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Yao X, Wu K, Lu B, Lin F. Neuroendocrine carcinoma of the gallbladder: A case report and literature review. Medicine (Baltimore) 2024; 103:e39147. [PMID: 39093760 DOI: 10.1097/md.0000000000039147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
RATIONALE Neuroendocrine neoplasms (NENs) originating from neuroendocrine cells occur in the thyroid, respiratory, and digestive systems, with Gallbladder Neuroendocrine Carcinoma (GB-NEC) accounting for only 0.5% of all NENs and 2.1% of gallbladder cancers. Due to its rarity, little is known about GB-NEC's clinical presentation and treatment. PATIENT CONCERNS We report a case of a 52-year-old male presenting with acute upper right abdominal pain, leading to further investigation. DIAGNOSES Initial diagnostic workup, including abdominal ultrasound and contrast-enhanced CT, suggested gallbladder malignancy. Post-surgical pathology confirmed GB-NEC, with immunohistochemistry supporting the diagnosis. INTERVENTIONS The patient underwent radical cholecystectomy, followed by etoposide plus cisplatin chemotherapy. After disease progression indicated by CT, the patient received additional cycles of chemotherapy with cisplatin and irinotecan, plus targeted therapy with anlotinib and immunotherapy with paimiplimab. OUTCOMES The patient showed a partial response to initial treatment. Subsequent liver biopsy confirmed NEC, consistent with small cell carcinoma. With continued treatment, the patient maintains a good survival status. LESSONS GB-NEC is associated with poor prognosis, emphasizing the importance of early detection and multimodal treatment strategies. Our case underlines the potential benefit of a comprehensive treatment plan, including aggressive surgery and chemotherapy, with further research needed to standardize treatment for this rare condition.
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Affiliation(s)
- Xiaofei Yao
- Pathology Department, Shaoxing People's Hospital, Shaoxing, People's Republic of China
| | - Kangze Wu
- Department of Hepatobiliary Surgery, Shaoxing People's Hospital, Shaoxing, People's Republic of China
| | - Baochun Lu
- Department of Hepatobiliary Surgery, Shaoxing People's Hospital, Shaoxing, People's Republic of China
| | - Feizhuan Lin
- Department of Hepatobiliary Surgery, Shaoxing People's Hospital, Shaoxing, People's Republic of China
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2
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Gulubova M, Tolekova A, Berbatov D, Aydogdu N. Development of pancreatic islet cells in the extrahepatic bile ducts of rats with experimentally-induced metabolic syndrome. Arch Physiol Biochem 2023:1-9. [PMID: 37651586 DOI: 10.1080/13813455.2023.2252205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/27/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
CONTEXT There is data about the existence of some endocrine cells in the epithelial layer of the bile duct in humans and rats. OBJECTIVE We evaluated Ghrelin-, Insulin-, Glucagon- and Somatostatin-positive cells in peribiliary glands, mast cells, and nerve fibres. MATERIALS AND METHODS Wistar rats were used for dietary manipulation with a 15% fructose solution for 12 weeks. Tissue samples were elaborated with immunohistochemistry for Insulin, Glucagon, Ghrelin, and Somatostatin. Glucose and lipid parameters were studied. RESULTS In treated animals, Ghrelin+ and Insulin+ cells in perybiliary glands (PBGs) were significantly increased. In the male fructose group there was a significant increase of the homeostasis model assessment insulin resistance (HOMA-IR). CONCLUSIONS Stem/progenitor cells in extrahepatic bile tree (EHBT) could be a source of Insulin-producing cells in metabolic syndrome. Fructose treatment induces the increase of Ghrelin+ and Insulin+ cells in PBGs and the elevation of Insulin and Ghrelin plasma concentration.
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Affiliation(s)
- Maya Gulubova
- Department of pathology, Trakia University, Stara Zagora, Bulgaria
| | - Anna Tolekova
- Medical College, Trakia University, Stara Zagora, Bulgaria
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3
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Hsiao TH, Wu CC, Tseng HH, Chen JH. Synchronous but separate neuroendocrine tumor and high-grade dysplasia/adenoma of the gall bladder: A case report. World J Clin Cases 2022; 10:2322-2329. [PMID: 35321155 PMCID: PMC8895191 DOI: 10.12998/wjcc.v10.i7.2322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/22/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gall bladder neuroendocrine tumors (GB-NETs) are rare, accounting for less than 0.5% of all NETs. They usually lack specific symptoms and are difficult to diagnose preoperatively. In most cases, GB-NETs are incidentally found after cholecystectomy for large polyps or cholelithiasis, causing acute or chronic cholecystitis. The coexistence of GB-NET and GB adenocarcinoma is very rare.
CASE SUMMARY We report a case of synchronous but separate GB-NET and adenoma with high-grade dysplasia in a patient who had undergone surgery for a progressively growing GB polypoid lesion. To the best of our knowledge, simultaneous separation of NETs and cancer in the GB has not been reported.
CONCLUSION Coexistent GB carcinoid tumor and adenocarcinoma is rare. A surveillance program is needed for these large GB polyps.
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Affiliation(s)
- Tsung-Hsien Hsiao
- Division of Gastroenterology and Hepatology, Taipei Tzu Chi Hospital, New Taipei City 231, Taiwan
| | - Chao-Chuan Wu
- Department of Surgery, Taipei Tzu Chi Hospital, New Taipei City 231, Taiwan
| | - Hui-Hwa Tseng
- Department of Pathology, Taipei Tzu Chi Hospital, New Taipei City 231, Taiwan
| | - Jiann-Hwa Chen
- Division of Gastroenterology and Hepatology; Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
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4
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Luchini C, Pelosi G, Scarpa A, Mattiolo P, Marchiori D, Maragliano R, Sessa F, Uccella S. Neuroendocrine neoplasms of the biliary tree, liver and pancreas: a pathological approach. Pathologica 2021; 113:28-38. [PMID: 33686308 PMCID: PMC8138696 DOI: 10.32074/1591-951x-231] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 11/30/2020] [Indexed: 12/14/2022] Open
Abstract
Neuroendocrine neoplasms of the pancreatobiliary tract and liver are a heterogeneous group that encompass a spectrum of entities with distinct morphological, biological and clinical features. Although in the various anatomical sub-sites of this region they show specific characteristics, these tumors, as a whole, share several etiological and clinical aspects. This review systematically addresses NENs arising in the extrahepatic bile ducts, gallbladder, liver and pancreas, with the principal aim of pinpointing essential diagnostic and classification issues. In addition, the section on hepatic NENs has been expanded to include metastatic disease of unknown primary site.
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Affiliation(s)
- Claudio Luchini
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Italy
| | - Giuseppe Pelosi
- Department of Oncology and Hemato-Oncology, University of Milan, Italy.,Inter-Hospital Pathology Division, IRCCS MultiMedica, Milan, Italy
| | - Aldo Scarpa
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Italy.,ARC-NET Research Centre, University of Verona, Italy
| | - Paola Mattiolo
- Department of Diagnostics and Public Health, Section of Pathology, University and Hospital Trust of Verona, Italy
| | - Deborah Marchiori
- Department of Medicine and Surgery, Unit of Pathology, University of Insubria, Varese, Italy
| | - Roberta Maragliano
- Department of Medicine and Surgery, Unit of Pathology, University of Insubria, Varese, Italy
| | - Fausto Sessa
- Department of Medicine and Surgery, Unit of Pathology, University of Insubria, Varese, Italy
| | - Silvia Uccella
- Department of Medicine and Surgery, Unit of Pathology, University of Insubria, Varese, Italy
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5
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Singh R, Balasubramanian I, Zhang L, Gao N. Metaplastic Paneth Cells in Extra-Intestinal Mucosal Niche Indicate a Link to Microbiome and Inflammation. Front Physiol 2020; 11:280. [PMID: 32296343 PMCID: PMC7138011 DOI: 10.3389/fphys.2020.00280] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/12/2020] [Indexed: 12/12/2022] Open
Abstract
Paneth cells are residents of the intestinal epithelium. Abnormal appearance of Paneth cells has been widely documented in non-intestinal tissues within the digestive tract and even observed in non-gastrointestinal organs. Although metaplastic Paneth cells are part of the overarching pathology of intestinal metaplasia (IM), only a fraction of intestinal metaplastic lesions contain Paneth cells. We survey literature documenting metaplastic Paneth cells to gain insights into mechanism underlying their etiologic development as well as their potential relevance to human health. A synthesized view from this study suggests that the emergence of metaplastic Paneth cells at extra-intestinal mucosal sites likely represents a protective, anti-bacterial, and inflammatory response evoked by an altered microbial activity.
