Distal Humerus as Delayed Site of Metastasis from Small Cell Carcinoma of Gallbladder

Abstract

Background. Small cell carcinoma (SCC) of the gallbladder is a rare entity and is often seen in elderly women. SCC of gallbladder is typically a nonsecretory carcinoid tumor without overt clinical symptoms and is often discovered at advanced stages. SCC of gallbladder carries a dismal prognosis as compared to SCC of lung and adenocarcinoma of gallbladder. To date, only 73 case reports have been published in the world literature. Case Presentation. Herein, we report a case of a 73-year-old Saudi woman who presented with one week history of right upper quadrant abdominal pain and obstructive jaundice and was found to be a case of locally advanced, metastatic SCC of gallbladder cT4N1M1 (liver, para-aortic lymph nodes, and bone). The patient was treated with neoadjuvant etoposide and cisplatin (EP) chemotherapy three cycles after biliary stenting followed by radical cholecystectomy, lymphadenectomy, and adjuvant EP chemotherapy and then one year later developed distal humerus osseous metastasis. Conclusion. SCC of the gallbladder is very rare entity and is often seen at advanced stages. Osseous metastases of peripheral skeleton from SCC gallbladder are rarely reported. Surgery is curative option but only for early stage tumors. Incorporation of chemotherapy along with radical resection increases the survival.

Neuroendocrine Carcinoma of Gall Bladder: A Series of 19 Cases with Review of Literature

“…GB carcinomas form the fifth most common gastrointestinal malignancy, and adenocarcinoma is the most common histologic type [4,6]. Other types include adenosquamous, squamous, and NET.…”

“…They can be found in any location of the body, although the sites most commonly affected are the gastrointestinal and bronchopulmonary systems, representing approximately 67 and 25 % of cases, respectively [1]. [4,6], with approximately 4 % of these being SCC [3]. In the SEER registry, only 278 cases of NET have been reported between 1973 and 2005 [1 ], with only five welldifferentiated NETs.…”

“…NEC, 6 poorly differentiated NECs (SCC), and 5 mixed carcinomas [7]. The first case of primary NET tumor (a classic carcinoid) of the GB was reported in 1929 by Joel, and first SCC was reported in 1981 by Albores-Saavedra et al; since then, 73 cases of SCC and 10 cases of LCNEC [2] have been published in the literature till date [2,4].…”

“…Neuroendocrine neoplasms, according to World Health Organisation (WHO), are classified as grade 1 and 2 NET, neuroendocrine carcinoma (large cell or small cell type) and mixed adeno-neuroendocrine carcinoma (MANEC), and express neuroendocrine markers on immunohistochemistry [3]. Small cell carcinoma (neuroendocrine carcinoma, grade III) is often diagnosed at advanced stage (locally advanced or metastatic) and carries a grave prognosis with survival rates worse than GB adenocarcinomas [4]. They have an aggressive clinical behavior, and early surgical intervention with radiologic follow-up is mandatory to facilitate early detection of recurrence [2].…”

“…Surgery is the best curative option for early stage tumors. For locally advanced unresectable tumors, multimodality approach by palliative chemoradiation is the preferred modality [4].…”