title: A case of neuroendocrine carcinoma in the hepatic hilar lymph nodes concomitant with an adenocarcinoma of the gallbladder.
abstract: BACKGROUND
  Neuroendocrine tumors (NETs) are rare especially in the gallbladder. They have not been elucidated in the pathogenesis, clinicopathological characteristics, and treatment options.
  
  
  METHODS
  We present a 76-year-old woman with a gallbladder tumor and hepatic hilar lymph node swelling. The lymph node biopsy demonstrated neuroendocrine carcinoma (NEC). We performed cholecystectomy, hepatic hilar lymphadenectomy, extrahepatic biliary duct resection, and hepaticojejunostomy prior to chemotherapy. Pathological examination revealed the gallbladder mass was an adenocarcinoma invading to the muscular layer without any NEC components, whereas the hepatic hilar lymph nodes were filled with high-grade NEC cells with negligible area of adenocarcinoma. The patient received general chemotherapy consisting of carboplatin and etoposide, but a recurrence in the para-aortic lymph nodes occurred 4 months after surgery.
  
  
  CONCLUSIONS
  We report a rare case of NEC of the hepatic hilar lymph nodes that were concomitant with an adenocarcinoma of the gallbladder. High-grade NEC generally has an aggressive behavior and an optimal treatment strategy should be chosen for each patient.
authors.affiliation: Department of Gastroenterological Surgery and Oncology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, kita-ku, Osaka City, Osaka, 530-8480, Japan.|Present Address: Department of Surgery, National Hospital Organization Kyoto Medical Center, 1-1, Fukakusamukaihatacho, Fushimi-ku, Kyoto City, Kyoto, 612-8555, Japan.
authors.forename: Haruka
authors.initials: H
authors.lastname: Okada
authors.affiliation: Department of Gastroenterological Surgery and Oncology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, kita-ku, Osaka City, Osaka, 530-8480, Japan. uchiday@kuhp.kyoto-u.ac.jp.
authors.forename: Yoichiro
authors.initials: Y
authors.lastname: Uchida
authors.affiliation: Department of Pathology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.
authors.forename: Naomi
authors.initials: N
authors.lastname: Matsuzaki
authors.affiliation: Department of Gastroenterological Surgery and Oncology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, kita-ku, Osaka City, Osaka, 530-8480, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Goto
authors.affiliation: Department of Gastroenterology and Hepatology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.
authors.forename: Satoshi
authors.initials: S
authors.lastname: Nishimura
authors.affiliation: Department of Gastroenterology and Hepatology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Kurita
authors.affiliation: Department of Medical Oncology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Nishimura
authors.affiliation: Department of Gastroenterology and Hepatology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan.
authors.forename: Shujiro
authors.initials: S
authors.lastname: Yazumi
authors.affiliation: Department of Gastroenterological Surgery and Oncology, The Tazuke Kofukai Medical Research Institute, Kitano Hospital, 2-4-20 Ohgimachi, kita-ku, Osaka City, Osaka, 530-8480, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Terajima
mesh_terms: D000230:Adenocarcinoma / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D000368:Aged; D017734:Bile Ducts, Extrahepatic / Q000601:surgery; D014408:Biomarkers, Tumor / Q000097:blood; D001706:Biopsy; D018278:Carcinoma, Neuroendocrine / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D049448:Cholangiopancreatography, Magnetic Resonance; D002763:Cholecystectomy; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D016099:Endoscopy, Gastrointestinal; D017809:Fatal Outcome; D005260:Female; D019788:Fluorodeoxyglucose F18 / Q000008:administration & dosage; D005706:Gallbladder Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D007582:Jejunostomy; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy; D000072078:Positron Emission Tomography Computed Tomography; D014057:Tomography, X-Ray Computed
chemical_list: D014408:Biomarkers, Tumor; D019788:Fluorodeoxyglucose F18
keywords: Gallbladder cancer; Intestinal metaplasia; Neuroendocrine carcinoma; Neuroendocrine tumor