A 0.8-cm clear cell neuroendocrine tumor G1 of the gallbladder with lymph node metastasis: a case report

Hirose, Yuki; Sakata, Jun; Endo, Kenji; Takahashi, Masato; Saito, Reijiro; Imano, Hiroshi; Kido, Tomoki; Yoshino, Kei; Sasaki, Toshiki; Wakai, Toshifumi

doi:10.1186/s12957-018-1454-y

Cited by 12 publications

(15 citation statements)

References 17 publications

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“…A few case reports have been published on the different histologic types of GB-NEN, including neuroendocrine carcinoma, LCNEC, SCC, MANEC, carcinoid tumors, and atypical carcinoid tumors (12, 13, 14, 15, 16, 17, 18, 19). A previous study of GB-NEN cases from the SEER database between 2000 and 2005 reported that among 105 GB-NEN cases, 1% were LCNEC, 30.5% were SCC, 32.4% were carcinoid tumors, 34.3% were neuroendocrine carcinoma, and 1.9% were MANEC (7).…”

Section: Discussionmentioning

confidence: 99%

Clinicopathological features and survival for gallbladder NEN: a population-based study

Cen

Liu

Wan

et al. 2019

Endocrine Connections

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Purpose Gallbladder neuroendocrine neoplasm (GB-NEN) is a relatively rare neoplasm, accounting for 0.5% of all neuroendocrine neoplasm cases and 2.1% of gallbladder cancers. Because of the limited understanding of GB-NEN, the aim of this study was to explore the clinicopathology and survival of GB-NEN patients selected from the Surveillance, Epidemiology, and End Results (SEER) database. Methods A total of 248 GB-NEN patients from the SEER database diagnosed between 2004 and 2015 were included. Kaplan–Meier curves were used to examine the survival time. Multivariate Cox proportional hazard models were used to estimate hazard ratios with 95% confidence intervals to analyze the impact of factors on overall survival and cancer-specific survival. Results The majority of the GB-NEN patients were women (67.3%), white (77%), and married (61.7%). Most tumors were <2 cm in size (31.0%), G3 stage (25.8%), and distant SEER stage (41.1%). 62.9% and 64.5% of cases showed an absence of lymph node metastasis and tumor metastasis, respectively. Patients who received gallbladder surgery had significantly better survival outcomes (P < 0.001). However, patients who received both gallbladder surgery and lymph node resection did not have better survival outcome compared with patients who received only gallbladder surgery. Multivariate Cox proportional hazard models indicated that older age, unmarried status, large tumor size (>5 cm), and distant SEER stage were significant independent predictors for decreased overall survival time and cancer-specific survival time (P < 0.05). Conclusion Age, marital status, tumor size, and SEER stage were predictors for the survival of GB-NEN patients. Gallbladder surgery was associated with better survival, but the combination of gallbladder surgery and lymphadenectomy had no effect on survival outcomes.

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Section: Discussionmentioning

confidence: 99%

Clinicopathological features and survival for gallbladder NEN: a population-based study

Cen

Liu

Wan

et al. 2019

Endocrine Connections

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“…The purpose of a radical resection is to eliminate lesions, confirm a clear diagnosis, provide a basis for post-operative comprehensive treatment and improve the quality of life of affected patients (33). Surgical methods include simple, radical and expanded radical cholecystectomy, whereby the choice of surgical type is often discussed between the medical professional and patient (44). The progress made in recent years to expand the time period during which radical resection can be performed, including R0 resection for GB-NEC, has increased the overall long-term survival time of patients (31).…”

Section: Treatment Optionsmentioning

confidence: 99%

“…Preoperative diagnosis often depends on the typical oncoid syndrome. Since GB-NEN and oncoid syndrome are not associated, patients typically visit the doctor only during middle-or late-stage presentation with metastasis (44). Therefore, to increase the diagnosis rate and prevent progression of GB-NEN, an appropriate treatment is advised following complete routine examination for all patients with chronic cholecystitis and cholecystolithiasis.…”

