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| | | Year : 2009 | Volume : 52 | Issue : 2 | Page : 244-245 | | | Carcinosarcoma of the gallbladder | | | Tanu Agarwal1, Manoj Jain1, Amit Goel1, Paari Visayaragavan2, RK Gupta1
1 Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
2 Department of Surgical Gasteroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Click here for correspondence address and email | |      | |  Abstract | | | Carcinosarcoma of the gallbladder is an uncommon neoplasm. We herein report the case of a patient with carcinosarcoma of the gallbladder, treated by simple cholecystectomy for a tumor which was confined to the gallbladder. Keywords: Carcinosarcoma, gall-bladder, immunohistochemistry How to cite this article:
Agarwal T, Jain M, Goel A, Visayaragavan P, Gupta R K. Carcinosarcoma of the gallbladder. Indian J Pathol Microbiol 2009;52:244-5 |
| Introduction | |  |
Carcinosarcoma of gallbladder is a rare malignancy characterized by both malignant epithelial and mesenchymal components. To the best of our knowledge, 27 cases have been reported in the world literature to date. [1] We present a case of carcinosarcoma of the gallbladder in a 60-year-old woman.
| Case Report | | |
A 60-year-old woman presented with a 2-month history of intermittent low-grade fever, anorexia and weight loss. There was one episode of severe pain in the right hypochondrium associated with vomiting for one day, one month back. There was no history of gastro-intestinal bleed or features of gastric outlet obstruction. A physical examination revealed a soft, palpable mass in the right upper quadrant of her abdomen moving with respiration. The liver was non-palpable and there was no free fluid in the abdomen. Per rectal examination was normal. Laboratory examinations showed hemoglobin of 10.5g/dl, normal leukocyte count, and normal liver function tests. The ultrasonographic examination showed a distended gallbladder with a polypoidal heterogeneous mass in the gallbladder neck with thick sludge in the gallbladder lumen. The computed tomographic scan showed a distended gallbladder with an irregular enhancing mass lesion projecting in the lumen of the gallbladder [Figure 1]. A preoperative diagnosis of gallbladder cancer was made and staging laparoscopy, laparotomy and simple cholecystectomy was performed. Per-operative findings revealed a distended gallbladder with a large growth in the peritoneal aspect of the gallbladder. There was no evidence of distant metastasis, ascites, or lymph nodes in the porta, pericholedochal, retro-portal or celiac areas. The resected specimen showed a firm pedunculated polypoid mass measuring 7 × 5 × 4cm in the body of the gallbladder. The cut surface of the mass was firm, solid and grayish white with focal areas of necrosis. Microscopically, the tumor was biphasic and composed of predominantly sarcomatoid areas with focal carcinomatous components. The sarcomatoid areas showed fascicles of spindle-shaped cells with focal carcinomatous element in the form of few scattered small glands [Figure 2]. Heterologous sarcomatous elements were not seen. The tumor was seen infiltrating across the muscularis propria into the adventitial fat but the liver bed and serosa were free of infiltration. On immunohistochemistry, the sarcomatoid areas were positive for vimentin and negative for cytokeratin and epithelial membrane antigen (EMA). The carcinomatous component was positive for cytokeratin and EMA, but was negative for vimentin. Postoperative recovery was uneventful. No adjuvant chemotherapy or radiotherapy was given since the tumor was confined to the gallbladder. The patient was alive 3 months after surgery with no evidence of distant metastasis.
| Discussion | | |
Spindle cell carcinoma of the gallbladder is an uncommon neoplasm that shows carcinoma with a variable component of sarcomatoid spindle cells and has been called by other names including sarcomatoid carcinoma, pseudosarcoma, and carcinosarcoma. [2] In the majority of cases, well to poorly differentiated adenocarcinoma comprises the carcinomatous element. There is occasionally a component of squamous cell carcinoma or squamous metaplasia. The sarcoma like portion consists of undifferentiated stellate and spindle-shaped cells variably admixed with foci resembling osteosarcoma, chondrosarcoma or rhabdomyosarcoma. [3],[4]
Gallbladder carcinosarcomas occur predominantly in elderly women, often presenting with abdominal tenderness, jaundice and right upper quadrant mass frequently associated with gallstones. These tumors are large and polypoid and often fill the gallbladder lumen. [5] They usually present with advanced disease and have an extremely poor prognosis. However, a curable resection is possible if the tumor is detected while it is still confined to the gallbladder.
Immunohistochemical staining and electron microscopic findings are helpful in making the diagnosis. The tumor cells of the sarcomatous area co-express cytokeratin (CK) and vimentin immunohistochemically and ultrastructurally, they show desmosome-like junctions and aggregates of cytoplasmic intermediate filaments. These findings suggest an epithelial origin of the sarcomatous components. [4]
In summary, we present a case of carcinosarcoma of the gallbladder. This case is being reported because of its rarity.
| References | | |
| 1. | Huguet KL, Hughes CB, Hewitt WR. Gallbladder carcinosarcoma: A case report and literature review. J Gastroint Surg 2005;9:818-21.  | | 2. | Arakawa A, Fujii H, Matsumoto T, Hirai S, Suda K. Loss of heterozygosity in clonal evolution with genetic progression and divergence in spindle cell carcinoma of the gallbladder. Hum Pathol 2004;35:418-23. [PUBMED] [FULLTEXT] | | 3. | Iezzoni JC, Mills SE. Sarcomatoid carcinoma (carcinosarcoma) of the gastrointestinal tract: A review. Semin Diag Pathol 1993;10:176-87. | | 4. | Kim MJ, Yu E, Ro JY. Sarcomatoid Carcinoma of the Gallbladder With a rhabdoid tumor component. Arch Pathol Lab Med 2003;127:e406-8. [PUBMED] [FULLTEXT] | | 5. | Rashid A, Ahrendt SA. Pathology and natural history of chronic cholecystitis and gallbladder carcinoma. In: Abbruzzese JL, Evans DB, Willett CG, Fenoglio-Preiser C, editors. Gastrointestinal oncology. USA: Oxford University Press; 2004. p. 420-7. |
Correspondence Address:
Manoj Jain
Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow - 226 014, Uttar Pradesh
India
DOI: 10.4103/0377-4929.48933 PMID: 19332928
[Figure 1], [Figure 2] | |
| This article has been cited by | | 1 | Carcinosarcoma of the gallbladder: report of two cases | | | Ho-Hyun Kim, Young-Hoe Hur, Eun-Hui Jeong, Eun-Kyu Park, Yang-Seok Koh, Jung-Chul Kim, Hyun-Jong Kim, Jin-Woong Kim, Chol Kyoon Cho | | Surgery Today. 2012; | | [VIEW] | | | 2 | Surgical therapy and prognosis of sarcomatoid carcinoma of the gallbladder | | | Hu, Z.H., Li, Z.W., Shen, L., Zhang, M., Zheng, S.S. | | Hepatobiliary and Pancreatic Diseases International. 2010; 9(2): 175-179 | | [Pubmed] | | | 3 | Surgical outcome of carcinosarcoma of the gall bladder: A review | | | Okabayashi, T., Sun, Z.-L., Montgomery, R.A., Hanazaki, K. | | World Journal of Gastroenterology. 2009; 15(39): 4877-4882 | | [Pubmed] | |
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