Paraganglia of the Gallbladder: An Underrecognized Incidental Finding and Potential Diagnostic Pitfall

Ramlal, Bharat; Voytek, Theresa M.; Ligato, Saverio

doi:10.5858/arpa.2020-0041-oa

Cited by 2 publications

(1 citation statement)

References 12 publications

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“…The major and most common cell types are oval and granular chief cells, which are usually positive for CgA, NSE, and SYN, and negative for cytokeratin. Another cell-type component, which is usually less easily recognized in Hematoxylin eosin (HE), is a supportive sustentacular cell; usually presented as a fusiform hyperchromatic nucleus and an ambiguous vacuolar cytoplasm, it can be detected by positive immunostaining for S-100 ( 22 ). To sum up, pathological examination is the gold standard for the diagnosis of paraganglioma.…”

Section: Discussionmentioning

confidence: 99%

Case Report: A rare case of primary paraganglioma of the gallbladder with a literature review

Xia

Wang

et al. 2023

Front. Oncol.

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IntroductionParagangliomas of the gallbladder are exceptionally rare. To date, only a few cases of this disease have been reported globally, and the majority were found incidentally during surgery. Although complete resection can achieve a curative effect, specific targeted drugs may have survival benefits for patients with potential recurrence and metastasis risks.Case presentationA 48-year-old woman was scheduled for anatomical central hepatectomy due to the discovery of a liver mass. Surprisingly, a gallbladder tumor accompanied by intrahepatic invasion was found rather than primary liver lesions during the operation. Postoperatively, the lesion was confirmed to be a paraganglioma originating from the gallbladder with intrahepatic invasion detectable on histopathology. After surgery, the patient was treated with a new targeted drug, surufatinib {200 mg, q.d. [quaque die (every day)]}, and no recurrence was observed during the regular follow-up.DiscussionGallbladder paraganglioma is rare and occult, and surgeons do not know it well, so it is easily misdiagnosed before surgery. Postoperative pathological examination is the gold standard for diagnosis.ConclusionGiven that the tumor contained abundant blood sinuses, the early and continuous enhancement of dynamic enhanced CT scanning was its characteristic manifestation. We presented a case in which a primary gallbladder paraganglioma was identified accidentally in a patient who was misdiagnosed with a liver lesion before surgery. Based on our experience in this work, the en bloc resection technique in combination with surufatinib might have a survival benefit to patients at risk of potential recurrence or metastasis; however, further follow-up observations are needed.

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Section: Discussionmentioning

confidence: 99%

Case Report: A rare case of primary paraganglioma of the gallbladder with a literature review

Xia

Wang

et al. 2023

Front. Oncol.

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Spectra of well‐differentiated neuroendocrine lesions in the extrahepatic biliary system: a case series

Liu,

Esnakula,

Jain

et al. 2024

Histopathology

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AimsNeuroendocrine tumours (NETs) occurring in the extrahepatic biliary system are exceedingly rare. While NETs typically manifest as mass lesions, the occurrence of microscopic neuroendocrine cell proliferation without a distinct mass remains undocumented at this location. This study aims to characterise the clinicopathological features of a series of well‐differentiated neuroendocrine lesions involving the extrahepatic biliary tree, including mass forming NETs and microscopic non‐mass‐forming neuroendocrine cell proliferation, designated neuroendocrine cell micronests (NCMs).Methods and resultsSurgical resections of NETs/NCMs involving the extrahepatic bile ducts and gallbladder were identified from electronic pathology databases among seven institutions spanning from January 2011 to September 2023. Clinical and histological findings were recorded. Ten patients (four female, six male: age range = 34–75 years) were included in the study. Histopathological examination revealed visible mass‐forming lesions in four cases (1.6–14.0 cm in size), identified in the gallbladder (n = two) or extrahepatic bile duct (n = two), all diagnosed as well‐differentiated NETs. The remaining six cases revealed incidental non‐mass‐forming NCMs in either the cystic duct (n = two), common bile duct (n = three) or gallbladder (n = one), ranging from < 0.1 to 0.4 cm; four were associated with biliary lithiasis. No evidence of metastasis or recurrence was seen in the follow‐up period (range = 0.1–11.2 years).ConclusionsThis study highlights the spectrum of extrahepatic biliary well‐differentiated neuroendocrine lesions, ranging from incidental microscopic NCMs to grossly apparent mass‐forming NETs, potentially requiring different clinical management. Noteworthy is the frequent association of incidental microscopic neuroendocrine cell proliferations with biliary lithiasis, indicating a potential neuroendocrine metaplastic pathogenesis that merits further exploration.

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Paraganglia of the Gallbladder: An Underrecognized Incidental Finding and Potential Diagnostic Pitfall

Cited by 2 publications

References 12 publications

Case Report: A rare case of primary paraganglioma of the gallbladder with a literature review

Case Report: A rare case of primary paraganglioma of the gallbladder with a literature review

Spectra of well‐differentiated neuroendocrine lesions in the extrahepatic biliary system: a case series

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