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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.
Adenosquamous and
squamous carcinoma of the gallbladder.
Cir Esp. 2007 Apr;81(4):202-6.
INTRODUCTION:
Squamous and adenosquamous carcinomas of the gallbladder have poor
prognosis. Because these tumors are silent in the initial stage, they
are generally diagnosed in advanced stages. MATERIAL AND METHOD: We
performed a retrospective observational study of five patients with
squamous or adenosquamous carcinoma of the gallbladder. There were two
women and three men with a mean age of 71 years (range, 68-75). All
patients showed abdominal pain, nausea, vomiting, and weight lost (4-8
kg). One patient presented with acute cholecystitis. None of the
patients had jaundice and all had gallstone disease. RESULTS: Surgery
was performed in all patients. Extended cholecystectomy was performed
in three patients, cholecystectomy and bile drainage in one patient,
and colonic bypass and cholecystectomy in the remaining patient.
Pathologic analysis revealed epidermoid carcinoma in two patients and
adenosquamous carcinoma in three patients. Two patients were treated
with adjuvant chemotherapy. All died within 6 months of surgery.
CONCLUSIONS: In both histological types of gallbladder carcinoma,
treatment depends on the grade of local and regional invasion and
tumor spread at diagnosis.
Adenosquamous/squamous
cell carcinoma of the gallbladder.J
Surg Oncol. 2007 Feb 1;95(2):129-34.
BACKGROUND AND
OBJECTIVES: Adenosquamous/squamous cell carcinoma is a rare
histopathologic subtype of gallbladder malignancy. Its clinical
features have rarely been described, and its differences from the
major histopathologic subtype, adenocarcinoma, remain uncertain.
METHODS: All patients with gallbladder carcinoma were retrospectively
reviewed. Patients with a histopathologic subtype of either
adenosquamous (n = 12) or squamous cell (n = 2) carcinoma were
categorized to group I, and patients with adenocarcinoma were
categorized to group II. The clinical characteristics and outcomes of
these two groups were compared. RESULTS: The two groups were generally
no different in clinical features. However, tumor stages of group I
patients were significantly advanced (P = 0.048) and included liver
involvement (P = 0.008). The outcomes of advanced-stage patients in
group II were not different from group I (P = 0.413). Nevertheless,
patients in both groups with advanced stage pT who had undergone
curative resection showed significantly better survival curves than
patients who had undergone non-curative resection (P = 0.003).
CONCLUSIONS: Patients with adenosquamous/squamous cell carcinoma of
the gallbladder were generally similar to those with adenocarcinoma in
clinical characteristics, but had a tendency for liver infiltration.
Although the two histopathologic subtypes of the gallbladder carcinoma
had similar poor outcomes, better survival could be obtained by
performing curative resection for these patients.
Squamous and
adenosquamous cell carcinomas of the gallbladder.J
Exp Clin Cancer Res. 2005 Mar;24(1):143-50.
Squamous and
adenosquamous cell carcinomas (ASC and SCC) are rare subtypes of
gallbladder cancer, traditionally considered more aggressive and with
a poorer prognosis than adenocarcinoma. We report about two patients
affected by an advanced squamous cell carcinoma of the gallbladder.
Both had a large tumour in the gallbladder fossa region with
infiltration of the liver. Surgical resection was radical in one, but
palliative in the other. pTNM was T3 N0 M0, G3, R0 in the former and
T3 N0 M0, G2 R1 in the latter. Patients died for local recurrence
after 12 and 5 months, respectively. Natural history, clinical
findings, prognosis and outcome of this rare gallbladder tumour are
discussed on the basis of a review of the English literature. In
conclusion, an aggressive and radical surgical treatment of advanced
squamous and adenosquamous cell gallbladder carcinomas seems to be
indicated for their low proclivity to distant spreading.
Adenosquamous carcinoma of the gallbladder.Hepatogastroenterology.
2002 Sep-Oct;49(47):1230-4.
BACKGROUND/AIMS:
Adenosquamous carcinoma of the gallbladder is relatively rare. Its
biological behavior and optimal surgical procedure are still
controversial. METHODOLOGY: Clinicopathological factors and
proliferating cell nuclear antigen expression were studied in four
stage IV adenosquamous carcinoma patients who underwent curative
surgery between June 1987 and April 2000, comparing those of 14 stage
IV adenocarcinoma patients at the same period. RESULTS: Preoperative
radiological evaluation disclosed a mass invading to the adjacent
organs in all cases (liver in 3 cases, and liver and stomach in one
case). Three patients (case 1, 2 and 3: well-differentiated
adenosquamous carcinomas) were all alive without recurrence in 10, 7,
and 2 years after surgery. In contrast, the remaining patient (case 4:
moderately differentiated adenosquamous carcinoma) with positive
pathologic factors (lymph node metastasis, vascular invasion, etc)
deceased one year after surgery due to peritoneal dissemination. When
survival rate of adenosquamous carcinoma was compared, the prognosis
of adenosquamous carcinoma was significantly better than that of
adenocarcinoma (P = 0.0103). Comparison of pathological factors
revealed that the frequency of lymph node metastasis was significantly
higher in adenocarcinoma than in adenosquamous carcinoma (P = 0.004).
