Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Feb 14, 2020; 26(6): 686-695
Published online Feb 14, 2020. doi: 10.3748/wjg.v26.i6.686
Flushing as atypical initial presentation of functional gallbladder neuroendocrine carcinoma: A case report
Ming Jin, Bo Zhou, Xiong-Ling Jiang, Qi-Yi Zhang, Xiang Zheng, Yuan-Cong Jiang, Sheng Yan
Ming Jin, Bo Zhou, Qi-Yi Zhang, Xiang Zheng, Yuan-Cong Jiang, Sheng Yan, Department of General Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China
Xiong-Ling Jiang, Department of Pathology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China
Author contributions: Jin M and Zhou B reviewed the literature, acquired the data and contributed to manuscript drafting; Jiang XL analyzed and interpreted the pathological and immunohistochemical findings, and contributed to manuscript drafting; Zhang QY was the patient’s surgeon, acquired the data, and contributed to manuscript drafting; Zheng X and Jiang YC analyzed and interpreted the imaging findings and contributed to manuscript drafting; Yan S acquired the data and was responsible for the revision of the manuscript for important intellectual content; All authors issued final approval for the version to be submitted.
Supported by The National Natural Science Foundation of China, No. 81572975; Key Research and Development Project of Science and Technology Department of Zhejiang, China, No. 2015C03053.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sheng Yan, MD, PhD, Chief Doctor, Associate Professor of Medicine, Department of General Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, No. 88 Jiefang Road, Hangzhou 310009, Zhejiang Province, China. shengyan@zju.edu.cn
Received: September 21, 2019
Peer-review started: September 21, 2019
First decision: November 4, 2019
Revised: December 31, 2019
Accepted: January 11, 2020
Article in press: January 11, 2020
Published online: February 14, 2020
Abstract
BACKGROUND

Neuroendocrine neoplasms are rarely located in the gallbladder (GB), and carcinoid syndrome is exceedingly rare in patients with GB neuroendocrine neoplasms.

CASE SUMMARY

We report a case of GB neuroendocrine carcinoma (GB-NEC) in a 65-year-old man, who presented with flushing for 2 mo. Pathological specimens of the flushed skin revealed that mucin was deposited between the collagen bundles in the dermis. Computed tomography and magnetic resonance imaging indicated neoplasm in the GB with liver invasion and enlarged lymph nodes in the portacaval space. High fluorodeoxyglucose uptake was detected in lymph nodes in the portacaval space, but distant metastasis was not seen by positron emission tomography. Ultrasound-guided needle biopsy of the GB neoplasm was suggestive of high-grade NEC. Because of the functional characteristics of poorly differentiated NEC, en bloc cholecystectomy, resection of hepatic segments IVb and V, pancreaticoduodenectomy, and regional lymphadenectomy were performed. A diagnosis of poorly differentiated NEC was made by pathological findings and immunohistochemical staining data. Ki-67 index was > 80%. The patient refused adjuvant therapy and passed away in the 7th month.

CONCLUSION

Distinctive manifestation combined with imaging helps make correct preoperative diagnosis. Radical surgery and adjuvant chemotherapy might improve prognosis.

Keywords: Malignant carcinoid syndrome, Neuroendocrine tumors, Carcinoma, Gallbladder, Carcinoid tumor, Case report

Core tip: Neuroendocrine neoplasms are rarely located in the gallbladder (GB), and carcinoid syndrome is exceedingly rare in patients with GB neuroendocrine neoplasms. We present herein, a rare case of GB neuroendocrine carcinoma in a 65-year-old man, who presented with flushing for 2 mo. En bloc cholecystectomy, resection of hepatic segments IVb and V, pancreaticoduodenectomy, and regional lymphadenectomy were performed. Surgery helped to alleviate his symptoms. Distinctive manifestation combined with imaging helps make correct preoperative diagnosis. Radical surgery followed by adjuvant chemotherapy might improve the prognosis of advanced GB neuroendocrine carcinomas.