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Tumours of the gallbladder and extrahepatic bile ducts. In: Hamilton
SR, Aaltonen LA, eds. World Health Organization classification of
tumors: pathology and genetics of tumours of the digestive system.
Lyon, France: IARC,2000 : 204-217.
Primary
liposarcoma of gallbladder diagnosed by preoperative imagings: a case
report and review of literature.World
J Gastroenterol. 2006 Mar 7;12(9):1472-5.
A 49-year-old
Japanese woman was referred to our department because of high fever
and a huge abdominal mass. Computed tomography (CT) and magnetic
resonance (MR) imagings revealed a tumor, about 30 cm in
diameter,occupied the right hepatic lobe and the peritoneal cavity.
Abdominal angiography showed that the tumor was fed mainly by the
cystic artery. We preoperatively diagnosed angiosarcoma of the
gallbladder and performed tumor resection with cholecystectomy because
the tumor was almost capsulated,however the posterior wall of the
gallbladder attached to the tumor firmly. Histologically,the tumor was
composed of spindle cells including lipoblasts with cellular
pleomorphism, which were also detected in the muscular layer of the
gallbladder. We finally diagnosed pleomorphic liposarcoma of the
gallbladder.At 10 mo and 29 mo after the first operation, she
underwent two more operations because of recurrence.Now she has a good
quality of life 3 yr and 6 mo after the first operation.
Leiomyosarcoma
of the gallbladder: a case report.Am
Surg. 2001 Sep;67(9):873-4.
Primary
sarcoma of the gallbladder is a rare disease. The tumor occurs more
frequently in women. Usually gallstones are present. Symptoms resemble
those of cholelithiasis or cholecystitis. The diagnosis is rarely made
preoperatively. The patient was a 51-year-old woman with a 2-month
history of right upper quadrant pain, nausea, vomiting, and a 10-pound
weight loss. Ultrasound showed cholelithiasis and cholecystitis.
Laparoscopic cholecystectomy was converted to open as a result of
dense tissue in the middle to distal gallbladder. Exploration by a
right subcostal incision revealed multiple implants on the surface of
the liver and the peritoneum of the upper abdomen. The wall of the
gallbladder was very thick and inflamed. Cholecystectomy with liver
biopsy was performed. Pathology revealed poorly differentiated
epithelioid leiomyosarcoma of the gallbladder with extension to the
liver. The disease followed a very aggressive course and the patient
died 3 weeks after the procedure. Recommended treatment is extensive
surgical resection that can be followed by radiotherapy or
chemotherapy. The tumor follows a very aggressive course, which often
lasts a few weeks. Prognosis is poor with rare reported 5-year
survivals.
Epithelioid
angiosarcoma of the gallbladder: case report.J
Gastrointest Surg. 2005
Jul-Aug;9(6):822-5.
A patient with
epithelioid angiosarcoma of the gallbladder is described. This is only
the second case of an extremely rare but highly aggressive tumor
reported in the international literature. Pathophysiological,
clinical, and therapeutic aspects are discussed in relation to the
available data on angiosarcomas of the gallbladder.
Gallbladder
carcinosarcoma: a case report and literature review.J
Gastrointest Surg. 2005 Jul-Aug;9(6):818-21.
Carcinosarcoma
of the gallbladder is a rare malignancy characterized by both
malignant epithelial and mesenchymal components. The clinical behavior
of this tumor is extremely aggressive. Only 26 cases have been
reported in the world literature to date. We report the case of a
64-year-old woman who had fever associated with a right upper quadrant
mass. An exploratory laparotomy through a right upper quadrant
incision was performed at another institution, and the patient was
thought to have severe acute cholecystitis that would require
additional antibiotic therapy before attempted resection. She was
referred to our center, where abdominal CT showed a 6.4 x 8.2 cm
pericholecystic mass involving the hepatic flexure of the colon. The
patient underwent cholecystectomy and hepatic wedge resection,
pancreaticoduodenectomy, and right hemicolectomy. Pathologic
examination of the surgical specimen revealed two histologic
components consisting of squamous cell carcinoma and spindle cell
sarcoma of gallbladder origin, consistent with carcinosarcoma. All
seven lymph nodes in the pancreaticoduodenectomy specimen were
negative for tumor. We present this case and a review of the
literature and current treatment recommendations.
