Combined Large Cell Neuroendocrine Carcinoma and Adenocarcinoma of the Gallbladder
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A 45-year-old male patient presented with right upper abdominal pain associated with anorexia, nausea, and passing of dark urine, a clinical picture of obstructive jaundice for 10 days. Laboratory tests revealed elevated liver enzymes as follows: alkaline phosphatase, 409 U/L (normal, 53–128); alanine transaminase, 356 U/L (normal, 10–60); aspartate aminotransferase, 166 U/L (normal, 10–40); total bilirubin, 136.5 μmol/L (normal, 3–20); and direct bilirubin, 94 mmol/L (normal 0–5). The patient underwent abdominal ultrasound and computerized tomography scan that revealed thickening of the gallbladder wall with multiple stones. In addition, there was a lobulated, “space-occupying lesion” in the liver at segment V. The mass extended to and was contiguous with the thickened fundus of the gallbladder. The entire mass (that involved the gallbladder and the liver) was 5.7 × 5.5 × 5.1 cm in size. The intra- and extrahepatic biliary radicals were dilated. Multiple enlarged...
KeywordsGall Bladder Neuroendocrine Tumor Carcinoid Tumor Obstructive Jaundice Small Cell Carcinoma