Indiana University Indianapolis, IN, United States
Rawan Aljaras, MD, Mohammad Al-Haddad, MD Indiana University, Indianapolis, IN
Introduction: Extra-pulmonary small cell carcinoma has been reported from multiple sites, including the gallbladder. Small cell carcinoma of the gallbladder is a very rare tumor, it comprises 0.5% of all gallbladder cancers. It is usually found in elderly women and associated with cholelithiasis. Surgical resection may result in prolonged survival in occasional patients with localized disease. However, the development of distant metastases in most patients has led to the use of systemic chemotherapy as adjuvant therapy in this setting. While chemotherapy is not known to improve survival, five fluorouracyl may be promising as adjuvant therapy associated with radiotherapy.
Case Description/Methods: We report a case of a 67 year old female patient who initially presented with abdominal pain, thought to be likely due to cholecystitis. On further radiologic evaluation, she was found to have a distended gallbladder with areas of wall thickening and irregular nodularity protruding into the lumen, in addition to a large complex cystic mass in the pelvis measuring 17.9 cm. Endoscopic ultrasound was noted for gallbladder wall thickening to 22 mm, as well as numerous lymph nodes in the area. Fine needle aspiration with cytologic examinational was done and showed evidence of small cell carcinoma of the gallbladder. PET scan revealed extensive metastatic disease throughout the bone, lymph nodes, lungs and possibly the peritoneum at the time she was diagnosed. The patient passed away in less than a month from the date of diagnosis.
Discussion: There is limited information in the literature on the best therapeutic approach towards this cancer with anecdotal therapy extrapolated from experience in small cell cancer of the lung. Despite advancements in oncology and treatment modalities of different cancers, small cell carcinoma of gallbladder still carries a grave prognosis. Unfortunately, it is known to metastasize early and cause death shortly after diagnosis, as evidenced by our case here. Consideration should be given to a more aggressive screening in high risk individuals and early cholecystectomy in suspicious cases.
Figure: A- CT abdomen with IV contrast showing gallbladder wall thickening and luminal irregularities. B- EUS image showing a stone containing gallbladder with wall thickening and a malignant lymph node (LN). C- Diff-Quik stained smear (400X magnification) shows a cluster of malignant cells with a very high nuclear to cytoplasmic ratio and nuclear molding. D- The neoplastic cells test positive for the neuroendocrine marker CD56.
Rawan Aljaras indicated no relevant financial relationships.
Mohammad Al-Haddad indicated no relevant financial relationships.
Rawan Aljaras, MD, Mohammad Al-Haddad, MD. P2163 - Small Cell Carcinoma of Gallbladder: A Report of a Rare and Unfortunate Case, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.