Carcinosarcoma Of Gallbladder Research Articles

Coexistence of gallbladder carcinosarcoma and mucinous neoplasia: a challenging case

Coexistence of gallbladder carcinosarcoma and mucinous neoplasia: a challenging case

Carcinosarcoma of the Gallbladder: A Rare Tumor.

Malignant tumors of the gallbladder are rare, with adenocarcinoma being the most common histological subtype. Carcinosarcoma of the gallbladder, first described in 1907 by Landsteiner, is an extremely rare tumor which comprises less than 1% of the uncommon gallbladder cancers. This unique type of tumor can develop at any major organ, with the uterus being the most common one. Being a tumor that contains epithelial and mesenchymal components, histopathological diagnosis of such rare tumor is a challenging issue. Up to date, there are less than 100 cases of gallbladder carcinoasarocoma reported in the English literature. Therefore, experience and knowledge regarding this rare disease are very limited. Due to the fact that gallbladder carcinosarcoma is a rare and highly forgotten tumor, this article aims to review the English literature to increase awareness of the treating physician to improve diagnosis, management, as well as overall survival.

Carcinosarcoma of Gallbladder with Osteosarcomatous Differentiation - a Case Report with Review of Literature.

A 44-year-old female presented with dull upper abdominal pain. Contrast-enhanced computed tomography (CECT) of the abdomen revealed a well-distended gallbladder with multiple foci of minimally enhancing, intraluminal, soft tissue lesion, and hyperdensity on non-contrast scan measuring 4.3 × 3.5cm in the fundus with few calculi embedded in it. There was no evidence of extraluminal extension. The patient underwent extended cholecystectomy with liver wedge resection. Histologically, the tumor showed both carcinomatous and sarcomatous components, with prominent osteosarcomatous differentiation. We report this unusual case and present a review of all cases of carcinosarcoma of the gallbladder with sarcomatous differentiation. Despite curative resection, CSGB prognosis remains poor, and thus, the authors recommend to focus their efforts to improve the surgical outcomes.

Two cases of resected gallbladder carcinosarcoma with a contrasting course

IntroductionCarcinosarcoma of the gallbladder is a rare tumor with both carcinoma and sarcoma components.Case presentationIn this paper, we report two cases. The first case is of a man in his 60s who was preoperatively diagnosed with gallbladder carcinosarcoma and has achieved 6 years and 6 months survival through aggressive surgical treatment. The second case is of a woman in her 70s who was diagnosed with locally advanced gallbladder cancer; she underwent multidisciplinary treatment for the same, but died 8 months after the surgery. While the primary disorder was the same in both cases, the clinical courses contrasted sharply.DiscussionThere is no established chemotherapy or radiation therapy for gallbladder carcinosarcoma, and the only curative treatment is surgery. However, it has a very poor prognosis.ConclusionCarcinosarcoma of the gallbladder may progress very rapidly, and the treatment management should be carefully decided.

Carcinosarcoma of gallbladder: A world review.

BACKGROUNDGallbladder carcinosarcoma is a rare hepatobiliary tumor comprising of both carcinomatous and sarcomatous components. Due to its rarity, the literature with regards to the topic is scarce and currently lacking, spanning less than 100 cases.AIMTo summarize the current literature on gallbladder carcinosarcoma. METHODSA literature review was performed on the PubMed database using the keywords “Gallbladder” AND “Carcinosarcoma” from 1970 to 2021. Additionally, similar searches were performed on MEDLINE and Web of Science.RESULTSRisk factors noted include female gender, gallstones and chronic cholecystitis. In the absence of any diagnostic biochemical testing or tumor markers, imaging modality serves as the key initial impression tool, which can be histologically confirmed only post-resection. While surgery is the only curative option, the use of adjunctive chemotherapy has been considered on top of excision in recent years, with some success. CONCLUSIONWhile this study has taken steps to bridge the gap in the literature, more cases should be reported to further ascertain the current associations and management potential for gallbladder carcinosarcoma.

