PMC3875121_01
Prechemotherapy abdominal computed tomography (CT) showing (a) a large 7.9 x 5.1 cm heterogeneous mass involving the gallbladder and the adjacent liver and (b) enlarged portocaval and para-aortic lymph nodes.
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A left paraaortic lymph node (PALN) was seen of size 2.9 x 4.7 x 4.7 cm. Another enlarged lymph node is seen at the aortocaval group measuring 1.8 x 1.7 cm (Figure 1).
Postchemotherapy abdominal CT showing interval regression of the known masses around the GB, portocaval, aortocaval, and left paraaortic stations by about 35-45%.
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Postchemotherapy CT imaging showed significant response (35-45% regression) (Figure 2), and patient underwent cholecystectomy, portahepatic lymphadenectomy, and hepatic metastasectomy.
Histopathology of surgical specimen showing (a) chromogranin positivity, (b) synaptophysin positivity, (c) Ki-67 positivity, and (d) hematoxylin and eosin stained small cells consistent with small cell carcinoma of gallbladder.
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One retrieved lymph node was found metastatic small cell carcinoma with extensive fibrosis (Figure 3).
Follow-up abdominal CT at one year showing the recurrent soft tissue mass adjacent to the liver inseparable from the right adrenal and interval increased in size of the left para-aortic lymph nodes.
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CT showed recurrent progressive disease with right adrenal gland invasion and progression of PALN size (Figure 4). CT-positron emission tomography (CT-PET) showed soft tissue lesion on the right adrenal region and it showed also focal fluorodeoxyglucose (FDG) uptake (SUV max 6.5).
Plain radiograph of right arm showing aggressive bony lesion involving the distal metadiaphysis and epiphysis of the right humerus and associated with the sunburst periosteal reaction and pathological fracture.
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X-ray was done which showed aggressive bony lesion involving the distal metadiaphysis and epiphysis of the right humerus and associated with the sunburst periosteal reaction and pathological fracture (Figure 5).