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Affiliation(s)
- Rajbir Singh
- Department of Biological Sciences, Rutgers University, Newark, NJ, United States
| | | | - Lanjing Zhang
- Department of Biological Sciences, Rutgers University, Newark, NJ, United States.,Department of Chemical Biology, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, NJ, United States.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States.,Department of Pathology, Princeton Medical Center, Plainsboro, NJ, United States
| | - Nan Gao
- Department of Biological Sciences, Rutgers University, Newark, NJ, United States.,Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
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6
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Rapidly growing neuroendocrine carcinoma of the gallbladder: A case report. Radiol Case Rep 2020; 15:259-265. [PMID: 31956384 PMCID: PMC6957802 DOI: 10.1016/j.radcr.2019.12.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/08/2019] [Accepted: 12/16/2019] [Indexed: 12/16/2022] Open
Abstract
Gallbladder neuroendocrine carcinomas are rare tumors with a prognosis poorer than that of other gallbladder carcinomas. These tumors are often detected late and are difficult to treat. We present the case of a 68-year-old woman with small-cell gallbladder neuroendocrine carcinoma. Abdominal sonography and dynamic contrast-enhanced MRI performed at different points in time showed rapid growth. Treatment with surgical resection and adjuvant chemotherapy was instituted. In view of the rapid growth of these tumors, suspicious cases should at least be considered for close follow-up with appropriate imaging studies.
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7
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Montalvo-Jave EE, Rahnemai-Azar AA, Papaconstantinou D, Deloiza ME, Tsilimigras DI, Moris D, Mendoza-Barrera GE, Weber SM, Pawlik TM. Molecular pathways and potential biomarkers in gallbladder cancer: A comprehensive review. Surg Oncol 2019; 31:83-89. [PMID: 31541911 DOI: 10.1016/j.suronc.2019.09.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 09/12/2019] [Indexed: 12/13/2022]
Abstract
The most common malignancy of the biliary tract, gallbladder cancer (GBC) often has a dismal prognosis. The aggressive nature of the tumor, delayed diagnosis at advanced stages of the disease, and lack of effective treatment options are some of the factors that contribute to a poor outcome. Early detection and accurate assessment of disease burden is critical to optimize management and improve long-term survival, as well as identify patients for adjuvant therapy and clinical trials. With recent advances in the understanding of the molecular pathogenesis of GBC, several specific diagnostic and biomarkers have been proposed as being of diagnostic and prognostic importance. Indeed, identification of novel diagnostic and prognostic markers has an important role in early diagnosis and development of targeted therapies among patients with GBC. Next-generation sequencing technology and genomewide data analysis have provided novel insight into understanding the molecular pathogenesis of biliary tract cancers, thereby identifying potential biomarkers for clinical use. We herein review available GBC biomarkers and the potential clinical implications in the management of GBC.
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Affiliation(s)
- Eduardo E Montalvo-Jave
- Servicio de Cirugía General, Clínica de Cirugía Hepato-Pancreato-Biliary, Hospital General de México, Mexico; Departamento de Cirugía, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico
| | - Amir A Rahnemai-Azar
- Department of Surgery, Division of Surgical Oncology, Kaiser Permanente School of Medicine, Los Angeles, CA, USA
| | | | - Mariana Espejel Deloiza
- Departamento de Cirugía, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico
| | - Diamantis I Tsilimigras
- Department of Surgery, Division of Surgical Oncology, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Dimitrios Moris
- Department of Surgery, Division of Surgical Oncology, The Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Sharon M Weber
- Department of Surgery, Division of Surgical Oncology, University of Wisconsin Hospital, Madison, WI, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University College of Medicine, Columbus, OH, USA.
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8
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Park JY, Jeon TJ. Large Cell Neuroendocrine Carcinoma of the Extrahepatic Bile Duct. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2019; 72:318-321. [PMID: 30642152 DOI: 10.4166/kjg.2018.72.6.318] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Revised: 05/24/2018] [Accepted: 06/02/2018] [Indexed: 11/03/2022]
Abstract
Primary neuroendocrine tumors originating from the extrahepatic bile duct are rare. Among these tumors, large cell neuroendocrine carcinomas (NECs) are extremely rare. A 59-year-old man was admitted to Sanggye Paik Hospital with jaundice that started 10 days previously. He had a history of laparoscopic cholecystectomy, which he had undergone 12 years previously due to chronic calculous cholecystitis. Laboratory data showed abnormally elevated levels of total bilirubin 15.3 mg/dL (normal 0.2-1.2 mg/dL), AST 200 IU (normal 0-40 IU), ALT 390 IU (normal 0-40 IU), and gamma-glutamyl transferase 1,288 U/L (normal 0-60 U/L). Serum CEA was normal, but CA 19-9 was elevated 5,863 U/mL (normal 0-37 U/mL). Abdominal CT revealed a 4.5 cm sized mass involving the common bile duct and liver hilum and dilatation of both intrahepatic ducts. Percutaneous transhepatic drainage in the left hepatic duct was performed for preoperative biliary drainage. The patient underwent radical common bile duct and Roux-en-Y hepaticojejunostomy for histopathological diagnosis and surgical excision. On histopathological examination, the tumor exhibited large cell NEC (mitotic index >20/10 high-power field, Ki-67 index >20%, CD56 [+], synaptophysin [+], chromogranin [+]). Adjuvant concurrent chemotherapy and radiotherapy were started because the tumor had invaded the proximal resection margin. No recurrence was detected at 10 months by follow-up CT.
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Affiliation(s)
- Ji Young Park
- Division of Gastroenterology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
| | - Tae Joo Jeon
- Division of Gastroenterology, Department of Internal Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea
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9
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Murakami M, Katayama K, Kato S, Fujimoto D, Morikawa M, Koneri K, Hirono Y, Goi T. Large-cell neuroendocrine carcinoma of the common bile duct: a case report and a review of literature. Surg Case Rep 2016; 2:141. [PMID: 27888490 PMCID: PMC5124016 DOI: 10.1186/s40792-016-0269-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 11/22/2016] [Indexed: 02/08/2023] Open
Abstract
Background Large-cell neuroendocrine carcinoma (LCNEC) of the bile duct is extremely rare and is a high-grade type of neuroendocrine tumor with an aggressive clinical course. Here, we report a case of LCNEC of the extrahepatic bile duct. Case presentation An 80-year-old man presented with severe jaundice. Endoscopic retrograde cholangiography and enhanced computed tomography revealed complete obstruction of the common bile duct (CBD) by a dense tumor measuring 1.5 cm in diameter. Although there were no malignant cells in the biliary brush cytology, we suspected a cholangiocarcinoma and performed extrahepatic bile duct resection. Histologically, the LCNEC occupied most of the places deeper than the stratum submucosum and an adenocarcinoma component, approximately 15%, was present in the mucosa. There were no transitional areas between the two components. Immunohistochemically, the LCNEC cells were reactive for CD56 and synaptophysin and had a high MIB-1 index (72%). The patient died of multiple liver, lung, and peritoneal metastases 3 months after surgery. Conclusions LCNEC of the CBD is particularly rare and has a very poor prognosis. Only five cases have been reported in the literature; therefore, there is no established effective therapy, including surgery, for LCNEC of the CBD at present. An accumulation of additional cases and further studies of multimodal treatment are required in the future to improve the prognosis.
