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. 2021 Mar 17;7(1):70.
doi: 10.1186/s40792-021-01152-4.

Mixed neuroendocrine-non-neuroendocrine neoplasms of the gallbladder: a case report

Tatsuki Ishikawa  1 , Katsunori Nakano  2 , Masafumi Osaka  2 , Kenichi Aratani  2 , Kadotani Yayoi  2 , Kiyokazu Akioka  2 , Kuniyuki Tsuchiya  2 , Yohei Hosokawa  3
Affiliations

Mixed neuroendocrine-non-neuroendocrine neoplasms of the gallbladder: a case report

Tatsuki Ishikawa et al. Surg Case Rep. .

Abstract

Background: Primary neuroendocrine tumors of the gallbladder (GB-NETs) are rare, accounting for 0.5% of all NETs and 2.1% of all gallbladder cancers. Among GB-NETs, mixed neuroendocrine-non-neuroendocrine neoplasms of the gallbladder (GB-MiNENs) are extremely rare.

Case presentation: We present the case of a 66-year-old woman who was referred to us for the management of a gallbladder tumor (incidentally found during abdominal ultrasonography indicated for gallbladder stones). The patient had no history of abdominal pain or fever, and the findings on a physical examination were unremarkable. Blood tests showed normal levels of tumor markers. Imaging studies revealed a mass of approximately 10 mm in diameter (with no invasion of the gallbladder bed) located at the fundus of the gallbladder. A gallbladder cancer was suspected. Therefore, an open whole-layer cholecystectomy with regional lymph nodes dissection was performed. The postoperative course was uneventful, and she was discharged on postoperative day 6. Pathological findings showed GB-MiNENs with invasion of the subserosal layer and no lymph node invasion (classified T2aN0M0 pStage IIA according to the Union for International Cancer Control, 8th edition staging system). Analysis of the neuroendocrine markers revealed positive chromogranin A and synaptophysin, and a Ki-67 index above 95%. Fourteen months after the operation, a local recurrence was detected, and she was referred to another hospital for chemotherapy.

Conclusions: GB-MiNENs are extremely aggressive tumors despite their tumor size. Optimal therapy should be chosen for each patient.

Keywords: Gallbladder cancer; Mixed adenoneuroendocrine carcinoma; Mixed neuroendocrine–non-neuroendocrine neoplasms.

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Conflict of interest statement

The authors declare no competing interest.

Figures

Fig.1
Fig.1
Abdominal computed tomography showed slightly enhanced tumor in the fundus of gallbladder (arrow)
Fig.2
Fig.2
Macroscopic findings showed papillary tumor in the fundus of gallbladder (arrow). Some gallstones existed within the gallbladder (arrowhead)
Fig.3
Fig.3
Histological findings of gallbladder tumor. a Hematoxylin–eosin staining (× 4). Adenocarcinoma component was located on the surface of tumor (red area), whereas neuroendocrine component in the deeper subserosal layer (blue area). b Hematoxylin–eosin staining (× 40). Papillary and tubular adenocarcinoma. c Hematoxylin–eosin staining (× 20). Neuroendocrine tumor cells arranged in nests. d Immunohistochemical staining for chromogranin A (× 20). Immunohistochemical staining revealed positive expression of synaptophysin
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