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Abstracts:
Albores-Saavedra J,
Henson DE, Sobin LH. WHO histological typing of tumors of the
gallbladder and extrahepatic bile ducts Berlin, Germany: Springer-Verlag,
1991.
Albores-Saavedra J,
Henson DE. Tumors of the gallbladder and extrahepatic bile ducts:
atlas of tumor pathology Fasc 22, ser 2. Washington, DC: Armed Forces
Institute of Pathology, 1986.
Small cell carcinoma of the gallbladder: a clinicopathologic,
immunohistochemical, and molecular pathology study of 12 cases.
Am J Surg Pathol. 2001 May;25(5):595-601.
Small cell
carcinomas of the gallbladder are unusual neoplasms that have been
characterized only recently. The authors describe the clinical,
histopathologic, immunohistochemical, and molecular features of 12
small cell carcinomas of the gallbladder. The mean age at diagnosis
was 69 years, and the male-to-female ratio was 5:7. The neoplasms had
an average size of 3 cm, and 90% showed invasion of the muscularis
propria and perimuscular connective tissue. Seventy-five percent of
the carcinomas had metastasized or extended locally beyond the
gallbladder at surgery. Survival was uniformly poor, with a mean
survival of 10.7 months (range, 3-25 months). Half the small cell
carcinomas were combined with other neoplasms. Four had foci of
adenocarcinoma, one contained areas of squamous differentiation, and
another had a component of carcinosarcoma. Immunohistochemical
analysis showed focal reactivity for chromogranin (six of six cases),
neuron-specific enolase (six of six cases), and Leu-7 (three of three
cases). The molecular changes in small cell carcinomas were similar to
those of adenocarcinomas occurring at this site, with a high frequency
of p53 (75%) and p16INK4a (33%) abnormalities, and a low frequency of
deleted in pancreatic carcinoma-4 inactivation (0%) and K-ras codon 12
mutations (17%). In contrast to pulmonary small cell carcinomas,
p16INK4a function appears to be abrogated more frequently in these
carcinomas.
Small cell carcinoma of the gallbladder.
J Surg Oncol. 1999
Jan;70(1):54-9.
BACKGROUND AND
OBJECTIVES: Small cell carcinoma of the gallbladder is rare with only
36 cases reported in the literature. Early reports demonstrated an
extremely poor prognosis for this histologic type. Five new cases are
reported and the previous experience in the literature is reviewed to
further clarify the clinical behavior of this malignancy. METHODS: A
retrospective analysis is performed on 5 new cases. An extensive
review of the literature is also performed. RESULTS: Twenty-eight pure
small cell carcinomas and 8 combined small cell carcinomas with
adenocarcinoma are reported in the literature. Conclusions from the
literature review reveal that small cell carcinoma of the gallbladder
affects an elderly patient population (median age 65 years), has a
female preponderance (76%), is associated with cholelithiasis (72%),
metastasizes to nodes (88%), liver (88%), lung (23%), and peritoneum
(19%), and has a median survival of 4 months. Pure tumors had median
survivals of 9 months and combined tumors had median survivals of 4.5
months. The 5 patients in the literature treated with surgery and
chemotherapy had improved median survival of 13 months. The 5 newly
reported cases had similar epidemiological characteristics to the
literature data, however, these cases were managed aggressively with
surgery and chemotherapy, demonstrating a median survival of 31
months. CONCLUSIONS: Although small cell carcinoma of the gallbladder
is a distinct histologic and clinical entity, it has many clinical
characteristics similar to adenocarcinoma of the gallbladder including
comparable natural history and tendency for locoregional spread.
Aggressive multimodality therapy, especially the combination of
surgery and chemotherapy, may improve survival.
Small cell carcinoma of the gallbladder: report of two cases.Pathol
Oncol Res. 1999;5(3):235-8.
Two Taiwanese
patients with gallbladder small cell carcinoma are reported. One is a
79 year-old male, the other, a 86 year-old female. They both presented
with the symptom/signs of acute cholecystitis and underwent
cholecystectomy. An intramural mass in the gallbladder neck region was
found in the first patient, while the second patient had a transmural
indurated tumor in the gallbladder body with extension to the neck
region. Characteristic histological and immunohistochemical features
of small cell carcinoma were present in both, and electron dense
neurosecretory granules were identified in the second. To our
knowledge, the second patient is the oldest ever reported. The first
patient received chemotherapy directed toward the initial erroneous
diagnosis of non-Hodgkin s lymphoma and developed liver metastasis in
two months. The second patient did not receive chemotherapy due to her
poor general condition and local recurrence occurred in six weeks.
