabolic nodule in the gallbladder area, with no other lesion all around the body. 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). Two enlarged lymph nodes were found in the hepatodudenal ligament. Considering the satisfying effect of the neo-adjuvant chemotherapy, we decided to perform radical operation on this patient based on MDT discussion.

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