Consistent with these findings, the positivity rate of proliferating
cell nuclear antigen labeling was significantly lower in squamous
carcinoma component, compared with adenosquamous component (P <
0.0001) or adenocarcinoma (P < 0.0001). CONCLUSIONS: Even in patients
with stage IV adenosquamous carcinoma of the gallbladder, a long-term
survival may be obtained by curative surgery if the squamous component
is predominant.
Adenosquamous carcinoma
of the gallbladder warrants resection only if curative resection is
feasible.Cancer.
2002 Jun 1;94(11):3000-5.
BACKGROUND:
Adenosquamous/squamous cell carcinoma of the gallbladder generally has
been considered a lethal disease. The objective of this study was to
clarify the effectiveness of resection for patients with adenosquamous/squamous
cell carcinoma of the gallbladder. METHODS: Twenty-nine patients who
underwent resection for either adenosquamous carcinoma (n = 28
patients) or squamous cell carcinoma (n = 1 patient) were analyzed
retrospectively. Sixteen patients underwent radical resection, whereas
the other patients underwent primary tumor resection alone. To
elucidate the factors that influenced postresectional survival, 10
variables (age, gender, presence or absence of gallstones, size of the
primary tumor, lymphatic vessel invasion, blood vessel invasion,
perineural invasion, TNM stage, residual tumor status, and type of
resection) were examined. RESULTS: Twenty-three patients (79.3%) were
categorized with T3 or T4 tumors that invaded adjacent organs. The
outcome after undergoing radical resection (cumulative 5-year survival
rate, 48.6%) was significantly better compared with the outcome of
patients after undergoing primary tumor resection alone (cumulative
3-year survival rate, 7.7%; P = 0.004). The outcome after undergoing
resection was better in 14 patients who had no residual tumor
(cumulative 5-year survival rate, 62.9%) compared with the outcome in
15 patients who had residual tumor (cumulative 5-year survival rate,
0%; P < 0.001). Univariate analysis revealed that residual tumor
status (P < 0.001), type of resection (P = 0.004), patient age (P =
0.012), and blood vessel invasion (P = 0.017) were significant
prognostic factors. Residual tumor status (P = 0.026) was the only
significant independent prognostic factor. CONCLUSIONS: Adenosquamous/squamous
cell carcinoma of the gallbladder warrants resection only if
potentially curative (R0) resection is feasible.
Adenosquamous carcinoma
of the gall-bladder with gastric foveolar-type epithelium.Pathol
Int. 1995 Mar;45(3):250-6.
An 80 year old
Japanese man had adenosquamous carcinoma of the gall-bladder
characterized by an adenocarcinoma (AC) in the gall-bladder lumen and
a squamous cell carcinoma (SCC) in the invaded region of the liver. In
the AC, the tumor cells consisted of atypical columnar epithelium with
pseudostratification, mimicking gastric foveolar epithelium, while
atypical signet-ring cells were scattered within the SCC. There was an
abrupt transition between the AC and SCC areas. The tumor cells in the
AC area were intensely positive for galactose oxidase-Schiff staining,
and paradoxical concanavalin A staining revealed these tumor cells to
have Class II mucins. Immunohistochemically, the tumor cells in
foveolar-type adenocarcinoma were diffusely positive for cathepsin D.
Flow cytometrical analysis of DNA content showed the AC area to be
diploid and the SCC area to be aneuploid. The S-phase fraction of the
SCC area (46.9%) was larger than that of the AC area (19.5%). The
positive rate of immunostaining for proliferating cell nuclear antigen
in the SCC area (mean 50.627%) was larger than that of the AC area
(mean 3.048%, P < 0.01). These results suggest that the AC area of
this tumor, histochemically and immunohistochemically, showed gastric
foveolar-type characteristics, the SCC component was squamous cell
metaplasia of the pre-existing AC, and that the SCC area had a greater
proliferating capacity than the AC area.
Hepatopancreatoduodenectomy for squamous and adenosquamous carcinoma
of the gallbladder.Hepatogastroenterology.