A case of primary hepatic mixed neuroendocrine-non-neuroendocrine tumor (MiNEN) associated with gallbladder carcinosarcoma

A woman in her seventies visited our hospital because of abdominal pain. Multiple hepatic tumors were detected and a liver biopsy revealed mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN), which was composed of cholangiocellular carcinoma and neuroendocrine tumor (NET). Diagnostic imaging ruled out primary malignancies other than the liver and identified that the tumor originated from the liver. Because a predominant and aggressive part of the tumor was considered to be cholangiocellular carcinoma, gemcitabine and S-1 were used as first-line treatment. After the treatment, octreotide acetate was administered for the NET component, followed by transcatheter arterial embolization. Subsequently, her gallbladder (GB) rapidly swelled with biliary tract obstruction, and cholecystectomy revealed carcinosarcoma of the GB. She is still undergoing treatment at 44months after diagnosis. Herein we report this case of primary hepatic MiNEN consisting of cholangiocarcinoma and NET, followed by GB carcinosarcoma. This is the first case illustrating that a multidisciplinary treatment approach for MiNEN accompanied with carcinosarcoma, involving assessment and treatment targeting the most aggressive component, can result in a long survival time.

Primary Gallbladder Carcinosarcoma: A Rare Biliary Malignancy

Gallbladder cancer comprises approximately 85-90% of all biliary tract malignancies, with carcinosarcomas accounting for less than 1%. Karl Landsteiner first described sarcomatoid carcinoma in the gallbladder in 1907, with less than 100 cases reported since that time. A 49-year-old male presented with 1 month of sharp, epigastric pain. Initial labs revealed a lipase of 3785 U/l, AST 658, ALT 489, total bilirubin 2.4 mg/dl, and direct bilirubin 1.3 mg/dl. Computer tomography (CT) of abdomen and pelvis revealed intra and extra-hepatic biliary duct dilation, cholelithiasis with biliary sludge, and hyper-enhancement of the gallbladder wall. Magnetic resonance cholangiopancreatography (MRCP) revealed gallbladder wall thickening with a polyp or a large amount of gallbladder sludge. There was no definite evidence of choledocholithiasis. Patient underwent laparoscopic cholecystectomy. Pathology of the gallbladder showed a circumferential tumor at the gallbladder fundus measuring 3.2 cm with gross and microscopic invasion through the muscular wall (Figure 1). The tumor showed glandular differentiation with pleomorphic spindle cell components consistent with sarcomatoid carcinoma of the gallbladder (Figure 2). Tumor markers including AFP, Ca 19-9, and CEA were negative. He underwent further robotic-assisted liver resection with lymphadenectomy. Lymph nodes were negative for malignancy. He was evaluated by oncology and recommended adjuvant platinum based chemotherapy for six months.1243_A.tif Figure 1: Gross image of gallbladder showing a 3.2 cm, circumferential, intramural mass with associated mucosal ulceration1243_B.tif Figure 2: No Caption available.Carcinosarcoma is a rare gallbladder malignancy without clear diagnostic and treatment guidelines. Preoperative diagnosis is difficult as there are no specific radiographic findings. Histologically these tumors are characterized by malignant epithelial and mesenchymal cells, that stain positive for cytokeratin and vimentin respectively. Tumor markers are often nonspecific. Major prognostic factors may include tumor size, staging, and depth of invasion. Primary therapy is surgical resection. Some cases have reported chemotherapy regimens including a combination of 5-fluorouracil with a carboplatin. Overall prognosis is poor in locally advanced disease with a 5-year survival rate of approximately 16%. This case illustrates the importance of considering carcinosarcoma as a differential in a patient with prolonged epigastric pain with non-specific image findings. It stresses the importance of ongoing research to help define adjuvant chemotherapy or chemoradiation regimens to improve survival.

Carcinosarcoma of Gallbladder with Metastases in Liver and a Lymph Node

Carcinosarcoma of Gallbladder with Metastases in Liver and a Lymph Node

高度十二指腸浸潤を伴う胆嚢癌肉腫の1例

症例は69歳，女性．嘔気，全身倦怠感を主訴に前医を受診．CTで胆嚢底部に径7cmの肝・十二指腸に浸潤する腫瘤性病変を認めた．上部消化管検査で十二指腸に浸潤を認め，生検で腺癌の診断であった．下血が続くため当科紹介．切除不能因子が明らかでないため肝切除術および膵頭十二指腸切除を施行し，肉眼的に完全切除した．組織所見では円形核・紡錘形核が主体となる腫瘍で，ごく一部には腺管分化を示す部位もあり，免疫染色ではCAM5.2，AE1/AE3が陽性．34betaE12はfocalに陽性，p40は陰性であった．神経内分泌系・筋原性マーカーは陰性でS100のみ陽性部分があり，いわゆる胆嚢癌肉腫の診断であった．切除から3カ月目に腹壁に再発を認めたが放射線加療による腫瘍の縮小を得，術後5カ月現在生存中である．今回われわれは，稀ないわゆる胆嚢癌肉腫の1例を経験したので文献的考察を加え報告する．

