[Rare neuroendocrine carcinoma of the gall bladder. Coincidental occurrence of an endometrioid ovarian adenocarcinoma].

HISTORY AND CLINICAL FINDINGS: The histological investigation of a surgical specimen (after cholecystectomy) from a 73-year-old woman revealed a poorly differentiated carcinoma with glandular structures and a lymph node metastasis.

INVESTIGATIONS: Comparative immunochemistry, done to exclude metastatic growth of the previously demonstrated endometrioid ovarian carcinoma, was (1) negative for CK7 and CA125, positive for CK20, chromogranin A and synaptophysin (gall bladder and lymph node metastasis); (2) positive for CK7 and CA125, negative for CK20, chromogranin A and synaptophysin (ovary).

DIAGNOSIS: The tumor lesion within the gall bladder and lymph node was classified as a neuroendocrine carcinoma, not a metastasis of the ovarian carcinoma.

TREATMENT AND CLINICAL COURSE: The patient underwent another laparotomy with resection of the stump of the cystic duct and the liver parenchyma surrounding the former gall bladder, including dissection of the lymph nodes within the hepatoduodenal ligament. After 14 months another metastasis of the neuroendocrine carcinoma of the gall bladder was found. But for eight years there has been no recurrence of the endometrioid adenocarcinoma of the left ovary.

CONCLUSION

Because of the increasing incidence of malignant diseases and second neoplasms there is a growing need for such diagnostic tests as histological and immunohistochemical analysis. This is the first case, according to the available literature, of an endometrioid adenocarcinoma of the ovary concomitant with a neuroendocrine carcinoma of the gall bladder.