Mixed adenoneuroendocrine carcinoma of the gallbladder,amphicrine type: Case report and review of literature |
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| Affiliation: | 1. Department of Pathology and Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, USA;2. Department of Pathology and Laboratory Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA;1. School of Life Sciences, Zhengzhou University, Zhengzhou 450001, China;2. Department of Clinical Laboratory, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450007, China;3. Department of Orthopedics, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450007, China;4. Department of Pathology, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou, 450007, China;5. Department of General Surgery, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou 450007, China;1. Iranshahr University of Medical Sciences, Iranshahr, Iran;2. Department of Gynecology Oncology, Woman Health Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran;3. Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran;4. Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran;5. Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran;6. Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex BN1 9PH, UK;1. Department of Pathology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea;2. Department of Pathology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, South Korea;1. Ospedale Policlinico San Martino IRCCS, Genova, Italy;2. Anatomic Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Italy;1. Ospedale Policlinico San Martino IRCCS, Genova, Italy;3. Gastroenterology Unit, Ospedale Policlinico San Martino IRCCS, Genova, Italy;1. Ospedale Policlinico San Martino IRCCS, Genova, Italy;5. Endocrinology Unit, Department of Internal Medicine (DIMI), University of Genova, Italy;1. Ospedale Policlinico San Martino IRCCS, Genova, Italy;2. Anatomic Pathology Unit, Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genova, Italy;1. Department of Pathology, Military Institute of Medicine, Warsaw, Poland;1. Division of Gastroenterology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York;3. Department of Pathology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York |
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| Abstract: | Amphicrine type mixed adenoneuroendocrine carcinoma (MANEC), also known as amphicrine carcinoma, is an exceedingly rare neoplasm comprising of tumor cells simultaneously demonstrating both neuroendocrine and exocrine differentiation. Majority of reported cases were found in tubular gastrointestinal tracts such as colon. Herein, we report the first case of amphicrine carcinoma in gallbladder in a 57-year-old female who presented with abdominal pain, vomiting, and gallbladder mass on imaging followed by radical cholecystectomy. Macroscopically, the tumor was a polypoid solid mass with a firm and tan-white cut surface located at the gallbladder fundus. Histologically, the tumor cells were composed of monotonous-appearing signet-ring cells with fine chromatin, variably conspicuous nucleoli, brisk mitotic figures, and spotty necrosis. They were loosely clustered, forming nests and cords but no glandular formation. Immunohistochemically, the entire tumor showed strong and diffuse immunoreactivity for CDX2, p53, and synaptophysin, with patchy positivity for CD56, chromogranin, and INSM1. Kreyberg stain highlighted both intracytoplasmic and extracellular mucin. Ki-67 proliferation index was approximately 70%. Next-generation sequencing performed on a 724 cancer-related gene panel identified TP53 mutation at c.844C>T (p.R282W). To our knowledge, this is the first case of amphicrine carcinoma in gallbladder. It highlights the complex dynamism and controversial pathogenesis of this unique entity, the exact mechanism and clinicopathologic behavior of which are not yet understood. |
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| Keywords: | Mixed adenoneuroendocrine carcinoma Amphicrine Gallbladder |
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