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Affiliation(s)
- Makoto Murakami
- First Department of Surgery, School of Medicine, University of Fukui, 23 Shimoaiduki, Matsuoka, Eiheiji-cho, Fukui, 910-1193, Japan.
| | - Kanji Katayama
- First Department of Surgery, School of Medicine, University of Fukui, 23 Shimoaiduki, Matsuoka, Eiheiji-cho, Fukui, 910-1193, Japan
| | - Shigeru Kato
- First Department of Surgery, School of Medicine, University of Fukui, 23 Shimoaiduki, Matsuoka, Eiheiji-cho, Fukui, 910-1193, Japan
| | - Daisuke Fujimoto
- First Department of Surgery, School of Medicine, University of Fukui, 23 Shimoaiduki, Matsuoka, Eiheiji-cho, Fukui, 910-1193, Japan
| | - Mitsuhiro Morikawa
- First Department of Surgery, School of Medicine, University of Fukui, 23 Shimoaiduki, Matsuoka, Eiheiji-cho, Fukui, 910-1193, Japan
| | - Kenji Koneri
- First Department of Surgery, School of Medicine, University of Fukui, 23 Shimoaiduki, Matsuoka, Eiheiji-cho, Fukui, 910-1193, Japan
| | - Yasuo Hirono
- First Department of Surgery, School of Medicine, University of Fukui, 23 Shimoaiduki, Matsuoka, Eiheiji-cho, Fukui, 910-1193, Japan
| | - Takanori Goi
- First Department of Surgery, School of Medicine, University of Fukui, 23 Shimoaiduki, Matsuoka, Eiheiji-cho, Fukui, 910-1193, Japan
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10
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Okada H, Uchida Y, Matsuzaki N, Goto T, Nishimura S, Kurita A, Nishimura T, Yazumi S, Terajima H. A case of neuroendocrine carcinoma in the hepatic hilar lymph nodes concomitant with an adenocarcinoma of the gallbladder. World J Surg Oncol 2016; 14:284. [PMID: 27842605 PMCID: PMC5109806 DOI: 10.1186/s12957-016-1039-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 11/04/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Neuroendocrine tumors (NETs) are rare especially in the gallbladder. They have not been elucidated in the pathogenesis, clinicopathological characteristics, and treatment options. CASE PRESENTATION We present a 76-year-old woman with a gallbladder tumor and hepatic hilar lymph node swelling. The lymph node biopsy demonstrated neuroendocrine carcinoma (NEC). We performed cholecystectomy, hepatic hilar lymphadenectomy, extrahepatic biliary duct resection, and hepaticojejunostomy prior to chemotherapy. Pathological examination revealed the gallbladder mass was an adenocarcinoma invading to the muscular layer without any NEC components, whereas the hepatic hilar lymph nodes were filled with high-grade NEC cells with negligible area of adenocarcinoma. The patient received general chemotherapy consisting of carboplatin and etoposide, but a recurrence in the para-aortic lymph nodes occurred 4 months after surgery. CONCLUSIONS We report a rare case of NEC of the hepatic hilar lymph nodes that were concomitant with an adenocarcinoma of the gallbladder. High-grade NEC generally has an aggressive behavior and an optimal treatment strategy should be chosen for each patient.
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Affiliation(s)
- Haruka Okada
- Department of Gastroenterological Surgery and Oncology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, kita-ku, Osaka City, Osaka, 530-8480, Japan.,Present Address: Department of Surgery, National Hospital Organization Kyoto Medical Center, 1-1, Fukakusamukaihatacho, Fushimi-ku, Kyoto City, Kyoto, 612-8555, Japan
| | - Yoichiro Uchida
- Department of Gastroenterological Surgery and Oncology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, kita-ku, Osaka City, Osaka, 530-8480, Japan.
| | - Naomi Matsuzaki
- Department of Pathology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Toru Goto
- Department of Gastroenterological Surgery and Oncology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, kita-ku, Osaka City, Osaka, 530-8480, Japan
| | - Satoshi Nishimura
- Department of Gastroenterology and Hepatology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Akira Kurita
- Department of Gastroenterology and Hepatology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Takafumi Nishimura
- Department of Medical Oncology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Shujiro Yazumi
- Department of Gastroenterology and Hepatology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Hiroaki Terajima
- Department of Gastroenterological Surgery and Oncology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, kita-ku, Osaka City, Osaka, 530-8480, Japan
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11
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Buscemi S, Orlando E, Damiano G, Portelli F, Palumbo VD, Valentino A, Marrazzo A, Buscemi G, Lo Monte AI. "Pure" large cell neuroendocrine carcinoma of the gallbladder. Report of a case and review of the literature. Int J Surg 2015; 28 Suppl 1:S128-32. [PMID: 26708705 DOI: 10.1016/j.ijsu.2015.12.045] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 04/30/2015] [Accepted: 05/15/2015] [Indexed: 01/07/2023]
Abstract
Primary Neuroendocrine Tumours (NETs) of the gallbladder are rare. Among all NETs of the gallbladder, large cell neuroendocrine carcinoma (LCNEC) is exceedingly rare. In most of the cases LCNECs are combined with other histological components. We reviewed clinical presentation and management of all patients with "pure" LCNEC from published literature since the first case was published in 2000, as well as one patient from our experience. Only 7 cases of "pure" LCNEC has been described in the last 15 years, our case is the eighth. The diagnosis of gallbladder NETs is rarely made preoperatively since the presentation generally consists of non-specific symptoms including upper abdominal pain, discomfort, jaundice, weight loss. The majority of patients are identified incidentally at the time of cholecystectomy for cholelithiasis. It is not possible to differentiate preoperatively between gallbladder adenocarcinoma and gallbladder neuroendocrine carcinoma (NEC) with imaging techniques. The only curative therapeutic modality for LCNECs is a complete en bloc surgical resection, including regional lymph node clearances and hepatic lobectomy, but only in patients without multiple metastasis. LCNECs benefit from an aggressive surgical resection in combination with chemotherapy, if resectability is possible. If the tumour is non-resectable, the primary management is therefore medical and not surgical. All patients with LCNEC presented a poor prognosis with a median survival of 10 months after the initial diagnosis. Only in five patients (62.5%) a wide surgical excision was performed, while in the other cases the tumour was non-resectable or multiple liver metastases were present at diagnosis.
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Affiliation(s)
- Salvatore Buscemi
- PhD Course on Oncology and Experimental Surgery, University of Palermo, Via Liborio Giuffrè 5, 90127, Palermo, Italy; Department of Surgical, Oncological and Dentistry Science, University of Palermo, Via Liborio Giuffrè 5, 90127, Palermo, Italy.
| | - Elisabetta Orlando
- AUOP "P.Giaccone" Universitary Hospital, Histopatology Unit, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Giuseppe Damiano
- AUOP "P.Giaccone" Universitary Hospital, School of Medicine, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Francesca Portelli
- AUOP "P.Giaccone" Universitary Hospital, Histopatology Unit, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Vincenzo Davide Palumbo
- AUOP "P.Giaccone" Universitary Hospital, School of Medicine, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Alessandro Valentino
- AUOP "P.Giaccone" Universitary Hospital, Histopatology Unit, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Antonio Marrazzo
- Department of Surgical, Oncological and Dentistry Science, University of Palermo, Via Liborio Giuffrè 5, 90127, Palermo, Italy
| | - Giuseppe Buscemi
- Department of Surgical, Oncological and Dentistry Science, University of Palermo, Via Liborio Giuffrè 5, 90127, Palermo, Italy; AUOP "P.Giaccone" Universitary Hospital, School of Medicine, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
| | - Attilio Ignazio Lo Monte
- Department of Surgical, Oncological and Dentistry Science, University of Palermo, Via Liborio Giuffrè 5, 90127, Palermo, Italy; AUOP "P.Giaccone" Universitary Hospital, School of Medicine, University of Palermo, Via del Vespro 129, 90127, Palermo, Italy
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12
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Park SB, Moon SB, Ryu YJ, Hong J, Kim YH, Chae GB, Hong SK. Primary large cell neuroendocrine carcinoma in the common bile duct: First Asian case report. World J Gastroenterol 2014; 20:18048-18052. [PMID: 25548506 PMCID: PMC4273158 DOI: 10.3748/wjg.v20.i47.18048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 10/07/2014] [Accepted: 11/19/2014] [Indexed: 02/06/2023] Open
Abstract
Large cell neuroendocrine carcinoma (LCNEC) in the biliary system is a poorly differentiated, high-grade neuroendocrine tumor. These tumors exhibit aggressive behavior and an increased tendency for early nodal and distant metastases. Herein, we report an unusual case of a pure primary LCNEC of the common bile duct (CBD). A 75-year-old female presented with nausea and jaundice. The patient underwent a CBD excision with lymph node dissection. Upon histological and immunohistochemical examination, the tumor exhibited pure large cell-type neuroendocrine features. Metastases were noted in two of the eight lymph nodes. The patient was administered adjuvant chemotherapy. The patient’s cancer recurred 7 mo after surgery, and the patient died from liver failure 5 mo after recurrence. The prognosis of LCNEC of CBD remains poor despite curative resection and adjuvant chemotherapy. The role of additional therapies, such as multimodal treatment including radiation therapy, must be further studied to improve the prognoses of patients.
