Primary Mixed Adenoneuroendocrine Carcinoma (MANEC) of Gallbladder


Primary Mixed Adenoneuroendocrine Carcinoma (MANEC) of Gallbladder

Mixed adenoneuroendocrine carcinoma (MANEC), described and recognized by WHO in 2010, is a rare gastrointestinal neoplasm [1], characterized by the presence of at least 30% each of epithelial and neuroendocrine components [2]. Нe tumor may appear in various levels of the digestive tract including the oesophagus, stomach, colon and appendix, as well as other sites, such as the bladder. MANEC is an exceptionally rare neoplasm of gallbladder. Нe neoplasm occurs mostly in the middle-aged to elderly females with mean age of 64 years. Based on few case studies, suggested pathogenesis includes intestinal metaplasia-dysplasia-carcinoma sequence or a neoplastic stem cell with potential for transformation along several tissue cell lines. Нe prognosis is generally poor unless early cholecystectomy is performed and MANEC is an incidental find LnJ.

An obese 74-year-old female with history of hypertension and hypercholesterolemia presented with complaints of general malaise and anorexia of two weeks duration. She had a single brief episode of syncope while at a shopping mall a few days preceding her presentation. One other episode of syncope was reported 2 years prior, for which the patient was treated conservatively Нe patient also admitted to a history of peptic ulcer disease which was treated medically, and a history of vague abdominal pain. At the time of clinical presentation, the patient denied headache, nausea, abdominal pain, abdominal distention, vomiting, blurring of vision, changes in weight or in bowel habits. Нe patient denied history of cardiovascular disease or diabetes.

She had a breast-cyst removed many years ago which was found to be benign. Нe patient’s family history was unremarkable with no sLJnLficant health concerns. Нe patient denied smoking or drinking alcohol. Upon physical examination, the abdomen was negative for masses or tenderness on palpation with no rebound tenderness or guarding. A CT of the abdomen and pelvis was performed, which showed sludge in the gallbladder. Ultrasound revealed an indeterminate mass in the gallbladder, and a follow-up MRI showed a 2.7x4.2x1.7 cm enhancing mass extending from the floor of the gallbladder fundus. Нere was no evidence for common bile duct or intrahepatic duct dilatation. Нe patient underwent a laparoscopic cholecystectomy with a wedge resection of the liver.

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Mary Wilson
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Journal of Tumor Research