■神经内分泌肿瘤是胆囊中罕见的发现。在美国,胆囊中这种实体的发病率约为每100,000例1.13例,在过去十年中稳步增长。胆囊神经内分泌肿瘤通常无症状;大多数病例被报道为标本中的偶然发现,由于次要症状而切除,如慢性胆囊炎。治疗策略有限,部分原因是这种疾病通常处于晚期。此外,诊断工具对早期检测的实用性有限;这些因素导致该疾病过程的预后不良。
■我们描述了一例胆囊类癌,偶然发现于一名78岁的男性患者,他出现在急诊室,抱怨慢性间歇性右上腹疼痛,伴有恶心和呕吐。体格检查时出现了积极的墨菲症状,否则是平淡无奇的。腹部超声检查显示胆囊外观正常,但“漂浮息肉”没有可疑的放射学特征。推测诊断为慢性胆囊炎,患者被带到手术室进行腹腔镜胆囊切除术。胆囊标本的显微镜评估诊断为分化良好的神经内分泌肿瘤和复杂的胆固醇息肉,在慢性胆囊炎的背景下。
■胆囊的神经内分泌肿瘤,一个稀有的实体,通常是无症状的,大多数病例在胆囊标本中被诊断为偶然切除,原因不是怀疑的恶性肿瘤。慢性炎症过程被认为与化生的发展以及可能与神经内分泌谱系肿瘤的发展有关。在文献综述的基础上,我们发现没有具体的治疗方法,除了手术切除,可以管理患有这种疾病的患者。成立专家委员会,以审查和讨论适当的临床监测指南,并建议考虑多站点前瞻性注册表。
UNASSIGNED: Neuroendocrine tumors are a rare finding in the gallbladder. The incidence of this entity in the gallbladder is roughly 1.13 cases per 100,000 in the US, with a steady increase in the last decade. Gallbladder neuroendocrine tumors are generally asymptomatic; the majority of cases have been reported as incidental findings in specimens, resected due to secondary symptomatology, such as chronic cholecystitis. Treatment strategies are limited, in part due to the often advanced stage in which this disease presents. Furthermore, there is a restricted utility of diagnostic tools for early detection; these factors contribute to the poor prognosis of this disease process.
UNASSIGNED: We describe a case of a gallbladder carcinoid tumor, incidentally found in a 78-year-old male patient who presented to the emergency room complaining of chronic intermittent right upper quadrant pain, accompanied by nausea and vomiting. A positive murphy sign was elicited on physical examination, which was otherwise unremarkable. An abdominal ultrasound showed an otherwise normal-appearing gallbladder except for a \"floating polyp\" with no suspicious radiologic features. A diagnosis of chronic cholecystitis was presumed, and the patient was taken to the operative room for laparoscopic cholecystectomy. Microscopic evaluation of the gallbladder specimen yielded a diagnosis of a well-differentiated neuroendocrine tumor and complex cholesterol polyps, in a setting of chronic cholecystitis.
UNASSIGNED: Neuroendocrine tumors of the gallbladder, a rare entity, are generally asymptomatic, with most cases diagnosed incidentally in gallbladder specimen resected for reasons other than suspected malignancy. Chronic inflammatory processes are seen to be related to the development of metaplasia and possibly the development of tumors of the neuroendocrine lineage. Based on a review of literature, we have found that no specific treatment approach, beyond surgical resection, is in place to manage patients with this condition. Formation of an expert committee to review and discuss guidelines for appropriate clinical monitoring, as well as consideration of a multi-site prospective registry is suggested.