Both passed away three and five months after surgery, respectively.
Small-cell
undifferentiated carcinoma of neuroendocrine type originating in the
gallbladder.Curr
Surg. 2002 Sep-Oct;59(5):495-7.
PURPOSE: We
report a case of small-cell undifferentiated carcinoma with
neuroendocrine (SCUCN) of the gallbladder in a 67-year-old man who
presented with suspected cholelithiasis. Treatment included a
cholecystectomy and a 4-cycle course of etoposide and carboplatin.
CONCLUSIONS: Small-cell undifferentiated carcinoma with neuroendocrine
features of the gallbladder is a rare disease with approximately 30
cases reported in the literature. Clinical characteristics include an
association with cholelithiasis, an elderly age distribution, a female
preponderance, and a correlation with cigarette smoking. It is known
to behave aggressively and carry a grave prognosis, with extensive
local invasion and early metastasis being characteristic. Medical and
surgical therapies exist and have demonstrated best results when used
in combination.
Primary small cell
carcinoma of the common bile duct, in which surgical treatment was
performed after neoadjuvant chemotherapy: report of a case.Surg
Today. 2003;33(11):870-2.
Primary small
cell carcinoma of the hepatobiliary tract is rare. Most cases occur in
the gallbladder or in the ampulla of Vater, and such cases in the
common bile duct (CBD) are extremely rare. We herein report a case of
small cell carcinoma arising in the CBD. In this case, neoadjuvant
chemotherapy followed by pylorus-preserving pancreaticoduodenectomy
showed an excellent response. To our knowledge, this is the first
reported case of small cell carcinoma of the CBD in which a radical
resection was performed after successful neoadjuvant chemotherapy.
Small-cell carcinoma
manifesting systemic lymphadenopathy combined with adenocarcinoma in
the gallbladder: aggressiveness and sensitivity to chemotherapy.J
Gastroenterol. 2003;38(8):801-5.
Small-cell
carcinoma of the gallbladder is a very rare tumor. In this report, we
describe a patient with small-cell carcinoma combined with
adenocarcinoma in the gallbladder. The patient was a 70-year-old man,
who clinically manifested systemic lymphadenopathy. An incisional
biopsy of Virchow's lymph node revealed small-cell carcinoma.
Abdominal computed tomography (CT) showed massive multiple paraaortic
lymph node swelling and a round mass in the gallbladder, although
chest CT did not show any abnormal masses in the lung. After two
courses of chemotherapy (PVP therapy; cisplatin [CDDP], 80 mg/m(2),
day 1, intravenous injection; and etoposide [VP-16], 50 mg/m(2), every
day, per oral intake; given every 3 weeks) were performed, the
systemic lymphadenopathy had completely diminished and only the
gallbladder tumor remained on clinical examinations. Endoscopic
retrograde cholangiopancreatography (ERCP) revealed nodular tumors in
the gallbladder fundus. Cholecystectomy with partial resection of the
liver was performed. Pathological examination revealed small-cell
carcinoma combined with adenocarcinoma of the gallbladder. We discuss
the characteristics and the treatment of this rare tumor.
Small cell carcinoma of
the gallbladder: a case report and review of 53 cases in the
literature.
Hepatogastroenterology. 2001 Nov-Dec;48(42):1588-93.
Although small
cell carcinoma of the gallbladder is rare, the prognosis of this tumor
type is poorer than that of differentiated carcinomas. We report
herein the case of a 62-year-old man with small cell carcinoma of the
gallbladder. The operative findings showed an unresectable large tumor
of the gallbladder and multiple metastases involving the liver and
lymph nodes. Pathological findings revealed small sized carcinoma
cells, round or oval in shape which displayed a cord-like or solid
appearance. Diagnosis was confirmed by ultrastructural study that
showed the presence of neurosecretory-type cored granules. He was
treated by intraarterial chemotherapy with cisplatin and etoposide.