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Chiorean L, Bartos A, Pelau D, Iancu D, Ciuleanu T, Buiga R, Oancea I, Mangrau A, Iancu C, Badea R. Neuroendocrine tumor of gallbladder with liver and retroperitoneal metastases and a good response to the chemotherapeutical treatment. J Med Ultrason (2001) 2014; 42:271-6. [PMID: 26576584 DOI: 10.1007/s10396-014-0585-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 10/06/2014] [Indexed: 12/25/2022]
Abstract
Neuroendocrine carcinoma of the gallbladder is an uncommon disease. We present the case of a 45-year-old woman with a mass located in the gallbladder, whose diagnosis was based on contrast-enhanced ultrasound and magnetic resonance imaging. The tumor involved the liver and retroperitoneum, and was histopathologically confirmed by liver biopsy as a neuroendocrine tumor grade 3. The patient received chemotherapy with good response, followed by surgery with cholecystectomy and partial hepatectomy.
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Affiliation(s)
- Liliana Chiorean
- Department of Ultrasonography, "Octavian Fodor" Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Adrian Bartos
- Department of Surgery, "Octavian Fodor" Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| | - Doris Pelau
- Department of Oncology, "Prof. Dr. Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania
| | - Dana Iancu
- Department of Oncology, "Prof. Dr. Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania
| | - Tudor Ciuleanu
- Department of Oncology, "Prof. Dr. Ion Chiricuta" Institute of Oncology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Rares Buiga
- Department of Pathology, "Prof. Dr. Ion Chiricuta" Institute of Oncology, Cluj-Napoca, Romania
| | | | | | - Cornel Iancu
- Department of Surgery, "Octavian Fodor" Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Radu Badea
- Department of Ultrasonography, "Octavian Fodor" Institute of Gastroenterology and Hepatology, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Abstract
Gallstone disease (GSD) is one of the most common biliary tract disorders worldwide. The prevalence, however, varies from 5.9-21.9% in Western society to 3.1-10.7% in Asia. Most gallstones (75%) are silent. Approximately half of symptomatic gallstone carriers experience a second episode of biliary pain within 1 year. These individuals are at increased risk of developing acute cholecystitis, acute cholangitis, and biliary pancreatitis. As can be expected, these complications burden health care systems because of their invasive nature and surgical cost. Factors that contribute to gallstone formation include supersaturation of cholesterol in bile, gallbladder hypomotility, destabilization of bile by kinetic protein factors, and abnormal mucins. Epidemiologic studies have implicated multiple environmental factors and some common genetic elements in gallstone formation. Genetic factors that influence gallstone formation have been elaborated from linkage studies of twins, families, and ethnicities. Accumulating evidence suggests that genetic factors play a role in GSD.
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Affiliation(s)
- Shih-Chang Chuang
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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15
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Furrukh M, Qureshi A, Saparamadu A, Kumar S. Malignant neuroendocrine tumour of the gallbladder with elevated carcinoembryonic antigen: case report and literature review. BMJ Case Rep 2013; 2013:bcr-2013-008778. [PMID: 23661652 DOI: 10.1136/bcr-2013-008778] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
A 58-year-old woman presented to a tertiary care centre with signs and symptoms of acute cholecystitis, cholelithiasis and diagnoses of a high-grade neuroendocrine tumour of the gallbladder primarily with peritoneal and liver metastases. She had a liver abscess secondary to Salmonella and Enterococcus fecalis that was drained and treated with appropriate antibiotics. Interestingly, the serum chromogranin A levels were within normal limits, but carcinoembryonic antigen was elevated, which helped evaluate responses and pick progression. She was treated with 10 cycles of palliative chemotherapy when malignancy associated complications started to recur, that is, cholangitis, worsening pain, cachexia, intestinal obstruction, etc leading to chemotherapy delays. Her disease progressed during these times with rapid deterioration of performance status. She died of septic complications postlaparotomy for intestinal obstruction. Her progression-free survival remained for 8 months with subjective and objective improvements, and her overall survival remained at 13 months. We describe the course of her illness and give a brief review of the literature.
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Affiliation(s)
- Muhammad Furrukh
- Department of Oncology, Sultan Qaboos University Hospital, Muscat, Oman
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16
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Shintaku M, Kataoka K, Kawabata K. Mixed adenoneuroendocrine carcinoma of the gallbladder with squamous cell carcinomatous and osteosarcomatous differentiation: report of a case. Pathol Int 2013; 63:113-9. [PMID: 23464969 DOI: 10.1111/pin.12029] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 12/21/2012] [Indexed: 01/13/2023]
Abstract
An extremely rare case of mixed adenoneuroendocrine carcinoma (MANEC) of the gallbladder is reported, in which the tumor showed diverse differentiation toward neuroendocrine tumor (grade 2), tubular adenocarcinoma, squamous cell carcinoma, and, in addition, osteosarcoma. The patient was an 80-year-old man, who underwent cholecystectomy because of a large polypoid tumor filling the gallbladder lumen. The tumor consisted of an intimate admixture of neuroendocrine tumor (grade 2) and tubular adenocarcinoma, and, in many areas, cell nests of neuroendocrine tumor appeared to bud off from tubular structures of the adenocarcinoma, in a manner resembling the 'ductulo-insular complex' seen in nesidioblastosis of the pancreas. Small areas of squamous cell carcinoma were also found. The stroma consisted of a dense proliferation of atypical spindle cells showing focal osteosarcomatous differentiation, and an apparent transition from an epithelial tissue component to atypical spindle cells was observed. Immunohistochemically, neuroendocrine cells were positive for synaptophysin, chromogranin A, and serotonin, and the sarcomatoid stroma was partly immunoreactive for cytokeratin. The present case is the first example of MANEC of the gallbladder with simultaneous squamous cell carcinomatous and osteosarcomatous differentiation. 'Neometaplasia' of carcinoma cells in diverse directions was considered the most plausible explanation for the formation of this multifaceted neoplasm.
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17
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Ishida M, Shiomi H, Naka S, Tani T, Okabe H. Clear cell neuroendocrine tumor G1 of the gallbladder without von Hippel-Lindau disease. Oncol Lett 2012. [PMID: 23205114 DOI: 10.3892/ol.2012.899] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Clear cell neuroendocrine tumor (NET) is a rare but distinct histopathological variant of NET most often observed in patients with von Hippel-Lindau disease (VHL). Clear cell NET in non-VHL patients is extremely rare and this report is only the second to describe a case of clear cell NET G1 (carcinoid tumor) of the gallbladder without VHL. A 71-year-old male without past or family history of VHL presented with a polypoid lesion in the fundus of the gallbladder and laparoscopic cholecystectomy was performed. Histopathological study revealed that the polypoid lesion was comprised of nests or trabecular growths of clear cells without atypia. Immunohistochemically, the neoplastic cells were diffusely positive for endocrine markers, but negative for α-inhibin. Clinicopathological review of cases with clear cell NET G1 of the gallbladder revealed that this disease occurs in patients with or without VHL, but that gallbladder stones and cholecystitis were present in non-VHL cases. We hypothesized that the occurrence of clear cell NET of the gallbladder (particularly non-VHL cases) may be associated with chronic cholecystitis induced by gallbladder stones. Moreover, α-inhibin was detected in clear cell NET tumor cells in one VHL case, but not in two non-VHL cases. These findings suggest that α-inhibin expression is a useful determinant of an association between clear cell NET and VHL.
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Affiliation(s)
- Mitsuaki Ishida
- Department of Clinical Laboratory Medicine and Division of Diagnostic Pathology
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18
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Chuang SC, Hsi E, Lee KT. Mucin genes in gallstone disease. Clin Chim Acta 2012; 413:1466-71. [PMID: 22705400 DOI: 10.1016/j.cca.2012.06.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 06/04/2012] [Accepted: 06/07/2012] [Indexed: 01/27/2023]
Abstract
Gallstone disease is a complex disorder that can be caused by environmental influences, common genetic factors and their interactions. Three major pathogenic abnormalities are considered to involve in gallstone formation: cholesterol supersaturation in bile, precipitation and nucleation of excess cholesterol, and gallbladder hypomotility, while, mucin takes part in the cholesterol nucleation process. Up to date, more than 20 mucin genes have been reported, 9 of them are identified at the mRNA and/or protein level in native gallbladder and its associated diseases. In the gallbladder, mucin is essential for best protection against detergent effect of high concentration of bile acids. Over the past decade, the properties, expressions and functions of the gallbladder mucins are delineated in animal and human studies. Alteration expressions of mucins are thought to response during the pathogenesis of gallstone formation. Moreover, recent genetic association study demonstrated mucin gene polymorphisms may also influence susceptibility to gallstone disease. This review is not to provide a complete coverage of all the aspects of mucin glycoproteins, but focus on the role and expression of mucins involve in the regulation of cholelithogenesis.
