Cisplatin and Gemcitabine for Small Cell Carcinoma of the Gall Bladder

Abstract

S mall cell carcinomas of the gall bladder (SCGB) are rare, poorly differentiated, aggressive, neuroendocrine tumors that are clinicopathologically different from other carcinomas of the GB. We describe 2 cases of SCGB treated with cisplatin and gemcitabine chemotherapy.A 48-year-old male, presented with abdominal discomfort for one month. On examination, there was obvious hepatomegaly. Computed tomography (CT) angiography revealed extensive tumor involvement within all hepatic segments consistent with extensive regional spread, along with peri-pancreatic lymphadenopathy. CT scan of the chest revealed no thoracic primary. Octreotide scan revealed abnormal hepatic uptake. Liver biopsy indicated high-grade neuroendocrine carcinoma (Fig. 1). Immunostains were positive for synaptophysin, chromogranin, and gastrin and negative for mucin.Systemic therapy administered included cisplatin 100 mg/m 2 on day 1 and gemcitabine 1000 mg/m 2 on days 1, 8, and 15; cycles repeated every 28 days. The patient tolerated the chemotherapy well. Repeat CT scan of the chest, abdomen, and pelvis revealed interval improvement after 2 cycles, with a notable decrease in the size of liver metastases and gallbladder primary. After the 5th cycle of chemotherapy, he developed increased abdominal discomfort. Repeated CT scan revealed an increase in the number of liver metastases. His condition deteriorated, with the development of ascites and encephalopathy and patient died 7 months after diagnosis.A 51-year-old Hispanic male, presented with complaints of abdominal pain for 1 month. CT scan of the abdomen revealed large gall bladder mass and gall bladder wall thickening. On physical examination he had icteric sclera and a nontender hepatomegaly without ascites or splenomegaly. CT abdomen and pelvis (Fig. 2) showed large mass in gall bladder, invading the liver, significant lymphadenopathy in the retroperitoneum, celiac axis and adjacent to superior mesenteric artery.An ultrasound-guided biopsy of retroperitoneal lymph node confirmed a high-grade neuroendocrine tumor, small cell type. CT scan of the chest was negative for thoracic primary. Serum total bilirubin was 11.2 mg/dL, alkaline phosphatase 1218 mg/dL, AST 85 U/L, and ALT was 74 U/L. Internal biliary stent was placed and palliative chemotherapy was administered: gemcitabine 800 mg/m 2 on days 1, 8 and 15 and cisplatin 75 mg/m 2 day 1, every 4 weeks. Patient

Small Cell Carcinoma of the Gall Bladder: Role of Adjuvant Chemotherapy

“…Intuitively, the chemotherapy regimen used in the adjuvant or first-line setting (for inoperable disease) has been similar to the small cell cancer of the lung, i.e., with platinum drugs (cisplatin and carboplatin) along with etoposide. There have been two reported cases in which the combination of cisplatin and gemcitabine was used in the first-line setting [5] with no observed efficacy. There also have been two reported cases of long-term survival; one patient (regional lymph node involvement) survived over 189 months after surgery and chemotherapy [6] while the other patient (regional lymph node involvement) survived more than 71 months after receiving surgery as the only primary therapy [7].…”

Small-Cell Carcinoma of the Gall Bladder: A Rare Tumor of the Gall Bladder

“…Similar to its efficacy in pulmonary SCC, the combination of etoposide and cisplatin has demonstrated effectiveness in treating patients with SCC of the gallbladder. As previously documented, gemcitabine can also be combined with platinum agents for administration in these cases [ 9 ]. SCC of the gall bladder has an extremely low incidence and poor prognosis.…”

Small Cell Carcinoma of Gallbladder With Nodal Metastasis Mimicking As Synchronous Malignancy in Gallbladder and Common Bile Duct

“…Cisplatin or carboplatin and etoposide have been used in the SCC of the gallbladder. The chemotherapeutic agents such as topotecan, irinotecan, taxanes, and gemcitabine or gemcitabine with platinum agents have been reserved for salvage with variable success [ 15 ]. Streptozocin with fluorouracil or doxorubicin was used for pancreatic NETs.…”