Radiological and pathological data of the case before chemotherapy. A. CT scan showed a gallbladder mass invading liver, head of pancreas with metastasis of peritoneum and enlarged lymphnodes in hepatic hilar. B. Diffuse small round cells with scanty cytoplasm and round nucleus (HE×200). C. Strong positive cytoplasmic expression of Syn (IHC×400). D. Over 80 % tumor cells show positive expression of Ki-67 (IHC×200).