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Affiliation(s)
- Shih-Chang Chuang
- Department of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Abstract
BACKGROUND Gallbladder neuroendocrine tumors (GB-NETs) represent only 0.5% of all NETs, and little is known about their biological behavior. We sought to provide an overview of the current state of knowledge about GB-NETs and provide a recommendation for management. STUDY A PubMed search was undertaken using the following criteria: primary gallbladder and carcinoid or NET. We also interrogated the SEER 9, 13 and 17 registries (1973 to 2005) and the Niigata registry (2003) to assess the epidemiology and clinicopathological characteristics. Finally, we compared the clinical presentation, management and prognosis of GB-NETs to that of gallbladder adenocarcinoma. RESULTS GB-NETs probably derive from either a multipotent stem cell or neuroendocrine cells in intestinal or gastric metaplasia of the gallbladder epithelium, which occurs consequent upon cholelithiasis/chronic inflammation. Clinically and at surgery, GB-NETs are indistinguishable from gallbladder cancer (GBC) and "carcinoid syndrome" is evident in only ∼1%.The median survival was only 9.8 months among 278 cases of GB-NETs reported in SEER. The 5 year survival rate for tumors classified as carcinoids/neuroendocrine carcinoma or small cell cancer (SCC) was 36.9 and 0%, respectively. Soga divided GB-NETs into typical and variant carcinoids with 5 year survival rates of 60.4% and 21.3% respectively. CONCLUSIONS GB-NETs have an aggressive behavior, and once diagnosed, extensive surgical management and careful NET follow up with CT scan is mandatory to facilitate early detection of recurrence. Since more aggressive surgical management for GBC has shown increased survival rates for these tumors, a similar strategy seems reasonable for GB-NETs. However, in high grade metastatic tumors, the primary management is mainly medical.
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20
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Yoon KW, Park CH, Lee WS, Joo YE, Kim HS, Choi SK, Rew JS, Lee JH. A case of primary neuroendocrine carcinoma of the gallbladder associated with anomalous union of the pancreaticobiliary duct. Gut Liver 2009; 3:231-4. [PMID: 20431753 PMCID: PMC2852714 DOI: 10.5009/gnl.2009.3.3.231] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2009] [Accepted: 05/30/2009] [Indexed: 12/22/2022] Open
Abstract
Primary neuroendocrine carcinoma of the gallbladder is extremely rare because normal gallbladder mucosa does not contain neuroendocrine cells. Neuroendocrine cells can be detected at sites of intestinal metaplasia induced by chronic inflammation, which may be the initial step in the development of neuroendocrine tumor of the gallbladder. Anomalous union of the pancreaticobiliary duct (AUPBD) is an uncommon congenital anomaly that is frequently associated with choledocholithiasis, cholangitis, pancreatitis, and cancer of the gallbladder or bile duct. In AUPBD, cancers of the gallbladder and bile duct can be induced by chronic inflammation. We report herein a case of large-cell neuroendocrine tumor of the gallbladder associated with AUPBD.
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Affiliation(s)
- Kyoung-Won Yoon
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea
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21
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Large cell neuroendocrine carcinoma of the gallbladder: long survival achieved by multimodal treatment. Int J Clin Oncol 2009; 14:351-5. [PMID: 19705247 DOI: 10.1007/s10147-008-0843-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2008] [Accepted: 10/01/2008] [Indexed: 12/17/2022]
Abstract
Large cell neuroendocrine carcinoma of the gall-bladder is a rare disease in which the prognosis worsens with size. We report a case of large cell neuroendocrine carcinoma of the gallbladder in a 64-year-old woman who presented with a right upper quadrant mass whose longest diameter was 11.5 cm; the mass was initially considered to be unresectable because of probable invasion to the main portal vein and biliary tract. The patient received multi-modal treatment, consisting of intraarterial chemotherapy, three-dimensional radiation therapy, right trisegmentectomy, and gamma-knife irradiation (for brain metastases). She has survived for 69 months since the initial diagnosis and has shown no signs of recurrence at 35 months after the last gamma-knife irradiation for brain metastases. This result suggests that multimodal treatment including surgery, chemotherapy, and radiation therapy achieved a good response and led to long survival.
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Sakamoto H, Mutoh H, Ido K, Satoh K, Hayakawa H, Sugano K. A close relationship between intestinal metaplasia and Cdx2 expression in human gallbladders with cholelithiasis. Hum Pathol 2007; 38:66-71. [PMID: 16996572 DOI: 10.1016/j.humpath.2006.06.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2006] [Revised: 06/04/2006] [Accepted: 06/08/2006] [Indexed: 12/14/2022]
Abstract
We previously reported a case of a human gallbladder with cholelithiasis consisting of intestinal metaplasia with the expression of caudal-related homeobox transcription factor (Cdx2). However, it is unclear how often intestinal metaplasia and Cdx2 expression occur in human, nontumorous gallbladders with cholelithiasis. We studied the incidence of intestinal metaplasia and Cdx2 expression in human gallbladders with cholelithiasis. Gallbladders were resected under laparoscopy from 103 patients with cholelithiasis between September 2003 and March 2005. The mean age of the patients was 59.6 +/- 15.0 years (range, 22-92 years). We retrospectively reviewed these cases to look for the presence of intestinal metaplasia and the expression of Cdx2. In addition, the characteristics of intestinal metaplasia were examined by immunostaining for Muc2, chromogranin A, and serotonin. Intestinal metaplasia was found in 11.7% (12/103) of the gallbladders with cholelithiasis. The mean ages of patients with and without intestinal metaplasia were 60.8 +/- 15.4 and 59.4 +/- 14.9 years, respectively. Cdx2, Muc2, chromogranin A, and serotonin were expressed in 91.7% (11/12), 91.7% (11/12), 83.3% (10/12), and 50.0% (6/12) in intestinal metaplastic mucosa, respectively. Only one case (1.1%) that expressed Cdx2 without intestinal metaplasia did not express Muc2, chromogranin A, and serotonin. We found that 10.7% (11/103) of nontumorous gallbladders resected because of cholelithiasis under laparoscopy revealed intestinal metaplasia with Cdx2 expression.
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Affiliation(s)
- Hirotsugu Sakamoto
- Department of Medicine, Division of Gastroenterology, Jichi Medical University, Shimotsuke, Tochigi 329-0 431, Japan
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23
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Hashimoto M, Okuda C, Sakurai C, Seki K, Matsuda M, Nagao G, Ueno M, Watanabe G. Adenoendocrine cell carcinoma of the gallbladder: differentiation of the endocrine component. J Gastroenterol Hepatol 2007; 22:141-2. [PMID: 17201900 DOI: 10.1111/j.1440-1746.2006.04288.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Abstract
BACKGROUND Gallbladder cancer is an uncommon disease except in countries like Chile and areas of India and Japan. The knowledge regarding the etiology and mechanisms through which this neoplasia is developed is significantly less compared to other malignant tumors. RESULTS The epithelial lesions involved in gallbladder carcinogenesis are dysplasia and adenomas that represent two biologically distinct carcinogenetic models. Dysplasia progresses to carcinoma in situ (CIS) and subsequently becomes invasive. Over 80% of invasive gallbladder cancers present areas adjacent to the CIS and epithelial dysplasia. Other authors have demonstrated adenomatous areas in carcinomas, or malignant transformation in an adenoma. The low incidence of gallbladder adenomas (0.14% of cholecystectomies) and the presence of adenomatous remnants in the neighboring mucosa to early carcinomas in less than 3% of the cases suggest the limited importance of this carcinogenic pathway. Epithelial dysplasia which is not associated with gallbladder cancer is observed in approximately 1% of cholecystectomies for symptomatic lithiasis. Metaplasia, dysplasia, and CIS are present in the mucosa adjacent to the cancer in 66%, 81.3%, and 69%, respectively. The average ages of patients with dysplasia not associated to cancer (51.9 years), early carcinomas (56.8 years), and advanced carcinomas (62.9 years) demonstrate a gradient which suggests the progression of these lesions. CONCLUSIONS From the morphological point of view, the dysplasia-carcinoma sequence is the most plausible carcinogenic pathway for gallbladder cancer, a process which would require a period of approximately 10 years.
