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

Table 1 Patient details, neoplasm localization, pathology, treatment, and follow-up of reported functional gallbladder neuroendocrine neoplasms

Case	Ref.	Age in yr, sex	Presentation	Physical examination	Primary site	Pathology	Treatment	Follow-up
1	Monier et al[12]	60, M	Epigastric pain, jaundice, flushing, cough, wheezing	NA	fundus of GB	Size: NA; PI: ~ 60%; IHC: Chromogranin A (+), synaptophysin (+), CD56 (+), CK7 (+), polyclonal carcinoembr-yonic antigen (+), Caudal-type homeobox transcription factor 2 (+), S-100 (−), CK20 (−), CD10 (−), CK19 (−), prostate-specific antigen (−),thyroid transcription factor-1 (−), HepParl (−)	NA	NA
2	Lin et al[13]	65, F	3 mo progressive generalized weakness and anorexia	Proximal muscle weakness, hirsutism, moon face, buffalo hump	Body of GB	Size: NA; PI: NA; IHC: Chromogranin (+), synaptophysin (+), adrenocortico-tropic hormone -stain (+)	Cholecystect-omy and wedge-shaped liver resection	Hepatic metastasis 2 mo after surgery
3	Howlett et al[14] and Coates et al[15]	68, F	NA	Cushing’s syndrome	GB	Size: NA; PI: NA; IHC: Neuron specific enolase immunostain-ing (+)	NA	Survived for 1 mo following presentation
4	Ahn et al[16]	52, F	Episodic hypoglycemia of 10 mo duration	NA	GB	Size: 10.3 cm × 7 cm × 5.3 cm; PI: NA; IHC: CD56 (+), chromogranin (+), synaptophysin (+), immunochem-ical staining for insulin (+)	Hepatic segmentectomy, cholecystecto-my, pancreaticosp-lenectomy	NA
5	Salimi et al[17]	79, M	Watery diarrhea, abdominal pain, and weakness for several weeks	NA	GB	Size: 0.5 cm in thickness and 1.5 cm in diameter; PI: NA; IHC: Neuron specific enolase immunostain-ing (+), chromogranin (+)	NA	The patient died on his 3rd day of hospitalization from multiple organ failure
6	Present case	65, M	A history of flushing for 2 mo	The skin over face, neck, upper chest and limbs flushed and was scaly	neck of GB	Size: 4.0 cm × 2.0 cm; PI: Ki-67 (80%+++); IHC: Chromogranin A (+), synaptophysin (+), pan-CK (+), CK19 (+), CD56 (+), thyroid transcription factor-1 (a few +), CK7 (−), glypican-3 (−)	En bloc cholecystect-omy, resection of hepatic segment IVb and V, Whipple and regional lymphadenec-tomy were performed	The skin became flushed in 3rd month after surgery and the patient passed away in 7th month

M: Male; F: Female; NA: Not available; GB: Gallbladder; PI: Proliferation index; IHC: Immunohistochemistry; CD: Cluster of differentiation; CK: Cytokeratin.