case_images: PMC8637330_01
case_images: Pathology results. H&E staining of the biopsy specimen showed poorly differentiated adenocarcinoma.
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case_images: The postoperative pathology showed that the tumor adjacent to the gallbladder was poorly differentiated adenocarcinoma with intrahepatic metastasis, classified as clinical stage T3N2M0 according to the tumor-node-metastasis (TNM) staging of the American Joint Committee on Cancer (AJCC) ( Figure 1 ).
case_images: Tumor parameters. CA-199 concent (A). CEA consent (B). Red line, upper limits of normal; yellow line, lower limits of normal; blue line, actual value.
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case_images: CEA, 16.6 mug/L, and CA199, 1,270 U/ml ( Figure 2 ). The patient reexamined after three cycles of treatment. CT showed that the size of tumor and lymph node significantly reduced ( Figure 3 ). Meanwhile, CEA and CA199 decreased significantly to 3.83 mug/L and 114 U/ml, respectively ( Figure 2 ).
case_images: CT images of baseline (A, C) and after sintilimab treatment (B, D).
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case_images: f3
case_images: CEA, 16.6 mug/L, and CA199, 1,270 U/ml ( Figure 2 ). The patient reexamined after three cycles of treatment. CT showed that the size of tumor and lymph node significantly reduced ( Figure 3 ).
case_images: Surgical photo (A). Pathology results (B). H&E staining of the surgical specimen showed mixed neuroendocrine-nonneuroendocrine tumors.
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case_images: f4
case_images: CT revealed local liver metastasis, and the levels of CEA and CA 199 were 14.5 mug/L and 333 U/ml, respectively. Considering the progress of the disease, the entire liver metastasis and gallbladder were removed, and the lymph node dissection in the first porta hepatis was performed ( Figure 4A ). Postoperative pathology showed a poorly differentiated malignant tumor of the gallbladder, consistent with mixed neuroendocrine-nonneuroendocrine tumors (poorly differentiated adenocarcinoma accounted for 60%, small cell neuroendocrine carcinoma accounted for about 40%) ( Figure 4B ).