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Affiliation(s)
- Iván Roa
- Department of Pathology, Faculty of Medicine, Universidad de la Frontera, Temuco, Chile
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25
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Mukhopadhyay S, Landas SK. Putative precursors of gallbladder dysplasia: a review of 400 routinely resected specimens. Arch Pathol Lab Med 2005; 129:386-90. [PMID: 15737036 DOI: 10.5858/2005-129-386-ppogda] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Dysplasia is thought to be a precursor of invasive gallbladder carcinoma, but it is unsettled whether dysplasia arises from other precursor lesions. OBJECTIVE To ascertain the presence and nature of precursors of dysplasia in the gallbladder. DESIGN Four hundred consecutive cholecystectomy specimens were processed and stained routinely for diagnosis. We retrospectively reviewed these cases to look for the presence of epithelial changes, including antral-type metaplasia, intestinal metaplasia, and dysplasia. RESULTS Antral-type metaplasia, intestinal metaplasia, and dysplasia were found in 238 (59.5%), 39 (9.8%), and 20 (5.0%) cases, respectively. The mean patient age was 47.7 years (range, 15-93 years). The mean ages for patients with antral-type metaplasia, intestinal metaplasia, and dysplasia were 49.4, 50.9, and 52.6 years, respectively. Statistically significant associations were found between antral-type metaplasia and intestinal metaplasia (P = .007, chi2 test) and between intestinal metaplasia and dysplasia (P < .001, chi2 test). CONCLUSION These associations, along with the age gradient from antral-type metaplasia to dysplasia, suggest a progression from antral-type metaplasia to dysplasia via intestinal metaplasia.
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Affiliation(s)
- Sanjay Mukhopadhyay
- Department of Pathology, State University of New York Upstate Medical University, Syracuse 13210, USA
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26
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Yoon AJ, Cowles RA, Stylianos S, O'Toole KM. Heterotopic gastric mucosa in the gallbladder: a rare cause of massive hemobilia. J Pediatr Gastroenterol Nutr 2005; 40:606-8. [PMID: 15861025 DOI: 10.1097/01.mpg.0000161040.73329.cb] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Affiliation(s)
- Angela J Yoon
- Department of Pathology, Division of Surgical Pathology, College of Physicians and Surgeons, Columbia University Medical Center, New York, New York, USA
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27
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Cabibi D, Licata A, Barresi E, Craxì A, Aragona F. Expression of cytokeratin 7 and 20 in pathological conditions of the bile tract. Pathol Res Pract 2003; 199:65-70. [PMID: 12747467 DOI: 10.1078/0344-0338-00356] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Expression of cytokeratin 7 (CK7) and cytokeratin 20 (CK20) helps to establish the origin of biliary and metastatic carcinomas. We investigated the expression of CK7 and CK20 in inflammatory, metaplastic and neoplastic conditions of the bile ducts, and evaluated possible relationships between the CK expression pattern and extrahepatic bile duct/gallbladder carcinomas (EBDCs) or intrahepatic bile duct carcinomas (IBDCs). We used immunohistochemistry for the investigation of 48 formalin-fixed, paraffin-embedded specimens grouped as: A) lithiasic or inflamed surgically resected extrahepatic bile ducts/gallbladders: all were CK7+/CK20+; B) percutaneous liver biopsies from patients with chronic hepatitis C primary biliary cirrhosis and primary sclerosing cholangitis: all were CK7+/CK20-; C) EBDCs: all were CK7+/CK20+, except for two cases which were CK7-/CK20-; D) IBDCs: all were CK7+/CK20-, except for one case showing CK20 positivity. Metaplastic changes were seen only among specimens in groups A and C: in these cases, CK20 was either focally or diffusely expressed. Our study suggests that the expression of cytokeratins under specific stimuli can be different from normal tissues, and that sometimes CK20 expression can be related to and precede the occurrence of metaplastic alterations.
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28
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Abstract
A 7-year-old girl presented with recurrent acute pancreatitis. Detailed investigations, including endoscopic retrograde cholangiography, suggested a poorly defined biliary tract abnormality. At laparotomy, this was discovered to be a duplicate gallbladder each with a separate cystic duct but contained within a single serosal envelope. Both gallbladders were removed, and histologic examination found the inferior organ to be lined by heterotopic fundic-type gastric mucosa. Despite the absence of any remaining structural biliary abnormality and no evidence of residual ectopic gastric mucosa, the patient experienced a few further episodes of self-limiting mild acute pancreatitis during the following 3 years. The presence of heterotopic gastric mucosa in a duplicate gallbladder has not been described previously.
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Affiliation(s)
- Alan G Bailie
- Children's Liver & GI Unit, Leeds Teaching Hospitals NHS Trust, Leeds England, UK
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29
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Lane JE, Walker AN, Ayers GW, Foster JL, Williams JT. Small-cell undifferentiated carcinoma of neuroendocrine type originating in the gallbladder. ACTA ACUST UNITED AC 2002; 59:495-7. [PMID: 15727797 DOI: 10.1016/s0149-7944(02)00638-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE We report a case of small-cell undifferentiated carcinoma with neuroendocrine (SCUCN) of the gallbladder in a 67-year-old man who presented with suspected cholelithiasis. Treatment included a cholecystectomy and a 4-cycle course of etoposide and carboplatin. CONCLUSIONS Small-cell undifferentiated carcinoma with neuroendocrine features of the gallbladder is a rare disease with approximately 30 cases reported in the literature. Clinical characteristics include an association with cholelithiasis, an elderly age distribution, a female preponderance, and a correlation with cigarette smoking. It is known to behave aggressively and carry a grave prognosis, with extensive local invasion and early metastasis being characteristic. Medical and surgical therapies exist and have demonstrated best results when used in combination.
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Affiliation(s)
- Joshua E Lane
- Department of Surgery, Mercer University School of Medicine, The Medical Center of Central Georgia, Macon, USA.
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30
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Hoang MP, Murakata LA, Padilla-Rodriguez AL, Albores-Saavedra J. Metaplastic lesions of the extrahepatic bile ducts: a morphologic and immunohistochemical study. Mod Pathol 2001; 14:1119-25. [PMID: 11706073 DOI: 10.1038/modpathol.3880446] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Although metaplastic changes can occur in the extrahepatic bile ducts, a detailed morphologic study of these lesions has not been done. We examined the bile duct mucosa in 42 pancreaticoduodenectomy specimens, 32 with neoplastic lesions and ten with inflammatory lesions of the extrahepatic bile ducts, to assess the prevalence and type of metaplastic lesions. For comparison, the common bile ducts from 10 autopsy cases were reviewed. Twenty of the 42 total cases (48%), 13 of the 32 neoplastic cases (40%), and 7 of the 10 inflammatory cases (70%) had metaplastic changes. Pyloric gland metaplasia was the most common type (16/20 cases; 80%), whereas intestinal metaplasia was seen in 1/20 cases (5%). A combination of pyloric gland and intestinal metaplasia occurred in 2/20 cases (10%), and squamous metaplasia plus the above-mentioned two types of metaplasia was seen in 1/20 cases (5%). None of the normal common bile ducts obtained from ten autopsies had metaplastic changes. Endocrine cells were identified in nine (56%) of 17 metaplastic lesions. In contrast, endocrine cells within the intramural glands were seen in only 2 of the 10 normal common bile ducts. Although a significant proportion of carcinomas (6/13 cases) was in close proximity to areas of metaplasia, we were unable to find dysplastic foci within the metaplastic glands or the metaplastic surface epithelium. Reactive atypical cells involved the surface biliary epithelium and intramural glands and were associated with inflammation and metaplastic changes. The presence of goblet, mucinous, squamous, and reactive atypical cells in association with hyperplasia of intramural glands in frozen sections or small biopsy specimens may be mistaken for malignancy; hence, recognition of these lesions is of diagnostic importance.
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Affiliation(s)
- M P Hoang
- Division of Anatomic Pathology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75235, USA
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31
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Papotti M, Cassoni P, Sapino A, Passarino G, Krueger JE, Albores-Saavedra J. Large cell neuroendocrine carcinoma of the gallbladder: report of two cases. Am J Surg Pathol 2000; 24:1424-8. [PMID: 11023106 DOI: 10.1097/00000478-200010000-00014] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
We report two cases of primary large cell neuroendocrine carcinoma (LCNEC) of the gallbladder, which, to the best of our knowledge, represent the first description of this entity. One of the tumors consisted entirely of LCNEC, whereas the second tumor was composed of LCNEC and the more common intestinal-type adenocarcinoma. Both tumors were morphologically similar to their pulmonary counterpart and were characterized by large cells with prominent nucleoli, coarse chromatin, and a high mitotic rate. The cells showed an organoid growth pattern with rosette formation and frequent areas of necrosis. Panendocrine markers were expressed in a variable proportion of tumor cells in both cases, and one of the cases also showed focal positivity for type 2 somatostatin receptors. One of the tumors followed a rapidly fatal course despite aggressive surgical treatment and chemotherapy administration, and the second patient is still alive and disease-free 12 months after surgery. The description of these two cases of LCNEC of the gallbladder is significant for two reasons. From an academic standpoint, we now know that all the neuroendocrine tumors described in other organs can arise de novo in the gallbladder. More importantly, however, the recognition of this rare tumor type carries important clinical implications in regard to the use of chemotherapeutic agents and supplemental treatments (for example, somatostatin analogs).
