Clinicopathological characterization of gall bladder neuroendocrine neoplasm.  A case series.

Aarushi  Anupriya; Ravi  Reshav; Zikki Hasan  Fatima; Swarnim Kumar

doi:10.51168/sjhrafrica.v6i9.2109

Authors

Aarushi Anupriya Tutor, Department of Pathology, Shri Krishna Medical College, Muzaffarpur, Bihar, India
Ravi Reshav Post Graduate, Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India
Zikki Hasan Fatima Consultant Pathologist, Department of Pathology, Homi Bhabha Cancer Hospital and Research centre, Muzaffarpur, Bihar, India
Swarnim Kumar Chief Consultant / Assistant Professor, Department of Surgery, Homi Bhabha Cancer Hospital and Research centre, Muzaffarpur, Bihar, India

DOI:

https://doi.org/10.51168/sjhrafrica.v6i9.2109

Keywords:

Gallbladder, Neuroendocrine neoplasm, small cell carcinoma, Immunohistochemistry

Abstract

Background

Gallbladder neuroendocrine neoplasms (GB-NENs) are rare, aggressive tumors with limited data on their clinicopathological characteristics. This study aims to evaluate the clinical presentation, radiological features, histopathology, and immunohistochemical (IHC) profile of GB-NENs to enhance diagnostic and therapeutic strategies.

Methods

A retrospective case series of 15 patients diagnosed with GB-NENs at Homi Bhabha Cancer Hospital and Research Centre over one year was analyzed. Clinical symptoms, radiological findings, tumor markers, histopathology, and IHC markers were reviewed.

Results

Most patients were female (80%), with a mean age of 56.7 years. Abdominal pain (100%) was the most common symptom, while hepatic invasion (53.3%) was frequently observed on imaging. Histopathology revealed small cell neuroendocrine carcinoma (66.6%), neuroendocrine tumor grade 3 (20%), and mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN) (13.3%). IHC positivity for PanCK, INSM1, and chromogranin confirmed neuroendocrine differentiation.

Conclusion
GB-NENs exhibit aggressive behavior with poor prognosis, emphasizing the need for early diagnosis and standardized treatment approaches. Further studies focusing on molecular profiling and targeted therapies are essential for improving patient outcomes.

Recommendation
Given the rarity and diagnostic complexity of GB-NENs, clinicians should maintain a high index of suspicion in gallbladder masses with atypical imaging or histological features. Routine inclusion of neuroendocrine markers such as INSM1 and chromogranin in gallbladder biopsy evaluations can improve diagnostic accuracy. Multicenter collaborations, molecular characterization, and standardized therapeutic protocols are strongly recommended to enhance patient outcomes and guide future clinical practice.

References

Albores-Saavedra J, Batich K, Chable-Montero F, Sagalowsky AI, Henson DE. Neuroendocrine carcinomas of the gallbladder: Clinicopathologic analysis of 100 cases with a focus on striking histology. J Surg Oncol. 2010;101(6):500-5.

Roy P, Chetty R. Gallbladder neuroendocrine neoplasms: A case series and literature review emphasizing histological, prognostic, and therapeutic features. J Clin Pathol. 2016;69(8):686-91.

Zhang L, Garcia A, Kern S, Shi C. Gallbladder neuroendocrine tumors: Insights from a population-based study of the epidemiology and survival patterns. Cancer Epidemiol Biomarkers Prev. 2018;27(4):497-503.

Han X, Xu X, Ma H, Ji Y, Wang D, Kuang TT. Clinicopathological and prognostic features of gallbladder neuroendocrine neoplasms: A multicenter study in China. Asian Pac J Cancer Prev. 2014;15(19):8489-94.

Lee KC, Lee JK, Choi JS, Lee KT, Rhee JC, Kim KH. Clinicopathologic characteristics and outcomes of gallbladder neuroendocrine tumors: A retrospective analysis of the National Cancer Data Base. J Gastroenterol Hepatol. 2011;26(9):1306-11

Rindi G, Kloppel G, Alhman H, et al. TNM staging of foregut (neuro)endocrine tumors: a consensus proposal including a grading system. Virchows Arch. 2006;449(4):395-401. https://doi.org/10.1007/s00428-006-0250-1 PMid:16967267 PMCid:PMC1888719

Zhang L, Chen Z, Wang Y, et al. Clinical and pathological characteristics of gallbladder neuroendocrine neoplasms: A study of 19 cases. World J Gastroenterol. 2019;25(30): 4286-4294.

Moran CA, Suster S, Koss MN. Neuroendocrine carcinomas of the gallbladder: A clinicopathologic and immunohistochemical study of 12 cases. Am J Surg Pathol. 2017;21(6): 749-756.

Rindi G, Arnold R, Bosman FT, et al. Nomenclature and classification of neuroendocrine neoplasms of the digestive system. Histopathology. 2018;72(1): 182-190.

Albores-Saavedra J, Batich K, Hossain S, et al. Neuroendocrine tumors of the gallbladder: A clinicopathologic study of 32 cases. Am J Surg Pathol. 2004;28(9): 1189-1201.

Modlin IM, Shapiro MD, Kidd M. An analysis of rare gallbladder neuroendocrine tumors: Understanding symptoms, diagnostics, and outcomes. Cancer Epidemiol Biomarkers Prev. 2018;27(5): 654-661.

Igarashi M, Tsuchiya A, Ota T, et al. Outcomes of surgery versus non-surgical management for gallbladder neuroendocrine carcinoma. J Hepatobiliary Pancreat Sci. 2021;28(8): 1021-1030.

O'Toole D, Grossman A, Gross D, et al. ENETS Consensus Guidelines for the Standards of Care in Neuroendocrine Tumors: Pathology: diagnosis and prognostic stratification. Neuroendocrinology. 2009;90(2):162-6. https://doi.org/10.1159/000182196 PMid:19060454

Bosman FT, Carneiro F, Hruban RH, et al. WHO Classification of Tumours of the Digestive System. 4th ed. IARC Press; 2019.