CHGA and cholelithiasis: Chronic inflammation was believed to promote metaplastic changes of gallbladder epithelial cells to neuroendocrine cells, since NEC was mostly accompanied with cholelithiasis.[3] It has been reported that intestinal metaplasia was presented in 11.7% of patients with cholelithiasis and 83.3% of them showed positive staining of chromogranin A (CgA), a specific marker of neuroendocrine cells.[8] In the study performed by Chen et al,[7] 8 of 10 patients with GB-NEC had the history of cholecystitis.