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Affiliation(s)
- M Papotti
- Department of Pathology, University of Turin, Italy.
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Albores-Saavedra J, Delgado R, Henson DE. Well-differentiated adenocarcinoma, gastric foveolar type, of the extrahepatic bile ducts: A previously unrecognized and distinctive morphologic variant of bile duct carcinoma. Ann Diagn Pathol 1999; 3:75-80. [PMID: 10196386 DOI: 10.1016/s1092-9134(99)80033-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Two examples of a rare but distinctive morphologic variant of extremely well-differentiated adenocarcinoma of the extrahepatic bile ducts are reported. One tumor arose in the common bile duct of a 51-year-old man; the other arose in the common hepatic duct of a 27-year-old man. Both tumors were composed predominantly (>95%) of gastric foveolar-type epithelium. Because of their bland nuclear features, low mitotic index, and focal polypoid and lobular architecture, they were initially confused with adenomas. Foci of less-differentiated adenocarcinoma and perineural invasion present in the deep portions of the tumors facilitated recognition. The neoplastic cells and extracellular mucin were periodic acid-Schiff- and alcian blue-positive. By immunohistochemistry, the tumor cells expressed cytokeratins 8 and 20 as well as cathepsin D, as reported in normal foveolar cells. Likewise, p53 overexpression was documented immunohistochemically in both adenocarcinomas, which also stained with the Ki-67 antibody. Despite the well-differentiated nature of the neoplasms and their deceptively benign microscopic appearance, one patient developed recurrence and liver metastasis 5 years after surgery. The other patient is disease-free 2 years following a segmental resection of the common hepatic duct, cystic duct, and gallbladder. The cell phenotype of these tumors can be explained by the ability of the bile duct epithelium to differentiate along gastric cell lines.
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Affiliation(s)
- J Albores-Saavedra
- Division of Anatomic Pathology, The University of Texas Southwestern Medical Center, Dallas, TX 75235-9073, USA
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34
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Bakotic BW, Robinson MJ, Sturm PD, Hruban RH, Offerhaus GJ, Albores-Saavedra J. Pyloric gland adenoma of the main pancreatic duct. Am J Surg Pathol 1999; 23:227-31. [PMID: 9989851 DOI: 10.1097/00000478-199902000-00013] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A case of a pyloric gland type adenoma of the main pancreatic duct in a 69-year-old woman is reported. The tumor led to occlusion and cystic dilatation of the main duct in the pancreatic tail. The surgical resection specimen disclosed a polypoid, bilobed mass attached to the wall of the main pancreatic duct by a thin fibrous stalk. Light-microscopic examination revealed a well-demarcated nodule composed of closely packed tubular glands lined by columnar, mucin-secreting cells with abundant clear cytoplasm and basally oriented nuclei. Focal, mild cytologic atypia was seen. Pyloric metaplasia and focal papillary hyperplasia was present in the adjacent ductal epithelium. Periodic acid-Schiff reactions, with and without diastase predigestion, showed reactivity in the tubular glands, whereas alcian blue (pH 2.5) was negative. Immunohistochemical stains for chromogranin, serotonin, somatostatin, and gastrin failed to detect the respective antigens. Genetic analysis using polymerase chain reaction with mutant enrichment and allele specific oligonucleotide hybridization detected a single mutation at codon 12 of K-ras, which changed the wild-type glycine to arginine. This mutation is commonly found in invasive pancreatic ductal carcinomas. Although tumors with microscopic and immunohistochemical features consistent with pyloric gland adenoma have been described in the gallbladder, to our knowledge, this is the first reported case within the pancreatic ductal system. The finding of a K-ras, codon 12 mutation and the presence of focal dysplasia may denote neoplastic potential in association with this lesion.
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Affiliation(s)
- B W Bakotic
- The Department of Pathology and Laboratory Medicine, Mount Sinai Medical Center, Miami Beach, Florida 33140-2800, USA
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35
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Abstract
A case of small cell carcinoma of the gall-bladder is described. Immunohistochemically, the tumor cells were positive for chromogranin A, synaptophysin and neuronspecific enolase, which suggests that they derived from neuroendocrine cells. The overlying and surrounding epithelium of the tumor showed intestinal metaplasia including goblet cells, pseudopyloric glands, Paneth's cells, and chromogranin A and synaptophysin-positive endocrine cells. Definite adenocarcinoma was absent. The endocrine cells in the epithelium were more numerous in the vicinity of the tumor. The present case supports the supposition that endocrine cell tumor (including small cell carcinoma) of the gall-bladder may develop from endocrine cells of the intestinal metaplastic lesion.
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Affiliation(s)
- H Kuwabara
- Second Department of Pathology, Kagawa Medical University, Japan.
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36
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Duarte I, Llanos O, Domke H, Harz C, Valdivieso V. Metaplasia and precursor lesions of gallbladder carcinoma. Frequency, distribution, and probability of detection in routine histologic samples. Cancer 1993; 72:1878-84. [PMID: 8364865 DOI: 10.1002/1097-0142(19930915)72:6<1878::aid-cncr2820720615>3.0.co;2-2] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Gallbladder diseases, especially cholelithiasis, are extremely frequent in Chile, and an increasing frequency of gallbladder carcinoma has been observed during the last decades. Hyperplastic and atypical epithelial lesions of gallbladder epithelium have been considered potential precursors of invasive carcinoma. The current study was designed to study the frequency, distribution, extension, and probability of routine detection of potentially preneoplastic changes of gallbladder epithelium. METHODS Epithelial changes were histologically studied by mapping gallbladders obtained at elective cholecystectomy for lithiasis in 162 Chilean patients. RESULTS Antral-type metaplasia was found in 95.1% of the cases, intestinal metaplasia in 58.1%, hyperplasia in 46.9%, dysplasia in 16%, and carcinoma in situ in 2.5%. A significant association of intestinal metaplasia with hyperplasia, intestinal metaplasia with dysplasia, and hyperplasia with dysplasia was found. Hyperplasia and dysplasia were also present in four cases with carcinoma in situ. Mean extension of the lesions (percentages of the sections in which the change was observed) was antral-type metaplasia (62.7%), intestinal metaplasia (25.3%), hyperplasia (24.1%), dysplasia (15.5%), and carcinoma in situ (9.7%). Antral-type and intestinal metaplasia were more extensive and more severe in patients older than 50 years of age. Hyperplasia was more extensive in cases in which it was associated with dysplasia and carcinoma in situ. CONCLUSIONS The extension of metaplasia seems to depend in part on the age of the patients. The association of intestinal metaplasia with hyperplasia and dysplasia agrees with the findings of other authors that relate metaplasia to gallbladder cancer. The epithelial lesions are focal or partially confluent, thus a single random histologic section will detect less than one third of the hyperplasias, dysplasias, and carcinomas in situ.
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Affiliation(s)
- I Duarte
- Department of Pathology, Pontificia Universidad Catolica de Chile, Santiago
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Magnani L, Bani D, Biliotti G, Bani Sacchi T. Structural changes of the exocrine pancreas in a patient with cholecystolithiasis. INTERNATIONAL JOURNAL OF PANCREATOLOGY : OFFICIAL JOURNAL OF THE INTERNATIONAL ASSOCIATION OF PANCREATOLOGY 1992; 12:53-9. [PMID: 1527451 DOI: 10.1007/bf02927070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The exocrine pancreas has been studied histologically, morphometrically, and ultrastructurally in a patient with cholecystolithiasis in comparison with three control patients free from gastrointestinal or pancreatic diseases. In the gallstone-bearing patient, acinar cells undergo a significant increase in the average cell area and average zymogenic area (i.e., the portion of acinar cell cytoplasm occupied by zymogen granules). In addition, these cells showed cytological signs of enhanced synthesis of secretory proteins and increased formation and release of zymogen granules. The findings concerning centroacinar/ductular cells are consistent with a significant increase in their number and average cell area that is associated with ultrastructural signs of enhanced functional activity.
