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Mixed adenoneuroendocrine carcinoma of the gallbladder with squamous cell carcinomatous and osteosarcomatous differentiation: report of a case.
[carcinoma of the gallbladder]
An
extremely
rare
case
of
mixed
adenoneuroendocrine
carcinoma
(
MANEC
)
of
the
gallbladder
is
reported
,
in
which
the
tumor
showed
diverse
differentiation
toward
neuroendocrine
tumor
(
grade
2
)
,
tubular
adenocarcinoma
,
squamous
cell
carcinoma
,
and
,
in
addition
,
osteosarcoma
.
The
patient
was
an
80
-
year
-old
man
,
who
underwent
cholecystectomy
because
of
a
large
polypoid
tumor
filling
the
gallbladder
lumen
.
The
tumor
consisted
of
an
intimate
admixture
of
neuroendocrine
tumor
(
grade
2
)
and
tubular
adenocarcinoma
,
and
,
in
many
areas
,
cell
nests
of
neuroendocrine
tumor
appeared
to
bud
off
from
tubular
structures
of
the
adenocarcinoma
,
in
a
manner
resembling
the
'
ductulo-insular
complex
'
seen
in
nesidioblastosis
of
the
pancreas
.
Small
areas
of
squamous
cell
carcinoma
were
also
found
.
The
stroma
consisted
of
a
dense
proliferation
of
atypical
spindle
cells
showing
focal
osteosarcomatous
differentiation
,
and
an
apparent
transition
from
an
epithelial
tissue
component
to
atypical
spindle
cells
was
observed
.
Immunohistochemically
,
neuroendocrine
cells
were
positive
for
synaptophysin
,
chromogranin
A
,
and
serotonin
,
and
the
sarcomatoid
stroma
was
partly
immunoreactive
for
cytokeratin
.
The
present
case
is
the
first
example
of
MANEC
of
the
gallbladder
with
simultaneous
squamous
cell
carcinomatous
and
osteosarcomatous
differentiation
.
'
Neometaplasia
'
of
carcinoma
cells
in
diverse
directions
was
considered
the
most
plausible
explanation
for
the
formation
of
this
multifaceted
neoplasm
.
Diseases
Validation
Diseases presenting
"osteosarcoma"
symptom
alpha-thalassemia
carcinoma of the gallbladder
dedifferentiated liposarcoma
focal myositis
kindler syndrome
liposarcoma
pleomorphic liposarcoma
pyomyositis
well-differentiated liposarcoma
werner syndrome
This symptom has already been validated