Loss of
heterozygosity in clonal evolution with genetic progression and
divergence in spindle cell carcinoma of the gallbladder.Hum
Pathol. 2004 Apr;35(4):418-23.
Spindle cell
carcinoma (SpCC) of the gallbladder is a rare neoplasm that shows
carcinoma with a variable component of sarcomatoid spindle cells. The
clinical and pathological features of this neoplasm have been well
documented, but the histogenesis has long been a matter of
speculation. In an attempt to clarify the clonality and genetic
relationships involved in the evolution of this neoplasm, we
microdissected a total of 18 carcinomatous and sarcomatous foci from 2
gallbladder SpCCs and analyzed the allelic status with 42
microsatellite markers on chromosomal arms 1p, 1q, 3p, 4q, 5q, 6q, 8p,
9p, 10q, 11p, 11q, 13q, 16q, 17p, 17q, 18q, and 22q. The 2 cases
examined had a polypoid tumor in the gallbladder, in which both
adenocarcinomatous and sarcomatoid spindle cell components were
identified histologically. In both SpCCs, homogenous allelic losses
were identified in both the carcinomatous and sarcomatous components;
17p, 18q, and 5q in case 1 and 17p and 11q in case 2. These indicated
that both SpCCs had a single clonal origin. In case 1, additional loss
of heterozygosity (LOH; 6q) consisting of genetic progression occurred
in both the carcinomatous and sarcomatoid components. In case 2, there
was additional LOH (9p) in the carcinomatous components and additional
microsatellite instability at D5S644 in both the carcinomatous and
sarcomatoid components, indicating a monoclonal neoplasm with genetic
progression and divergence. In the 2 cases, the genetic changes
indicated that an original clone of a pure adenocarcinoma apparently
acquired sarcomatoid spindle cell phenotype by successive genetic
changes. On the other hand, we saw no evidence of tumors in which a
sarcomatoid spindle cell appeared to give rise to a carcinomatous
subclone in the examined cases. In conclusion, the current study
includes the first LOH analyses of SpCC of the gallbladder. Our data
support the concept that gallbladder SpCC is derived from a single
clone originating from a carcinoma. Furthermore, we showed genetic
heterogeneity accompanying the phenotypic divergence, with patterns of
genetic alterations that are consistent with both the progression and
divergence within the individual tumors.
Sarcomatoid
carcinoma with components of small cell carcinoma and undifferentiated
carcinoma of the gallbladder.Pathol
Int. 2004 Nov;54(11):866-71.
We report a
case of sarcomatoid carcinoma with components of small cell carcinoma
and undifferentiated carcinoma of the gallbladder. An 84-year-old
woman was admitted to our university hospital with right upper
abdominal pain and back pain. Clinical diagnosis of a gallbladder
tumor was made based on the findings of abdominal ultrasonography,
computed tomography and endoscopic retrograde cholangiopancreatography,
and a cholecystectomy was carried out. On gross examination a
pedunculated polypoid tumor protruded into the lumen of the
gallbladder. Histologically the tumor was composed of carcinomatous
and sarcomatous components; the carcinomatous component consisted
mainly of small cell carcinoma and undifferentiated carcinoma. In
general, the carcinomatous component of sarcomatoid carcinoma of the
gallbladder consists of adenocarcinoma, and there have only been two
previously reported cases in which the carcinomatous component
consisted of small cell carcinoma or undifferentiated carcinoma.
Because the patient's prognosis may be influenced by the peculiar
carcinomatous component in such cases, it is important to accumulate
case reports that clarify their clinicopathological features.
Sarcomatoid
carcinoma of the gallbladder with a rhabdoid tumor component.Arch
Pathol Lab Med. 2003 Oct;127(10):e406-8.
We report the
case of a sarcomatoid carcinoma with a rhabdoid tumor component
originating in the gallbladder, along with immunohistochemical and
electron microscopic findings. A 61-year-old woman presented with a
5-month history of right upper quadrant pain. Ultrasonography and a
computed tomographic scan indicated gallbladder cancer. She underwent
a cholecystectomy and a common bile duct resection. A firm mass (4.5
cm in greatest dimension) was present in the neck portion of the
gallbladder. The mass was firm, solid, yellowish gray, and granular
with areas of necrosis. Microscopically, the tumor was a biphasic
sarcomatoid carcinoma and consisted of diffusely arranged pleomorphic
cells, focally showing rhabdoid features and neoplastic glands with
focal mucin production. Heterologous components such as osteoid,
chondroid, and rhabdomyoblastic elements were not identified. By
immunohistochemical staining, we demonstrated that the rhabdoid cells
coexpressed cytokeratin and vimentin. On electron microscopic
examination, the rhabdoid tumor cells showed cytoplasmic whorls of
intermediate filaments in the cytoplasm and eccentric nuclei. Two
months postoperatively, the follow-up computed tomographic scan showed
multiple intrahepatic metastases and omental seedings.
So-called
carcinosarcoma of the gallbladder; spindle cell carcinoma of the
gallbladder: report of a case.Surg
Today. 2002;32(5):462-7.
We report a
so-called carcinosarcoma of the gallbladder in a 53-year-old man. The
findings of ultrasonography, computed tomography, endoscopic
retrograde cholangiopancreatography, and angiography revealed a large
mass of the gallbladder with a cholesterol stone. He underwent three
operations, and died from liver failure with multiple liver metastasis
immediately after the third operation. A pathological examination
revealed neoplastic tissue composed of sarcomatous and glandular
components. Hematoxylin-eosin stain proved the presence of
carcinosarcoma in the gallbladder, but an immunohistochemical study
proved that the sarcomatous component was stained by antivimentin and
also anticytokeratin antibodies, which thus proved it to be so-called
carcinosarcoma of the gallbladder. As a result, an immunohistochemical
study is considered to provide valuable information regarding the
identification of sarcomatous elements in such cases.
Carcinosarcoma
of the gallbladder with chondroid differentiation.J
Gastroenterol. 2002;37(11):966-71.
Carcinosarcoma
of the gallbladder is an uncommon neoplasm. We herein report the case
of a patient with carcinosarcoma of the gallbladder with chondroid
differentiation, treated by cholecystectomy with liver segmentectomy
and lymph node dissection for a tumor which occupied the entire
gallbladder and spread to the liver. Histologically, the tumor
contained two distinct components: a mixture of both well and poorly
differentiated tubular adenocarcinoma and sarcomatoid tissue with
chondroid differentiation. From a review of the literature, it was
seen that carcinosarcomas of the gallbladder could be divided into two
groups: one group with apparent sarcomatous differentiation, such as
chondroid, osteoid, and rhabdomyosarcomatous differentiation, and the
other group, of carcinosarcomas with a sarcomatous portion composed of
anaplastic spindle cells. Each group had a poor prognosis in spite of
surgical resection of tumors. Our patient died of peritoneal
dissemination 7 months after surgery.
Sarcomatoid
carcinoma (carcinosarcoma) of the gallbladder.Gen
Diagn Pathol. 1998 Apr;143(5-6):321-5.
We report a
case of carcinoma of the gallbladder in a 67-year-old woman. The
description comprises the histological, immunohistochemical,
ultrastructural and cytogenetical picture of the tumor. The
ultrastructural features as well as chromosomal changes may denote the
epithelial derivation of the tumor studied.
Carcinosarcoma
of the gallbladder.Ann
Ital Chir. 1997 May-Jun;68(3):375-8;
discussion 379.
The authors
analyse and comment on a case of carcinosarcoma of the gallbladder
which they have recently observed. Given the rarity of this form of
cancer, it is interesting to note that this case presents some
peculiar aspects which have not been recorded in the few cases
previously published on the subject. The peculiarities are such that
they require a revision of what have until now been considered as
intrinsic characteristics in the clinical observation of this kind of
cancer. The authors maintain that the peculiarities of this case
concern: a) the clinic onset of the illness and the relative aspecific
symptomatology: b) that fact that laboratory tests did not signal any
biochemical alteration; c) that the instrumental investigation's
results pointed toward a non neoplastic pathology; d) that even the
intra-operatory examination did not reveal any suspicious element; and
last but by no means least the good survival of the patient which is
definitely superior to other cases already reported in literature. The
neoplasia, which manifested itself through a hemorrhage in the
gallbladder, represented in fact the very initial stage of the
illness, a condition rarely observed.
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