1995 Feb;42(1):47-50.
The
characteristics of squamous or adenosquamous cell carcinoma of the
gallbladder differ quite markedly from those of adenocarcinoma,
although the incidence is extremely low. Recently, we encountered both
of the former types of gallbladder carcinoma: a 77-year-old man with
squamous cell carcinoma and a 70-year-old man with adenosquamous cell
carcinoma of the gallbladder. Both had a large mass in the gallbladder
fossa region with infiltration to the liver and invasion of the
duodenum. Hepatopancreatoduodenectomy was performed on both of these
patients. The TNM stage of the former was IV (T4N0M0) and of the
latter IV (T4N0M0) and of the latter IV (T4N1bM0). The former has
remained well without recurrence for about 1 year and 4 months after
the operation, while the latter died of recurrent disease 6 months
after operation. The true reason for the difference in the prognosis
of these two patients was not known. However,
hepatopancreatoduodenectomy is considered to be a most adaptable
operative procedure for squamous or adenosquamous cell carcinoma of
the gallbladder in view of their mode of spread, and the presence of
lymph node metastasis might be a factor of poor prognosis.
Adenosquamous carcinoma
of the gallbladder: a clinicopathological, immunohistochemical and
flow-cytometric study of twenty cases.
Jpn J Cancer Res. 1994 Apr;85(4):389-99.
Twenty patients
(7.4%) with adenosquamous carcinoma of the gallbladder were selected
from 271 surgically resected gallbladder cancers. The 20 patients were
composed of 8 men and 12 women with a mean age of 66.9 years.
Histologically, all twenty tumors showed an abrupt transition between
the adenocarcinoma (AC) and squamous cell carcinoma (SCC) areas, and
well differentiated AC was also found in the peripheral area of the
tumor. A histochemical and immunohistochemical study using alcian
blue, periodic acid-Schiff, cytokeratins, involculin and tissue
polypeptide antigen disclosed a different nature of the two
components. DNA heterogeneity between the components was detected in 5
of 7 cases by flow cytometry. The positive rate of immunostaining for
proliferating cell nuclear antigen in the SCC areas (mean 20.55%) was
larger than that of the AC areas (mean 11.40%) (P = 0.0029), which
indicated that the SCC areas had a greater proliferative capacity than
AC areas. These results suggest that the SCC component of
adenosquamous carcinoma of the gallbladder arose by a stepwise
molecular progression of the pre-existing AC. Furthermore, the
prognosis of adenosquamous carcinomas of the gallbladder (mean
survival: 10 months) in the advanced stage (pTNM 2-4) was less
favorable than those of papillary and well differentiated AC (mean
survival: 99 months and 86 months) (P < 0.0001).
Stromal osteoclast-like
giant cells in an adenosquamous carcinoma of the gallbladder.
Hum Pathol. 1992
Jun;23(6):703-6.
We report a case
an adenosquamous carcinoma of the gallbladder that extended to the
proximal transverse colon. Metastatic tumor was present in regional
lymph nodes and the liver. Microscopically, the tumor was composed of
malignant epithelial cells that were cytokeratin-, epithelial membrane
antigen-, and carcinoembryonic antigen-positive. The adjacent
desmoplastic stroma of the primary tumor, as well as the metastasis,
contained giant cells that morphologically resembled osteoclasts.
Immunohistochemical studies showed that the giant cells were
cytokeratin-, epithelial membrane antigen-, and carcinoembryonic
antigen-negative but weakly alpha 1-antichymotrypsin-positive. While
tumors containing osteoclast-like giant cells have been described in
the breast, lung, liver, and thyroid, this is the first report of a
tumor with this morphology originating in the gallbladder. The
presence of the giant cells adjacent to both the primary and
metastatic tumor and not at any other location suggests that the tumor
cells are producing a substance that induces the formation of the
nontumoral giant cells.
Adenosquamous carcinoma
of the gallbladder with spindle cell features. A light microscopic and
immunocytochemical study of a case.Histopathology.
1987 Feb;11(2):209-14.
A case of
adenosquamous carcinoma of the gallbladder showing extensive spindle
transformation is presented. By light microscopy, areas showing
interwoven fascicles of fusiform, poorly differentiated cells closely
resembling a sarcoma were seen to merge imperceptibly with areas
showing more obvious glandular and squamous cell features.
Immunocytochemistry utilizing tissue-specific antibodies against
intermediate filaments demonstrated the exclusive presence of
prekeratin antibodies in both components of the tumour, thus
establishing the epithelial nature of this neoplasm. The importance of
immunological phenotyping in the differential diagnosis of epithelial
tumours of the gallbladder showing pseudosarcomatous features is
underscored.
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