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PMC6466883_02
(a) CT of the abdomen coronal and axial views. A complex mass with foci of calcification in gallbladder fossa and 9 cm heterogeneous mass in the right hepatic lobe. (b) MRI of the abdomen axial view: large gallbladder complex mass of 5 x 4 cm with engulfed calcifications and stones extending into the liver. 9 cm liver mass with some central necrosis and calcifications and loss of clear fat plane separation between the gallbladder and right liver, associated with large hilar lymphadenopathy (4 x 5 cm) and compressive effects on the distal biliary system.
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Computed tomography (CT) of the abdomen and pelvis with contrast (Figure 1(a)) showed a solid heterogeneous mass of 9 cm in the right hepatic lobe, and a 5 cm complex mass with foci of calcification was identified in the gallbladder fossa associated with portacaval and porta hepatis lymphadenopathy measuring 3.5 cm in anteroposterior and extending 7 cm in the craniocaudal dimension. Magnetic resonance (MR) imaging of the abdomen (Figure 1(b)) delineates the same findings with a high likelihood of a gallbladder tumor with liver metastases.
(a) Neuroendocrine carcinoma, small-cell type, comprised of tumor cells arranged in an organoid pattern with peripheral palisading. There is cell compression with molding and increased mitosis. H&E: magnification x400. (b) Neuroendocrine carcinoma, small-cell type; the tumor cells are immunoreactive to immunomarker synaptophysin. Immunohistochemical stain: x400. (c) Neuroendocrine carcinoma, small-cell type. Proliferating marker Ki-67 shows more than 90% intranuclear positivity. Immunohistochemical stain: x400.
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Tumor cells were negative for alpha-fetoprotein (AFP), cytokeratin 7 (CK07), cytokeratin 20 (CK20), cluster of differentiation 2 (CD2), cancer antigen 19-9 aka carbohydrate antigen 19-9 (CA19-9), and cancer antigen-125 (CA-125) antibodies (Figures 2(a)-2(c)).