胆嚢癌肉腫の1例

胆嚢癌肉腫の1例

Gallbladder carcinosarcoma with gallstones in the elderly: a report of one case and literature review

Gallbladder carcinosarcoma with gallstones in the elderly: a report of one case and literature review

A case report of carcinosarcoma of gall bladder characterized by good response to the chemotherapy

Carcinosarcoma, which comprises less than one percent of all gall bladder neoplasms, is characterized by the presence of variable proportions of carcinomatous and sarcomatous elements. We report a case of gall bladder carcinosarcoma arising in 69-year-old female. The patient was admitted to our hospital because of epigastric pain. CT revealed gall bladder tumor and liver invasion, portal vein invasion and peritoneal dissemination of the tumor. At the time of diagnosis, the tumor was considered inoperable. Following diagnosis, the patient received chemotherapy (1 course of gemcitabine). It was effective, and the tumor became operable. Curative surgical resection was performed. Histologically, viable tumor component remained mainly in the gall bladder. The tumor component consisted of sarcomatous and carcinomatous elements, and the latter was composed of squamous cell carcinoma and adenocarcinoma. In addition, remarkable necrosis and fibrosis was seen inside the tumor, especially in the part of liver invasion. We thought that the necrotic and fibrotic change indicated antitumor activity of the chemotherapy. On the basis of these findings, the tumor was diagnosed as carcinosarcoma of gall bladder. In summary, we reported the rare case of carcinosarcoma arose in gall bladder, which showed good response to the chemotherapy.

Gallbladder carcinosarcoma accompanied with bile duct tumor thrombi: A case report

Gallbladder carcinosarcoma is one of the rarest subsets of gallbladder malignancies. The first case of carcinosarcoma of the gallbladder was reported in 1907. To date, <100 cases have been reported in the English literature. The present study reports a case of gallbladder carcinosarcoma accompanied with tumor thrombi, presenting as a soft tissue mass in the common bile duct and resulting in the obstruction and inflammation of the biliary tract. Initially, the patient was diagnosed with a gallbladder tumor and choledocholithiasis. No cases of carcinosarcoma of the gallbladder accompanied with bile duct tumor thrombus formation have been reported to date. A cholecystectomy with liver segmentectomy (S4a+S5) and a lymph node dissection were performed. The presence of a tumor thrombus in the common bile duct was confirmed by analysis of a frozen section during surgery. Resection of the extrahepatic bile duct and Roux-en-Y type hepatic cholangiojejunostomy were also performed. In addition, the gallbladder carcinosarcoma was observed to produce α-fetoprotein. The patient underwent an uneventful post-operative recovery and, to date, no clinical or radiological evidence of disease recurrence or metastasis has been identified. Carcinosarcoma of the gallbladder accompanied with tumor thrombi is extremely rare. Tumor thrombi in the common bile duct may easily be misdiagnosed as choledocholithiasis. The treatment and prognosis of gallbladder carcinosarcoma is similar to that of gallbladder carcinoma.

胆嚢に発生し扁平上皮癌の成分を持った「いわゆる癌肉腫」の1例

癌肉腫は同一腫瘍内に上皮由来の癌と間葉系細胞由来の肉腫が混在する腫瘍であり，中でも「いわゆる癌肉腫」は癌腫の一部が肉腫様に変化したものとされる．一般的に，その上皮性腫瘍成分は腺癌であることが多く，扁平上皮癌であることは稀である．今回われわれは，胆嚢に発生し上皮性腫瘍成分が扁平上皮癌であった「いわゆる癌肉腫」の1例を経験したので報告する．症例は68歳の女性．嘔吐と食欲不振を主訴に受診し，十二指腸球部浸潤を伴う進行胆嚢頸部癌の診断で，拡大胆嚢摘出，亜全胃温存膵頭十二指腸切除術を施行した．病理組織学的に扁平上皮癌と紡錘形細胞腫瘍の混在を認め両者の間に移行像を認めた．紡錘形細胞腫瘍は上皮系マーカーであるkeratinによる免疫染色において陽性であり，「いわゆる癌肉腫」と診断した．術後3カ月で肝転移と腹膜再発により死亡した．

