An Early Diagnosed Case of Adenoendocrine Cell Carcinoma of the Gallbladder

Tatsuhiro Ishii, Hiroki Jyohira, Ryohei Watanabe, Katsusuke Ohmori, Nobuhiro Miyata Hiroshi Sonobe^* and Yuji Ohtsuki^*

Department of Surgery, Matsuyama-shimin Hospital

^*Second Department of Pathology, Kochi Medical School

A 70-year-old women complaining of diarrhea was admitted to our hospital. During the examination, computed tomography showed a mass in the cystic duct of the gallbladder. Subsequently, cholecystectomy and choledochectomy were performed. The histopathological diagnosis revealed that the resected tumor, 8×7mm in size on diameter was adenoendocrine cell carcinoma of the gallbladder. Adenocarcinoma in the mucosa showed gradual transition to endocrine cell carcinoma in the deeper tissues. Immunostaining disclosed a transitional form which was bonding between adenocarcinoma and endocrine cell carcinoma. Electron microscopy revealed that endocrine-granules detected even in adenocarcinoma cells were in transitional position. The granule was 0.3∼0.4μm in diameter, round-elldptic in shape, and distributed mainly in the basal part of cancer cells from the transitional border. There was no finding of exocytosis. These granules may suggest a differentiation marker to transitional form of the endocrine cells from the adenocarcinoma cells, beecause both kinds of cells were detected in the identical tubule. Developement of adenoendocrine cells are thought to bo a clonal growth of endocrine cells in deeper tissues. We believe that the debree of biological malignancy was very high in this case, because of the rapid progressive, vascular invasion, metastasis in a lymph node, and multiple metastases in liver observed 10 months postoperation.

Key words
adenoendocrine cell carcinoma, gallbladder, immunohistochemistry

Reprint requests
Tatsuhiro Ishii Department of Surgery, Matsuyama-shimin Hospital 2-6-5 Ootemachi, Matsuyama-city, 790-0067 JAPAN

Accepted
November 30, 1999

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