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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
"and"
symptom
achondroplasia
adrenomyeloneuropathy
aniridia
carcinoma of the gallbladder
cutaneous mastocytosis
cystinuria
esophageal squamous cell carcinoma
harlequin ichthyosis
hodgkin lymphoma, classical
hydrocephalus with stenosis of the aqueduct of sylvius
kallmann syndrome
liposarcoma
locked-in syndrome
neonatal adrenoleukodystrophy
omenn syndrome
oral submucous fibrosis
pleomorphic liposarcoma
primary hyperoxaluria type 1
proteus syndrome
pyomyositis
pyruvate dehydrogenase deficiency
sneddon syndrome
triple a syndrome
trochlear dysplasia
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