Section: Preventionmentioning

confidence: 99%

Neuroendocrine tumors of the gallbladder (Review)

et al. 2020

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A gallbladder neuroendocrine neoplasm (GB-NEN) is a unique heterogeneous neoplasm, originating from neuroendocrine cells and able to secrete peptides as its neurotransmitter. Among all the neuroendocrine tumors (NETs), the GB-NEN prevalence is 0.5%, which accounts for ~2.1% of all gallbladder tumors. The current study aimed to present an up-to-date review of the clinical features, diagnosis and treatment of NETs of the gallbladder. A systematic literature search was performed in order to identify all relevant studies published. Thus far, the etiology and pathogenesis of GB-NEN remains unclear. Moreover, an ambiguous clinical manifestation exists as observed during laboratory examinations. As GB-NEN is a rare gallbladder lesion and is seldom seen in clinical practice, there is a limited availability of review reports, and it is therefore often considered only as a case study. It is difficult to distinguish GB-NEN from other gallbladder diseases using imaging diagnostic techniques. Although chemotherapy treatment provides prolonged progression-free survival, surgery is considered the best option. Thus, to overcome the inherent risks or shortfalls of traditional surgery; early detection, diagnosis and treatment of GB-NEN are required to improve patient longevity.

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“…These observations indicate that the risk of metastasis increases with increase in tumor size. Conversely, Hirose et al reported that even G1 tumors of extremely small size (≤1 cm) metastasize to the gallbladder lymph nodes, and extended additional surgery is required in such cases (13). In general, in cases of gastrointestinal and pancreatic NETs, high mitotic counts, high Ki-67 proliferation index values, large tumor diameters, and high invasion depths are considered risk factors for the existence of lymph node or distant metastasis (14)(15)(16).…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, there is no evidence regarding the efficacy of extended surgery or adjuvant chemotherapy in GB-NET G1 and G2 cases (17). If metastasis is observed during the histopathological examination of the cystic duct node, it should be determined whether a radical second resection with regional lymphadenectomy is the appropriate treatment of choice (13). In cases with cystic duct lymph node metastasis, radical second resection with lymph node dissection should be considered as an option for accurate nodal evaluation, based on the reported outcomes of incidental gallbladder cancer (18).…”

Section: Discussionmentioning

confidence: 99%

Polypoid gallbladder neuroendocrine tumor diagnosed as benign polyp before surgery: A case report

Naito

Naito²,

Yamamoto³

et al. 2019

mol clin onc

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Gallbladder neuroendocrine tumors (GB-NETs) comprise only 0.5% of all NET cases, and their biology has been incompletely characterized. In the present study we report the case of a 50-year-old male patient with GB-NET who was admitted to Naito Hospital with diarrhea as the main complaint. At initial diagnosis, serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels were within the normal range. Abdominal ultrasonography and contrast-enhanced computed tomography (CT) revealed gallbladder adenomyomatosis and cholecystitis, and an 8-mm pedunculated polypoid lesion was found in the neck of the gallbladder using drip infusion cholecystocholangiography-CT. As it was considered a benign polyp, laparoscopic cholecystectomy was performed. Pathological examination revealed a polypoid lesion that comprised NET cells with a cord-like or ribbon-like arrangement, and the cells exhibited positive immunostaining for chromogranin A and synaptophysin. In addition, immunohistochemical staining showed a Ki-67 index (i.e., proliferation index) of <1%, and no necrosis or mitotic figures were observed in the background. Based on these observations, we diagnosed the following: GB-NET, G1, 10x12 mm in size and located in the gallbladder neck. According to the World Health Organization 2010 classification, NET G1 is a well-differentiated tumor, with the tumor cells having a low proliferative potential [Ki-67 index ≤2%; mitotic figure number <2 (/10 HPF)]. It is regarded as a low-to mild-grade malignancy. Low-grade GB-NET occurs relatively rarely, and no clear guidelines have been formulated regarding its surgical treatment, such as minimal surgical excision margins or lymph node dissection. Detailed treatment recommendations should be developed after systematic studies of additional cases of GB-NET.

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A 0.8-cm clear cell neuroendocrine tumor G1 of the gallbladder with lymph node metastasis: a case report

Cited by 12 publications

References 17 publications

Clinicopathological features and survival for gallbladder NEN: a population-based study

Clinicopathological features and survival for gallbladder NEN: a population-based study

Neuroendocrine tumors of the gallbladder (Review)

Polypoid gallbladder neuroendocrine tumor diagnosed as benign polyp before surgery: A case report

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