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Brain metastasis from gallbladder neuroendocrine carcinoma
  1. Hanako Sasaki1,
  2. Takayoshi Goto2,
  3. Motohiro Hirao3 and
  4. Yasunori Fujimoto1
  1. 1Neurosurgery, Osaka Rosai Hospital, Sakai, Osaka, Japan
  2. 2Pathology, Osaka Rosai Hospital, Sakai, Osaka, Japan
  3. 3Gastroenterology and Hepatology, Osaka Rosai Hospital, Sakai, Osaka, Japan
  1. Correspondence to Dr Hanako Sasaki; hanakos444{at}gmail.com

Abstract

A 52-year-old woman was diagnosed with unresectable gallbladder neuroendocrine carcinoma (GB-NEC) exhibiting lymph node and peritoneal metastases, and received eight courses of chemotherapy with irinotecan plus cisplatin. Radiological examinations revealed significant regression of the GB tumour and disappearance of metastatic lesions, so the patient underwent laparoscopic cholecystectomy. However, the patient presented with multiple haemorrhagic brain metastases (BMs) and died 13 months after the initial diagnosis despite neurosurgical interventions. Pathological examination of the resected gallbladder demonstrated an extensive fibrous scar along with tubular adenocarcinoma components, which may indicate that the chemotherapy eliminated a pre-existing neuroendocrine carcinoma (NEC) component. Furthermore, pathological analysis confirmed that the BMs comprised NEC. In patients with advanced GB-NEC, conversion surgery may be a reasonable option if a first-line chemotherapy leads to downstaging of the tumour. Second-line drug therapy and systemic screening might also be considered in cases with BMs.

  • neuroendocrinology
  • endocrine cancer

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Footnotes

  • Contributors HS and YF treated this patient neurosurgically and drafted the manuscript. TG carried out the pathological diagnosis and evaluated its pathological characteristics. MH provided the chemotherapy for the patient and critically revised the manuscript. YF supervised the work. All authors read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parents/Guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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