September 1992, Volume 42, Issue 9

Case Reports

CARCINOID TUMOUR OF GALL BLL&DDER

Farida Naseer  ( Departments of Pathology, Khyber Medical college, Peshawar. )
M. Kabir  ( Departments of Surgery, Khyber Medical college, Peshawar. )

Primary carcinoid tumour of gall bladder is rare. Only 6 cases were reported between 1929 and 19781,2 and by 1980 Bost et al3 could report only 17 cases in their review of the subject.

CASE REPORT

A sixty year old female was admitted with com­plaints of pain in right hypochondrium and dyspepsia. The pain was of two years duration and radiated to the back. On clinical examination she was pale and under­weight. Tenderness was present in the right hypochondrium. Ultrasound examination of the ab­domen showed multiple stones in the gall bladder. The patient was diagnosed as having cholilithiasis and cholecystectomy was done. Fler post-operative course was uneventful and she was able to go home on the 6th post-operative day. The specimen of gall bladder received in the histopathology laboratory was grayish brown in colour with an irregular surface and measured 4x3x2 cm. Cut surface showed a cavity full of black stones and a polypoidal pedunculated growth arising from the neck. This growth was yellowish in colour and measured 1. 5x1x. 5 cm. No mucosal ulceration was seen in the specimen examined. Sections were taken from different sites and slides were stained with haemotoxyline and eosin. On light microscopy the tumour was found to consist of small uniformly dark stained neoplastic cells (Figures 1 and 2)


forming acini and alveolar sheets. In some areas a pallisading arrangement of cells with desmoplastic reaction was prescnt (Figure 3)

while in others blood vessels and perineural invasion was evident (Figures 4 and 5).


A biopsy of the liver takcn at time of cholecystectomy appeared to be normal. The his­topathological diagnosis of primary carcinoid tumour of the gall bladder was confirmed by Armed Forces In­stitutes of Pathology, Rawalpindi and Washington D.C.

DISCUSSION

Most of the previous reports of carcinoid gall bladder arc autopsy findings. Also no association with gall stones has been reported previously. The age of our patient falls in the reported age range of 4th to 6th decade and her sex is also in accordance with the predominantly female cases reported1-3. The patient did not have features of the carcinoid syndrome and none of the previously reported cases had such features either. Our case had the same pedunculated appearance and his­topathological features as reported by Willis3. There was no evidence of metastasis in the liver biopsy specimens examined.

ACKNOWLEDGEMENT

Help of Maj. Gen. I.A. Malik of Army Medical College, Rawalpindi and Drs. A.D. Goodman and RF. Karnei of AFIP, Washington D.C. in confirming the diagnosis and Mr. A.G. Bhatti of Khyber Medical College, Peshawar for taking the microphotographs is gratefully acknowledged.

REFERENCES

1. Mark, c. Carcinoid turnours. A clinicopathologic study. Edited by C.K. Hall. Bostot, Maaaachusette, 1979, p.93.
2. Joel. MC. carcinoid turnouts. A clinicopathologic study. Edited by C.K. HalL Boston, Massacbusette, 1979, P. 93.
3. Willis, Mc. carcinoid tumours. A clinicopathologic study. Edited by C.K. Hall. Boston, Massacbusettc, 1979, p.93.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: