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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.
A
patient with undifferentiated carcinoma of gallbladder presenting with
hemobilia.J Gastroenterol.
2000;35(1):63-8.
Hemobilia is
relatively rare among hemorrhages in the digestive tract, and
hemobilia caused by tumors of the biliary tract is particularly rare.
We treated a 74-year-old-man with undifferentiated carcinoma of the
gallbladder presenting with hemobilia. During hospitalization for
neurogenic bladder at the Department of Urology, he showed progressive
anemia. Since hemorrhage in the digestive tract was suspected,
endoscopy of the upper gastrointestinal tract was performed, and
bleeding from the papilla of Vater was observed. On ultrasound
examination, findings were indicative of cholecystic cancer, and
hemorrhage from the cystic duct was found on percutaneous transhepatic
cholangioscopy. On perioral cholecystoscopy, however, masses of
coagulated blood were found only in the gallbladder. Abnormalities
such as dense staining of tumors or extravasation were not found on
angiography. The patient died of hepatic failure due to rapid invasion
of the liver by the tumor, associated with biliary infection and
disseminated intravascular coagulation. At autopsy, a nodal tumor was
found in the gallbladder, and the cavity of the gallbladder was filled
with coagulated masses of blood. Direct invasion of the tumor to the
liver, diaphragm, and transverse colon was found. The
histopathological diagnosis was undifferentiated carcinoma (pleomorphic
large-cell type).
Undifferentiated spindle-cell carcinoma of the gallbladder: an
immunohistochemical study.
J
Hepatobiliary Pancreat Surg. 2006;13(5):468-71.
A case of
undifferentiated spindle-cell carcinoma of the gallbladder is
described. A 72-year-old man presented with right hypochondralgia and
fever. Imaging studies revealed a well-demarcated solid tumor (with a
necrotic center) in the gallbladder that invaded the liver and
transverse colon. On gross examination of the surgical specimen, the
cut surface of the polypoid tumor showed nodular invasive growth.
Microscopically, the tumor was composed of atypical spindle-shaped
tumor cells that proliferated in a whirling or interlacing pattern.
The tumor also showed foci with a malignant epithelial component that
simulated a carcinosarcoma. Immunohistochemically, the biphasic
differentiation of the tumor was highlighted by the different
immunoreactivity to antibodies against cytokeratins, epithelial
membrane antigen (EMA), and vimentin shown by the malignant epithelial
components and the spindle-cell components. However the latter showed
faint positivity for cytokeratin antibody. These results suggested
that the spindle-cell carcinoma of the gallbladder originated from
cholecystic mucosa and showed sarcomatous reaction or
dedifferentiation, as indicated by the presence of vimentin-positive
cells. The proliferation index, as detected by ki-67, in the
spindle-cell component was higher than that in the epithelial
component, which may account for the more aggressive biological
behavior of the spindle-cell component.
Primary undifferentiated spindle-cell carcinoma of the gallbladder
presenting as a liver tumor.J
Gastroenterol. 2005 Oct;40(10):993-8.
Undifferentiated
spindle-cell carcinoma (SpCC) of the gallbladder is extremely rare.
There is very little information available regarding the
characteristics and treatment of this disease. We herein report the
unique case of a 76-year-old female patient with a primary SpCC of the
gallbladder that presented as a liver tumor. Preoperative radiologic
examinations showed a 5-cm liver tumor around the gallbladder bed, and
irregular thickening of the gallbladder wall. The patient underwent
en-bloc resection of the gallbladder and segments 4b and 5 of the
liver (including the liver tumor). Microscopic findings revealed that
both lesions consisted mainly of a sarcomatous spindle-shaped
component. Small foci of well-differentiated adenocarcinoma cells were
identified in the gallbladder mucosa. There was a gradual transition
between the two different components, thereby implying that these two
cell types had a common origin. Immunohistochemical studies showed
that the spindle-shaped cells were epithelial in nature. The patient's
postoperative course was uneventful. However, she died of recurrent
liver disease 6 months after the surgery. In conclusion, we surmised
that the sarcomatous spindle cells originated from a carcinomatous
component in the gallbladder mucosa through dedifferentiation. Further
studies are needed to better understand the characteristics of this
deadly tumor, and to establish an effective therapy for it.
Small-cell undifferentiated carcinoma of neuroendocrine type
originating in the gallbladder.Curr
Surg. 2002 Sep-Oct;59(5):495-7.
PURPOSE: We
report a case of small-cell undifferentiated carcinoma with
neuroendocrine (SCUCN) of the gallbladder in a 67-year-old man who
presented with suspected cholelithiasis. Treatment included a
cholecystectomy and a 4-cycle course of etoposide and carboplatin.
CONCLUSIONS: Small-cell undifferentiated carcinoma with neuroendocrine
features of the gallbladder is a rare disease with approximately 30
cases reported in the literature. Clinical characteristics include an
association with cholelithiasis, an elderly age distribution, a female
preponderance, and a correlation with cigarette smoking. It is known
to behave aggressively and carry a grave prognosis, with extensive
local invasion and early metastasis being characteristic. Medical and
surgical therapies exist and have demonstrated best results when used
in combination.
A
case of undifferentiated carcinoma of the gallbladder with anomalous
arrangement of the pancreaticobiliary ductal system.Oncol
Rep. 2001 Nov-Dec;8(6):1281-3.
Anomalous
junction of the pancreaticobiliary duct (AJPBD) is a congenital
anomaly associated with gallbladder carcinoma. Especially patients
with noncystic dilatation and without dilatation of the biliary tract
are at risk of gallbladder carcinoma. A 56-year-old woman with
advanced gallbladder cancer associated with AJPBD but without
dilatation of the biliary tract was treated at our hospital. Although
histologically cancer cells remained in the layer of the proprial
mucosa, extensive metastases to lymph nodes including the paraaorta
and peripancreas were detected. According to the TNM classification
this case was of Stage IVB. The cancer consisted of medullary round
cells, and was diagnosed as undifferentiated carcinoma. After surgery
poor prognosis was expected, but three years have elapsed with no
recurrence. The case is of interest because of two points of
discrepancy: the primary cancer did not show deep invasion but
demonstrated extensive lymph node metastases; the cancer was
histologically malignant but prognosis was relatively good.
Unusual
malignant epithelial tumors of the gallbladder.Semin
Diagn Pathol. 1996 Nov;13(4):326-38.
Most malignant
epithelial tumors of the gallbladder are heterogenous and classified
as adenocarcinomas. The authors report a previously unrecognized group
of unusual gallbladder carcinomas including two cases of signet ring
cell carcinoma in situ, three of cribriform invasive adenocarcinoma,
and one of adenocarcinoma with pseudoangiosarcomatous features. In
addition, the authors review their material and update the information
on clear cell, small cell, and undifferentiated carcinoma of the
gallbladder. A new morphologic variant of undifferentiated carcinoma
mimicking lobular carcinoma of the breast is identified. The clinical,
morphologic, and immunohistochemical features of these unusual
neoplasms are emphasized.
Elevated serum alpha-fetoprotein in a patient with undifferentiated
carcinoma of the gall bladder.J
Clin Pathol. 1995 Nov;48(11):1061-3.
An uncommon case
of undifferentiated carcinoma of the gall bladder in a 65 year old
Chinese man, who presented with an increased serum alpha-fetoprotein
concentration, is reported. Histologically, the tumour had a primitive
appearance and was composed of a pavement-like array of poorly
differentiated columnar/polygonal cells. Alpha-fetoprotein was
demonstrated in some of the tumour cells using an immunoperoxidase
technique. Alpha-fetoprotein secretion in this instance may have
occurred because the gall bladder and the liver are of similar
embryological origin. Alpha-fetoprotein may also be related to the
resurgent expression of oncofetal antigens. This tumour may represent
another rare cause of increased serum alpha-fetoprotein
concentrations.
