Nishtar Medical University, Multan Multan, Punjab, Pakistan
Ali Haider, MBBS1, Vinesh Kumar, MD2, Vinod Kumar, MD3, Yadile Benoit, APRN4, Fnu Vineesha, MD5, Vijay Kumar, MBBS5, Fnu Sandhiya, MD2 1Nishtar Medical University, Multan, Multan, Punjab, Pakistan; 2New York Medical College - Saint Michael's Medical Center, Kearny, NJ; 3Lee Memorial Hospital, Lithia, FL; 4Lee Memorial Hospital, Fort Myers, FL; 5liaquat national hospital and medical college,, Lithia, FL Introduction: Small cell neuroendocrine carcinoma (SCNEC) of the gallbladder is an extremely rare and aggressive malignancy with a poor prognosis. We present a case of gallbladder SCNEC initially presenting as acute calculous cholecystitis, followed by rapid metastatic progression and tumor-induced pancreatitis. To the best of our knowledge, this is the first reported case of its kind.
Case Description/
Methods: A 60-year-old man presented with right upper quadrant abdominal pain radiating to the back, consistent with acute calculous cholecystitis. Laboratory studies revealed elevated liver enzymes and bilirubin. Imaging showed gallbladder wall thickening and cholelithiasis without masses or metastases. The patient underwent laparoscopic cholecystectomy; the gallbladder was gangrenous with multiple small cholesterol stones. Histopathology unexpectedly revealed SCNEC of the gallbladder. A follow-up CT scan within 7 days showed new bilateral pulmonary nodules, mediastinal lymphadenopathy, and adrenal and pancreatic masses absent on preoperative imaging. Mediastinal lymph node biopsy confirmed metastatic small cell carcinoma. Immunohistochemistry revealed a Ki-67 index of 70%. The patient developed pancreatitis with lipase >6000 U/L; imaging demonstrated a pancreatic mass without gallstones or duct obstruction, consistent with tumor-induced pancreatitis. Liver enzymes normalized after surgery. Systemic chemotherapy was initiated. Discussion: This case underscores the aggressive nature of gallbladder SCNEC and its rare initial presentation as acute calculous cholecystitis. The rapid metastatic spread and tumor-induced pancreatitis observed emphasize the need for early diagnosis and management. To our knowledge, tumor-induced pancreatitis in metastatic gallbladder SCNEC has not been previously described.
Figure: Yellow arrow shows acute cholecystitis
Figure: Arrow shows Pancreatic mass
Disclosures: Ali Haider indicated no relevant financial relationships. Vinesh Kumar indicated no relevant financial relationships. Vinod Kumar indicated no relevant financial relationships. Yadile Benoit indicated no relevant financial relationships. Fnu Vineesha indicated no relevant financial relationships. Vijay Kumar indicated no relevant financial relationships. Fnu Sandhiya indicated no relevant financial relationships.
Ali Haider, MBBS1, Vinesh Kumar, MD2, Vinod Kumar, MD3, Yadile Benoit, APRN4, Fnu Vineesha, MD5, Vijay Kumar, MBBS5, Fnu Sandhiya, MD2. P2268 - An Unusual Case of Gallbladder Small Cell Neuroendocrine Carcinoma Presenting as Acute Calculous Cholecystitis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.
