Open AccessA Large Cell Neuroendocrine Carcinoma of the Gall Bladder: Diagnosis with 18FDG-PET/CT-guided Biliary Cytology and Treatment with Combined Chemotherapy Achieved a Long-term Stable Condition
Author(s) -
Yûsuke Okuyama,
Akihumi Fukui,
Yuichiro Enoki,
Hiroyuki Morishita,
Norimasa Yoshida,
Sotaro Fujimoto
Publication year - 2013
Publication title -
japanese journal of clinical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.768
H-Index - 85
eISSN - 1465-3621
pISSN - 0368-2811
DOI - 10.1093/jjco/hyt033
Subject(s) - medicine , gallbladder , lymph node , pathology , carcinoma , small cell carcinoma , chemotherapy , biopsy , neuroendocrine tumors , radiology
Poorly differentiated neuroendocrine cell carcinomas of the gallbladder are rare and patients with such tumors have a poor prognosis. We describe a 64-year-old male with a large cell neuroendocrine carcinoma of the gallbladder and multiple lymph node metastases. Diagnostic excisional biopsy of the left axillary lymph nodes revealed atypical cells with predominantly large-sized round-to-oval nuclei, proliferating in a solid and focal nesting pattern. The tumor cells were positive for synaptophysin and chromogranin A, and strongly positive for Ki-67, leading to a diagnosis of poorly differentiated neuroendocrine cell carcinoma of the gallbladder, of large cell type. Using (18)F-fluorodeoxy glucose-positron emission tomography/computed tomography to determine the origin of these tumors, we observed the accumulation of (18)F-fluorodeoxy glucose in multiple large lymph nodes, a small part of the liver and the fundus of the gallbladder. Computed tomography-guided aspiration of the gallbladder showed the same pleomorphic tumor cells as the lymph nodes. The patient was diagnosed with a large cell neuroendocrine carcinoma of the gallbladder, only ∼25 mm in diameter. Combination chemotherapy with cisplatin and docetaxel, the regimen used for non-small cell lung carcinomas, and probably large cell lung carcinomas, resulted in the disappearance of the lymph node metastases and a marked improvement in the performance status for ∼22 months. The poor prognosis of patients with these aggressive tumors may be improved by the use of minimally invasive diagnostic procedures and combined systemic chemotherapy as soon as possible.