Six months later, abdominal computed tomography scan confirmed loss of
the large mass. A complete response to the chemotherapy was noted over
a period of six months, suggesting the efficacy of intraarterial
chemotherapy for this disease. Fifty-three cases of small cell
carcinoma reported in the English literature are reviewed. In most
cases, including ours, a radical operation was not indicated and the
prognosis was extremely poor, due to the difficulty of early diagnosis
and the rapid progression of the disease. Chemotherapy is effective in
general and intraarterial chemotherapy performed in the present case
may be particularly useful to improve survival.
Small cell carcinoma of
the gall-bladder with intestinal metaplastic epithelium.Pathol
Int. 1998 Apr;48(4):303-6.
A case of small
cell carcinoma of the gall-bladder is described. Immunohistochemically,
the tumor cells were positive for chromogranin A, synaptophysin and
neuronspecific enolase, which suggests that they derived from
neuroendocrine cells. The overlying and surrounding epithelium of the
tumor showed intestinal metaplasia including goblet cells,
pseudopyloric glands, Paneth's cells, and chromogranin A and
synaptophysin-positive endocrine cells. Definite adenocarcinoma was
absent. The endocrine cells in the epithelium were more numerous in
the vicinity of the tumor. The present case supports the supposition
that endocrine cell tumor (including small cell carcinoma) of the
gall-bladder may develop from endocrine cells of the intestinal
metaplastic lesion.
Small-cell carcinoma of
gallbladder. An immunocytochemical and ultrastructural study.
Pathol Res Pract.
1991 May;187(4):472-6.
An unusual
carcinoma of the gallbladder in a seventy-one-year-old woman displayed
features of a well-differentiated adenocarcinoma, atypical carcinoid
and small cell undifferentiated carcinoma. The patient died from
progressive hepatic failure four months after surgery. Autopsy showed
bulky liver masses and several peritoneal nodules exclusively composed
of small, hyperchromatic cells. The neuroendocrine nature of the small
cell component of the tumor was documented by the presence of
neurosecretory granules at the ultrastructural level and by
immunocytochemical positivity to NSE and Synaptophysin. The epithelial
markers, cytokeratin and CEA, were also positive in the carcinoid and
in the undifferentiated portions of the tumor. A common endodermal
origin is suggested for carcinoid and small cell carcinoma of the
gallbladder.
Oat cell carcinoma of
the gallbladder. A rare and highly lethal neoplasm.Arch
Pathol Lab Med. 1993 Oct;117(10):1009-12.
Oat cell
carcinomas arising in the gallbladder are an extremely rare and
aggressive form of gallbladder cancer. These neoplasms are
morphologically identical to their pulmonary counterparts, contain
neurosecretory granules on ultramicroscopic examination, and
demonstrate immunohistochemical staining for cytokeratin,
neuron-specific enolase, and other neuroendocrine markers. Oat cell
carcinomas typically occur in elderly women with cholelithiasis, and
pursue a fulminant course with extensive metastases, especially to the
liver. The mean survival is less than 7 months. We present a
well-documented case of oat cell carcinoma of the gallbladder and
review the literature on this unusual entity.
Small cell carcinoma of
the gallbladder combined with adenocarcinoma.Acta
Pathol Jpn. 1991 Nov;41(11):841-6.
A rare case of
small cell carcinoma (SCC) of the gallbladder combined with
adenocarcinoma is reported. The patient was a 70-year-old Japanese
man, who died of the disease shortly after the onset of symptoms.
Autopsy disclosed a small tumor (1.0 cm in longest diameter) in the
fundus of the gallbladder, with widespread metastasis. Histochemically,
the tumor cells showed negative reactions for argyrophilic and
argentaffin stainings, a weak immunohistochemical reaction only for
neuron-specific enolase, and negative reactions for all of the other
neurosecretory markers used, including neurofilament, chromogranin,
somatostatin, gastrin and leu-7. However, electron microscopic
examination revealed a few typical neurosecretory granules (NSG) in
the cytoplasm of some tumor cells. We suggest that: 1. The presence of
NSG in the cytoplasm of tumor cells is the most reliable diagnostic
criterion for SCC. 2. SCC, at least the combined type, arises from a
multipotential stem cell.
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