胆囊癌肉腫と胆囊癌が並存した１例

患者は82歳，男性．平成22年５月頃近医にて便潜血陽性を指摘され，また半年で７kgの体重減少あり６月精査目的に当院紹介受診となった．下部消化管内視鏡検査で横行結腸肝彎曲部に20mm大の隆起性病変，その２cm肛門側に30mm大の１/４周性の２型病変を認めた．生検で類円形から紡錘形異型核腫瘍細胞の粘膜下増殖，浸潤が認められ，ケラチン陰性，白血球共通抗原陰性であり間葉系肉腫が疑われた．腹部超音波検査，腹部CTにて胆囊の内腔に充実性腫瘤が認められ，胆囊間葉系肉腫の横行結腸浸潤と診断し７月に手術施行した．術中所見では胆囊底部より壁外性に横行結腸へ浸潤する腫瘍を認め，拡大胆囊摘出術，および結腸右半切除術を施行した．摘出標本では病理学的には胆囊癌肉腫に胆囊癌を合併していた．術後合併症なく第15病日に退院した．今回胆囊癌肉腫と胆囊癌が並存した１例を経験したため若干の文献的考察を加えて報告する．

Clinicopathologic Analysis of Gallbladder Carcinosarcoma

Clinicopathologic Analysis of Gallbladder Carcinosarcoma

Carcinosarcoma of the gallbladder: report of two cases

Adenocarcinoma is the predominant histological type of carcinoma of the gallbladder, accounting for more than 80% of all gallbladder carcinomas. In contrast, carcinosarcoma of the gallbladder is an extremely atypical subset of gallbladder malignancies. It is characterized by the presence of both epithelial and mesenchymal components. Currently, fewer than 100 cases have been reported in the English literature. Therefore, knowledge and experience regarding this disease are limited. Recently, we experienced two cases of gallbladder carcinosarcoma, which were diagnosed as gallbladder carcinoma based on the preoperative clinical and radiological examinations. Cholecystectomies were performed in both cases, and the malignant tumor cells included carcinomatous and sarcomatous components histologically. The final pathological diagnoses were carcinosarcoma of the gallbladder. We herein report these two cases of gallbladder carcinosarcoma and review the previous pertinent literature.

胆嚢癌肉腫の1例

癌肉腫は上皮性悪性腫瘍の癌と非上皮性悪性腫瘍の肉腫が混在する腫瘍で，胆嚢原発の報告は45例しかなくまれな腫瘍である．症例は71歳の女性で，胆嚢内に3cm大の腫瘍を認め，胆嚢癌の診断で肝床切除術およびD2リンパ節郭清を施行した．病理組織検査では腺癌と紡錘形を呈する肉腫様の腫瘍細胞が混在し，両者の間に移行像を認めた．移行部付近の紡錘形腫瘍細胞の一部に上皮性マーカーが陽性であり「いわゆる癌肉腫」と診断した．文献的には乳頭状，結節状の形態を呈することが多く，自験例も有茎性の結節型腫瘍であり，浸潤性を示すことが多い通常の胆嚢癌との違いと考えられた．通常の腺癌より予後不良とされていることが多く，化学療法等は効果が期待できないとの意見が多い．しかし，自験例はS-1療法を選択し術後24カ月間継続投与し再発なく経過している．

Primary carcinosarcoma of the gallbladder

Carcinosarcoma of gallbladder (CSGB) is a rare malignancy characterized by malignant epithelial and mesenchymal components. Its pathogenesis is unknown and most CSGBs are associated with poor survival because the disease normally presents at an advanced stage, and as a result, curative resection is uncommon. This report describes a case that underwent curative resection. A 77-year-old woman presented with right upper quadrant pain. The preoperative diagnosis was gallbladder (GB) cancer, and thus, curative radical cholecystectomy was performed. However, pathologic examination of the surgical specimen revealed that the tumor was composed of two histologic components of squamous cell carcinoma and spindle cell sarcoma, which was consistent with a diagnosis of carcinosarcoma. The tumor was found to extend to the perimuscular connective tissue and to have metastasized to one lymph node (LN). The prognosis of CSGB remains poor despite curative resection, and thus, the authors recommend that effort be made to improve surgical outcomes.

Morphologic Heterogeneity in Carcinosarcoma of the Gallbladder: Report of a Rare Cases

Carcinosarcoma is a rare tumor composed of variable proportions of carcinomatous and sarcomatous elements and comprises less than one percent of all gallbladder malignancies. In most reported cases of carcinosarcoma of gallbladder, the epithelial component is adenocarcinoma. The mesenchymal component varies from homogenous sarcoma to more heterotopic elements like malignant bone, cartilage, and other mesenchymal tissues. We report a rare case of carcinosarcoma of the gallbladder in an 83-year-old male, with the carcinomatous component represented by undifferentiated carcinoma (spindle and giant cell type with osteoclastic giant cells) and the mesenchymal component seen as foci of chondrosarcoma.