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Affiliation(s)
- L Magnani
- Department of Human Anatomy and Histology, University of Florence, Italy
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38
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Albores-Saavedra J, Henson DE, Sobin LH. The WHO Histological Classification of Tumors of the Gallbladder and Extrahepatic Bile Ducts. A commentary on the second edition. Cancer 1992; 70:410-4. [PMID: 1617591 DOI: 10.1002/1097-0142(19920715)70:2<410::aid-cncr2820700207>3.0.co;2-r] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The second edition of the WHO Histological Classification of Tumors of the Gallbladder and Extrahepatic Bile Ducts is more comprehensive and detailed than the previous one. Advances in our understanding of dysplasia, carcinoma in situ, various lines of differentiation among the carcinomas, and the recognition of a variety of tumor-like lesions have resulted in more than three times as many entities in the current classification as in the previous one. The new edition should facilitate pathologic, epidemiologic, and therapeutic comparisons.
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39
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Tanaka K, Iida Y, Tsutsumi Y. Pancreatic polypeptide-immunoreactive gallbladder carcinoid tumor. ACTA PATHOLOGICA JAPONICA 1992; 42:115-8. [PMID: 1561882 DOI: 10.1111/j.1440-1827.1992.tb03085.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Gallbladder carcinoid tumor seen in a 62-year-old woman is described. The neoplasm with typical histologic features of classic carcinoid tumor was a 10 x 8 x 3 mm polyp at the neck of the gallbladder. The argyrophilic tumor cells were diffusely immunoreactive for neuron-specific enolase, cystatin C, chromogranin A and pancreatic polypeptide. A few cells were further positive for somatostatin. The presence of neurosecretory-type granules was confirmed ultrastructurally. The clinicopathologic significance of polypoid presentation of gallbladder carcinoid tumor is emphasized.
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Affiliation(s)
- K Tanaka
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
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40
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Kurumaya H, Terada T, Nakanuma Y. 'Metaplastic lesions' in intrahepatic bile ducts in hepatolithiasis: a histochemical and immunohistochemical study. J Gastroenterol Hepatol 1990; 5:530-6. [PMID: 2129825 DOI: 10.1111/j.1440-1746.1990.tb01436.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Pathology of the intrahepatic bile ducts bearing calculi was examined with an emphasis on metaplasia in 22 cases of hepatolithiasis and in seven cases of normal livers. Normal livers contained few glandular elements within the bile duct walls and no metaplastic lesions or endocrine cells. In hepatolithiasis, a number of mucous glands resembling pyloric glands (pseudopyloric gland metaplasia) were seen within duct walls in all cases. The epithelial cells of the glands were positive for class III mucin with paradoxical concanavalin A staining which is known to be specific for pyloric glands. These cells were also positive for neutral, sialo- and sulfomucin to a variable extent. Intestinal metaplasia, including goblet cell and Paneth cell metaplasia, was found within duct walls and in covering epithelia in five (23%) cases. Endocrine cells, including argyrophil, argentaffin and gut hormone-containing cells were present in these metaplastic lesions in 13 (59%) cases. The occurrence of endocrine cells was closely associated with intestinal metaplasia, although there were a few endocrine cells in metaplastic pseudopyloric glands. These findings suggest that metaplastic lesions similar to the well-known metaplastic lesions in the gallbladder occur in the intrahepatic bile duct walls in hepatolithiasis. The appearance of metaplastic lesions and endocrine cells may be causally related to chronic inflammatory processes associated with hepatolithiasis.
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Affiliation(s)
- H Kurumaya
- Second Department of Pathology, Kanazawa University School of Medicine, Japan
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41
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Abstract
A case of signet-ring cell carcinoid of the gallbladder is reported. The tumour diffusely infiltrated the gallbladder wall and extensively ulcerated the mucosa. Neoplastic nests were composed of numerous signet-ring cells mixed with clear endocrine cells. The latter expressed chromogranin A, gastrin and somatostatin and contained neurosecretory granules. The diagnostic problem of differentiating between signet-ring cell carcinomas and composite adenocarcinoma-carcinoid tumours is discussed.
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Affiliation(s)
- M Papotti
- Department of Biomedical Sciences and Human Oncology, University of Turin, Italy
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42
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Albores-Saavedra J, Defortuna SM, Smothermon WE. Primary papillary hyperplasia of the gallbladder and cystic and common bile ducts. Hum Pathol 1990; 21:228-31. [PMID: 2307450 DOI: 10.1016/0046-8177(90)90134-q] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A unique case of primary papillary hyperplasia of the gallbladder and cystic and common bile ducts occurring in a young female without calculi, ulcerative colitis, or primary sclerosing cholangitis is reported. The papillary lesion involved the mucosa of the entire gallbladder and of the cystic and common bile ducts. Histologically, the gallbladder mucosal folds were close to one another and taller than normal. They were lined by normal-appearing columnar cells and pencil-like cells. The papillary projections of the common bile duct were lined only by columnar cells with prominent subnuclear vacuoles. No endocrine cells or cytologic atypia were noted. The differential diagnoses, including secondary hyperplasia, multiple adenomas, and papillomatosis of the gallbladder, are discussed.
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Affiliation(s)
- J Albores-Saavedra
- Department of Pathology, University of Miami School of Medicine, Jackson Memorial Medical Center, FL 33101
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43
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Hopwood D, Wood R, Milne G. The fine structure and histochemistry of human bile duct in obstruction and choledocholithiasis. J Pathol 1988; 155:49-59. [PMID: 3379517 DOI: 10.1002/path.1711550109] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Biopsies from the common bile ducts from seven patients undergoing surgery for biliary obstruction due to stones or malignancy were studied histochemically and electron microscopically. The surface of the bile duct is lined by a tall epithelium which extends into diverticula. Apically, they contain some neutral and sialated mucosubstances. Fucosyl residues were found in the Golgi apparatus and along the apical cell membrane. The latter is lined by microvilli. There was a well-developed rough endoplasmic reticulum and Golgi apparatus and a small number of apical secretory droplets. Large numbers of lipid droplets were present basally in some cells. Lipid-containing macrophages were also seen intra-epithelially and in the lamina propria. This suggests a possible pathway for lipid transport. The glands were lined by cuboidal cells, some containing much mucus--sulphated, sialated, and neutral with a basal nucleus. A well-developed endoplasmic reticulum and Golgi apparatus were found with abundant secretory droplets. The glandular epithelium contained lysozyme, alpha-1-antitrypsin, and alpha-1-antichymotrypsin. These may play a protective role. The lamina propria contained scattered smooth muscle cells amongst the fibroblasts and inflammatory cells.
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Affiliation(s)
- D Hopwood
- Department of Pathology, Ninewells Hospital, Dundee, U.K
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Albores-Saavedra J, Nadji M, Henson DE, Angeles-Angeles A. Entero-endocrine cell differentiation in carcinomas of the gallbladder and mucinous cystadenocarcinomas of the pancreas. Pathol Res Pract 1988; 183:169-75. [PMID: 3387323 DOI: 10.1016/s0344-0338(88)80044-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Forty two carcinomas of the gallbladder and 25 mucinous cystadenocarcinomas of the pancreas were analyzed using silver stains and immunohistochemical techniques. Fourteen (33.3%) gallbladder carcinomas had argyrophil and argentaffin cells and 17 (40%) contained endocrine cells as shown by immunoperoxidase stains. The gallbladder tumors that had the largest number of endocrine cells were the well differentiated adenocarcinomas with colonic features. The most common endocrine cell in these tumors was the serotonin-containing (EC) cell followed by somatostatin-containing cells and cells that reacted to pancreatic polypeptide and gastrin. Intestinal metaplasia with pseudopyloric gland hyperplasia was present in the gallbladder mucosa adjacent to 11 carcinomas and had an endocrine cell population similar to that of the tumors. Endocrine cells were demonstrated in 18 (70%) of the 25 mucinous cystadenocarcinomas of the pancreas by the immunoperoxidase method although only 9 had argyrophil and argentaffin cells. The population of endocrine cells in these mucinous pancreatic tumors was similar to that found in gallbladder carcinomas. Endocrine cells were more numerous in areas with colonic-type glands, goblet cells and Paneth cells. The secretory products of the endocrine cells in these gallbladder and pancreatic tumors did not give rise to systemic endocrine manifestations. The presence of endocrine cells in these tumors can be explained on the basis of intestinal differentiation.
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Affiliation(s)
- J Albores-Saavedra
- Department of Pathology, University of Miami Jackson Memorial Medical Center
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