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Abstracts:
Albores-Saavedra J,
Henson DE, Sobin LH. WHO histological typing of tumors of the
gallbladder and extrahepatic bile ducts Berlin, Germany: Springer-Verlag,
1991.
Albores-Saavedra J,
Henson DE. Tumors of the gallbladder and extrahepatic bile ducts:
atlas of tumor pathology Fasc 22, ser 2. Washington, DC: Armed Forces
Institute of Pathology, 1986.
Clear cell carcinomas of the gallbladder and extrahepatic bile ducts.
Am J Surg Pathol. 1995 Jan;19(1):91-9.
Although clear
cell carcinomas have been described in numerous anatomic sites, their
occurrence in the gallbladder and extrahepatic bile ducts (EHBD) is
practically unknown. We report 10 such cases. Seven arose in the
gallbladder and three in the EHBD; all patients with gallbladder
tumors were females with cholelithiasis whose ages ranged from 56 to
68 years. Patients with EHBD tumors were younger (38 and 40 years of
age) and had extrahepatic biliary obstruction and abdominal pain. Two
patients with gallbladder carcinomas had elevated serum
carcinoembryonic antigen (CEA) levels, and another without hepatic
involvement had markedly elevated circulating levels of
alpha-fetoprotein (AFP). Histologically, nine tumors were
adenocarcinomas and one was a squamous cell carcinoma. Seven
adenocarcinomas consisted of cords, sheets, nests, papillae, and
trabeculae of clear cells with well-defined cytoplasmic borders. Two
were composed predominantly of glands and papillary structures. The
cells contained PAS-positive diastase-labile granules and were
cytokeratin- and EMA-positive and immunoreactive for erythropoiesis-associated
antigen. One gallbladder tumor contained areas of hepatoid
differentiation, a feature described in gallbladder neoplasms only
once before. These areas were AFP-positive and immunoreactive for CEA.
By electron microscopy, they showed hepatoid differentiation with
formation of bile canaliculi. In two gallbladder tumors, neoplastic
cells contained subnuclear vacuoles reminiscent of early secretory
endometrium. Foci of conventional adenocarcinoma or mucinous carcinoma
were recognized in all nine tumors. The squamous cell carcinoma showed
only foci of squamous differentiation with keratinization. The clear
cells of this neoplasm had a trabecular and solid growth pattern.
These clear cell neoplasms of the gallbladder and EHBD must be
differentiated from metastatic renal cell carcinoma, based upon the
presence of areas of conventional adenocarcinoma or foci of squamous
differentiation since results of special stains and
immunohistochemistry are similar in both neoplasms. One of the
patients with EHBD carcinoma is alive and symptom-free 6 years
following right hepatic lobectomy. Five patients with gallbladder
tumors had direct extension into the liver and died with metastases.
Two are living with metastases.
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