case_images: PMC3875121_01
case_images: Prechemotherapy abdominal computed tomography (CT) showing (a) a large 7.9 x 5.1 cm heterogeneous mass involving the gallbladder and the adjacent liver and (b) enlarged portocaval and para-aortic lymph nodes.
case_images: CRIM.GM2013-946835.001.jpg
case_images: PMC3875121_01_CRIM.GM2013-946835.001.jpg
case_images: fig1
case_images: A left paraaortic lymph node (PALN) was seen of size 2.9 x 4.7 x 4.7 cm. Another enlarged lymph node is seen at the aortocaval group measuring 1.8 x 1.7 cm (Figure 1).
case_images: Postchemotherapy abdominal CT showing interval regression of the known masses around the GB, portocaval, aortocaval, and left paraaortic stations by about 35-45%.
case_images: CRIM.GM2013-946835.002.jpg
case_images: PMC3875121_01_CRIM.GM2013-946835.002.jpg
case_images: fig2
case_images: Postchemotherapy CT imaging showed significant response (35-45% regression) (Figure 2), and patient underwent cholecystectomy, portahepatic lymphadenectomy, and hepatic metastasectomy.
case_images: Histopathology of surgical specimen showing (a) chromogranin positivity, (b) synaptophysin positivity, (c) Ki-67 positivity, and (d) hematoxylin and eosin stained small cells consistent with small cell carcinoma of gallbladder.
case_images: CRIM.GM2013-946835.003.jpg
case_images: PMC3875121_01_CRIM.GM2013-946835.003.jpg
case_images: fig3
case_images: One retrieved lymph node was found metastatic small cell carcinoma with extensive fibrosis (Figure 3).
case_images: Follow-up abdominal CT at one year showing the recurrent soft tissue mass adjacent to the liver inseparable from the right adrenal and interval increased in size of the left para-aortic lymph nodes.
case_images: CRIM.GM2013-946835.004.jpg
case_images: PMC3875121_01_CRIM.GM2013-946835.004.jpg
case_images: fig4
case_images: CT showed recurrent progressive disease with right adrenal gland invasion and progression of PALN size (Figure 4). CT-positron emission tomography (CT-PET) showed soft tissue lesion on the right adrenal region and it showed also focal fluorodeoxyglucose (FDG) uptake (SUV max 6.5).
case_images: Plain radiograph of right arm showing aggressive bony lesion involving the distal metadiaphysis and epiphysis of the right humerus and associated with the sunburst periosteal reaction and pathological fracture.
case_images: CRIM.GM2013-946835.005.jpg
case_images: PMC3875121_01_CRIM.GM2013-946835.005.jpg
case_images: fig5
case_images: X-ray was done which showed aggressive bony lesion involving the distal metadiaphysis and epiphysis of the right humerus and associated with the sunburst periosteal reaction and pathological fracture (Figure 5).