title: A 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.
abstract: 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.
authors.affiliation: Department of Gastroenterology, Japan Red Cross Kyoto Daiichi Hospital, Kyoto, Japan. yusuke-okuyama@kyoto1-jrc.org
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Okuyama
authors.forename: Akihumi
authors.initials: A
authors.lastname: Fukui
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Enoki
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Morishita
authors.forename: Norimasa
authors.initials: N
authors.lastname: Yoshida
authors.forename: Sotaro
authors.initials: S
authors.lastname: Fujimoto
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000556:secondary; D018287:Carcinoma, Large Cell / Q000175:diagnosis* / Q000188:drug therapy; D018278:Carcinoma, Neuroendocrine / Q000175:diagnosis* / Q000188:drug therapy; D002945:Cisplatin / Q000008:administration & dosage; D004211:Disseminated Intravascular Coagulation / Q000209:etiology; D000077143:Docetaxel; D017809:Fatal Outcome; D019788:Fluorodeoxyglucose F18; D005706:Gallbladder Neoplasms / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000556:secondary; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D064847:Multimodal Imaging / Q000379:methods; D049268:Positron-Emission Tomography; D019275:Radiopharmaceuticals; D043823:Taxoids / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed; D017211:Treatment Failure
chemical_list: D019275:Radiopharmaceuticals; D043823:Taxoids; D019788:Fluorodeoxyglucose F18; D000077143:Docetaxel; D002945:Cisplatin