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.
An 81-year-old woman who had undergone total hysterectomy and postoperative radiotherapy for uterine cervical cancer 45 years earlier visited Department of Urology in our hospital with the chief complaint of diarrhea and pain of the perineal region. Vesico-recto-vaginal fistula with pyelonephritis was diagnosed by a plain CT scan. Her general condition improved by antibiotics and percutaneous nephrostomy. However, urine and fecal fluid still flowed from the vagina, and she complained of marked pain at the perineal region due to erosion and ulcer. She was referred to our department to resume oral ingestion and to improve ADLs. Ileo-vesical fistula was also diagnosed by a plain abdominal CT scan with oral contrast medium on the 16 th hospital day. Laparotomy revealed firm bowel adhesions with multiple loops and radiation enteritis in the pelvic cavity. Considering that division of the adhesions might entail a high risk of bowel injuries, we performed a by-pass anastomosis of the small bowel and mode a transverse colostomy. Defluxion of digestive fluid from the vagina considerably reduced and the patient was discharged from our hospital on the 55 th postoperative day. Entero-vaginal fistula is a rare disease, especially, small bowel-vaginal one in extremely rare. This paper presents a case of ileo-vesico-recto-vaginal fistula caused by late complication of radiotherapy, together with some discussion on the literature.
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