Undifferentiated carcinoma of the gallbladder. Report of a case with
immunohistochemical findings.Arch
Pathol Lab Med. 1995 Mar;119(3):279-82.
One case of
undifferentiated carcinoma of the gallbladder was studied using an
extensive immunohistochemical panel of antibodies. The biphasic
differentiation of the tumor was highlighted by different
immunoreactivity to antibodies against cytokeratins, vimentin,
epithelial membrane antigen, and carcinoembryonic antigen of the
adenocarcinomatous and mesenchymallike components, although the latter
showed a faint positivity for CAM5.2 antibody, probably indicating an
epithelial origin. Furthermore, the higher levels of expression of p53
protein and the faster growth rate in the pseudosarcomatous component
suggest its more malignant phenotype. The relationship with "true"
carcinosarcomas of the gallbladder and the histogenetic theories
concerning these tumors are also discussed.
Undifferentiated spindle cell carcinoma of the gallbladder: a
clinicopathologic, immunohistochemical, and flow cytometric study of
11 cases.Hum
Pathol. 1993 Dec;24(12):1298-305.
Eleven primary
spindle cell carcinomas (SpCCs) of the gallbladder are reported. They
occurred in eight women and three men ranging in age from 59 to 80
years (mean age, 66.5 years). Histologically, the tumors showed
interlacing bundles of atypical spindle cells with eosinophilic
cytoplasm, oval to elongated nuclei, and conspicuous nucleoli. Eight
SpCCs contained tiny foci of neoplastic glands similar to those seen
in adenocarcinoma, and two of these cases also had small foci of
neoplastic squamous epithelium. A gradual transition between the
squamous cell carcinoma and the spindle cell component was observed in
one tumor. Immunohistochemically, all SpCCs were positive for at least
one of the epithelial markers (epithelial membrane antigen, nine
cases; AE1/AE3, nine cases; carcinoembryonic antigen, three cases; and
EAB 903, one case), and the tumor cells also were immunoreactive to
mesenchymal marker (vimentin, eight cases), muscle markers
(alpha-smooth muscle actin, one case; desmin, one case), and
histiocytic marker (HAM 56, one case). Abnormalities in tumor
suppressor gene p53 expression also were found in two of the 11 SpCC
cases using monoclonal antibody PAb 1801. In six cases for which data
were available flow cytometry revealed aneuploidy in three SpCCs
(50%). The survival curve of the SpCC cases (mean survival, 9 months)
was less favorable than that of 224 cases of adenocarcinoma of the
gallbladder (mean survival, 81 months) (P = .0011). These results
indicate that SpCC of the gallbladder is an epithelial tumor with
sarcomatoid components and its prognosis is unfavorable.
Undifferentiated carcinoma of the gallbladder. A clinicopathologic,
histochemical, and immunohistochemical study of 21 patients with a
poor prognosis.
Cancer. 1988 May 1;61(9):1872-9.
Among 284 cases
of carcinoma of the gallbladder, 21 were identified as
undifferentiated carcinoma (UC), with little glandular or other
specific epithelial differentiation. These tumors were classified into
three histologic types according to the components: (1) small cell
type (eight cases); (2) pleomorphic cell type (eight cases); and (3)
spindle cell or pseudosarcomatous type (five cases). Histochemical and
immunohistochemical study by the immunoperoxidase technique revealed
that most of the tumors (13/21) contained mucosubstances, and that all
examples of the UC were immunoreactive for epithelial membrane antigen
(EMA), keratin, and carcinoembryonic antigen (CEA), thereby indicating
the epithelial nature of the neoplastic cells. Vimentin
immunoreactivity was found in nine tumors. In 19, the tumor contained
various neoplastic endocrine cells, including
somatostatin-immunoreactive (14/19), gastrin-immunoreactive (14/19),
human chorionic gonadotropin (HCG)-immunoreactive (9/19), pancreatic
polypeptide-immunoreactive (4/19), and serotonin-immunoreactive cells
(4/19). The prognosis of patients with UC of the gallbladder was
poorer than that of patients with differentiated adenocarcinoma.
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