Department of Pathophysiological and Experimental Pathology, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Ishikawa 920-0293, Japan.
Pathol Res Pract. 2010 Jun 15;206(6):397-400. doi: 10.1016/j.prp.2009.10.008. Epub 2009 Nov 27.
Large cell neuroendocrine carcinoma (LCNEC) is a high-grade malignant neuroendocrine tumor that was first defined in the lungs. There are six previous reports on LCNEC in the gallbladder, comprising three cases combined with another tumor and three pure LCNECs. We describe a tumor combined with LCNEC and adenocarcinoma elements arising in the gallbladder and give a review of the literature. A 68-year-old woman was diagnosed as having gallbladder wall thickening and a hepatic mass. The surgically resected tumor had a dumbbell shape with gallbladder and liver elements. Histological examination revealed LCNEC in the liver and a deep infiltrative portion of the gallbladder, as well as a well-differentiated tubular adenocarcinoma in the mucosa of the gallbladder. The pseudoglandular structures of LCNEC were marked in the transitional area. Immunoreactivities for carcinoembryonic antigen and CA19-9 as well as for chromogranin A and synaptophysin were detected in the LCNEC element. High p53-protein expression and high proliferative activity estimated by Ki-67 positivity were observed in both elements. The results suggest a close relationship between LCNEC and adenocarcinoma, and support the theory that these elements originate from common cancer stem cells.
大细胞神经内分泌癌（LCNEC）是一种高级别恶性神经内分泌肿瘤，最初在肺部定义。已有 6 份关于胆囊 LCNEC 的报告，包括 3 例与另一种肿瘤合并的病例和 3 例纯 LCNEC 病例。我们描述了一例发生在胆囊的合并 LCNEC 和腺癌成分的肿瘤，并进行了文献复习。一名 68 岁女性被诊断为胆囊壁增厚和肝肿块。手术切除的肿瘤呈哑铃状，有胆囊和肝脏成分。组织学检查显示肝内 LCNEC 和胆囊深部浸润性部分，以及胆囊黏膜分化良好的管状腺癌。LCNEC 的假腺体结构在过渡区标记明显。LCNEC 成分中检测到癌胚抗原和 CA19-9 以及嗜铬粒蛋白 A 和突触素的免疫反应性。在两个成分中均观察到高 p53 蛋白表达和 Ki-67 阳性率估计的高增殖活性。这些结果表明 LCNEC 与腺癌密切相关，并支持这些成分起源于共同的癌症干细胞的理论。
