Flushing as atypical initial presentation of functional gallbladder neuroendocrine carcinoma: A case report

Figure 1 Visible changes of the skin. A, B: The skin over the face, neck, upper chest, and limbs was flushed, accompanied by desquamation before surgery; C, D: Flushing was obviously relieved on day 5 postoperatively; E, F: At 2 wk after surgery, flushing faded entirely and skin pigmentation was visible.

Figure 2 Computed tomography examination. A: Gallbladder neoplasm was visible in unenhanced imagery; B: Gallbladder neoplasm was mildly enhanced in arterial phases; C: Gallbladder neoplasm was mildly enhanced in venous phases; D: Enlarged lymph nodes were seen in the portacaval space.

Figure 3 Magnetic resonance imaging examination. A: The gallbladder neoplasm was revealed with liver invasion on T1-weighted imaging; B: The gallbladder neoplasm was revealed with liver invasion on T2-weighted imaging; C: The neoplasm showed increased signals in contrast-enhanced phase; D: Several enlarged lymph nodes were found in the portacaval space.

Figure 4 Positron emission tomography examination. A, B: Fluorodeoxyglucose uptake was higher in the gallbladder; C, D: Fluorodeoxyglucose uptake was higher in lymph nodes in the portacaval space; E, F: Fluorodeoxyglucose uptake did not significantly increase in other tissue.

Figure 5 Pathological examination and immunohistochemical staining (20 ×). A: Hematoxylin and eosin staining revealed poorly differentiated gallbladder neuroendocrine carcinoma with liver invasion; B: Immunohistochemical staining revealed positive expression of chromogranin A; C: Immunohistochemical staining revealed positive expression of synaptophysin; D: Immunohistochemical staining revealed that the Ki-67 index was > 80%.