Gallbladder small cell carcinoma: a case report and literature review

Abstract

Gallbladder small cell carcinoma (SCC) comprises only 0.5 % of all gallbladder cancer and consists of aggressive tumors with poor survival outcomes against current treatments. These tumors are most common in elderly females, particularly those with cholecystolithiasis. We report the case of a 79-year-old woman with gallbladder small cell carcinoma. The patient had intermittent right upper quadrant abdominal pain and was admitted to our hospital due to suspected acute cholecystitis. She regularly received medical treatment for diabetes, hypertension, and dyslipidemia. On initial laboratory evaluation, the levels of aspartate aminotransferase (AST), total bilirubin, and C-reactive protein (CRP) were markedly elevated. She underwent computed tomography (CT) for screening. CT images showed a thick-walled gallbladder containing multiple stones and multiple 3-cm-sized round nodular lesions, which were suggestive of metastatic lymph nodes. After percutaneous transhepatic gallbladder drainage was performed, endoscopic ultrasound-guided fine needle aspiration of enlarged lymph nodes resulted in a diagnosis of small cell carcinoma or adenocarcinoma. However, we could not identify the primary lesion before the surgery because of no decisive factors. We performed cholecystectomy because there was a possibility of cholecystitis recurrence risk and also partial liver resection because we suspected tumor invasion. The final pathological diagnosis was neuroendocrine carcinoma of the gallbladder, small cell type. The tumor stage was IVb, T3aN1M1. The patient died 13 weeks after the surgery. In the present paper, we review the current available English-language literature of gallbladder SCC.

Neuroendocrine tumors of the gallbladder (Review)

“…3). These scans also indicate a visible necrotic shadow in larger lesions (28). In studies examining the results of CT and MRI scans in GB-NEN, it was noted that after the enhancement of GB-NEN, the lesion continued to strengthen and the enhancement was slightly more obvious compared with that of adenocarcinoma (29).…”

“…To identify the root cause of the GB-NEN, a thorough examination and understanding of the cellular nature of the disease is important. In the process of examination, minimal neuroendocrine cells can be found on the gallbladder mucosa, if any exist in this space (11)(12)(13). Further GB-NEN etiological identifiers may be as follows: i) The undifferentiated gallbladder stem cells separate into neuroendocrine cells.…”

“…ii) The presence of gallbladder stones results in chronic inflammation of the gallbladder mucosa causing intestinal epithelium or gastric metaplasia, which are considered to be pathological metaplasia. In an advanced stage, this inflammation produces neuroendocrine cells at the lesion site eventually leading to the development of a GB-NEN (12,14,15). iii) In certain situations, the gallbladder adenocarcinoma function switches to a neuroendocrine one, resulting in chronic inflammation of gallbladder tissues and formation of stones, further exacerbating the other risk factors for gallbladder adenocarcinoma.…”

Gallbladder neuroendocrine carcinoma

“…Cisplatin or carboplatin plus etoposide were generally recommended as the primary program for poorly differentiated GB-NECs and achieved satisfactory responses. [ 25 ] In addition, Kanetkar et al [ 26 ] reported that in carefully selected patients, new adjuvant chemotherapy can help to reduce tumor burden and facilitate radical resection with negative margins.…”

A case of gallbladder neuroendocrine carcinoma diagnosed preoperatively using somatostatin receptor scintigraphy

“…According to the 2010 World Health Organization classification of tumors of the digestive tract, NETs are categorized into NET G1, NET G2, and NECs according to mitotic count and Ki-67 index (8). NEC is difficult to preoperatively differentiate from gallbladder adenocarcinoma, and most patients are diagnosed postoperatively by immunostaining for markers such as NSE, CD56, chromogranin A, and synaptophysin (9). Several hypotheses have been proposed on the pathogenesis of gallbladder NETs.…”