An autopsy case of pseudosarcoma of the common bile duct

Abstract

An autopsy case of pseudosarcoma in the common bile duct is reported. An 82-year-old Japanese male complaining of jaundice was admitted to our hospital; he was examined by abdominal ultrasonography (US), revealing biliary calculus, dilatation of the common bile duct, and choledocholithiasis, considered to be the possible cause of the obstructive jaundice. Endoscopic retrograde biliary drainage (ERBD) and cholangioscopy were performed concurrently, revealing a vaguely whitish tumor near the papilla of Vater. Two months later, the patient died from complications of the liver, infection, and disseminated intravascular coagulation (DIC). An autopsy study revealed tumor cells with extreme pleomorphic changes, growing diffusely, very like sarcoma. Further examination revealed epithelioid arrangements in the metastatic lymph node. Twelve kinds of immunohistochemical examination showed a positive reaction, reflecting the presence of an epithelioid cytoskeleton. Of 28 cases of true and pseudosarcoma of the biliary system reported in the Japanese literature, only 1 case was reported, in 1990, to involve the common bile duct. We therefore report the present case of pseudosarcoma of the common bile duct.

Undifferentiated carcinoma of the common bile duct: case report and review of the literature

“…Undifferentiated carcinomas are more common in the gallbladder than in the bile ducts. Moreover, in addition to our patient, only four cases of undifferentiated carcinoma in the extrahepatic ducts have been reported . The four previously described patients consisted of two men and two women ranging in age from 52 to 82 years (mean 67.3 years).…”

“…According to the World Health Organization (WHO) classification of tumors of the gallbladder and extrahepatic bile ducts, undifferentiated carcinoma is defined as a malignant epithelial tumor that resembles a sarcoma and consists of varying proportions of spindle, polygonal, and giant cells 19. This tumor has previously been reported under a wide variety of names, including pleomorphic spindle cell carcinoma,20 carcinoma with spindle cell features,17 pseudosarcoma,9 and sarcomatoid carcinoma 21…”

“…In the biliary tract, undifferentiated carcinoma sometimes occurs in the gallbladder but rarely in the extrahepatic bile duct. Only four cases have been reported in the literature . We report here another case of undifferentiated carcinoma of the common bile duct and demonstrate that this neoplasm exhibits a wide variety of immunohistochemical profiles.…”

Undifferentiated carcinoma of the common bile duct with intraductal tumor thrombi: Report of a case

“…12,23 Table 1 summarizes the 13 reported cases of undifferentiated carcinoma arising in the extrahepatic bile duct, including the present case. [6][7][8][9][10][11][12][13][14][15][16][17] Eleven of the 13 were nodular or polypoid macroscopically, and of the 12 patients with detailed follow-up information, 4 had stage IA disease (33%), 1 had stage IB (9%), 4 had stage II (33%), 1 had stage III (9%), and 2 had stage IV (17%). Undifferentiated carcinomas of the bile duct seem to be detected at an earlier stage than those of other organs, with stage I or II disease in 75% (9/12) of the patients reported.…”

“…To our knowledge, only 12 cases of undifferentiated carcinoma of the extrahepatic bile duct have been reported. [6][7][8][9][10][11][12][13][14][15][16][17] We report a case of undifferentiated carcinoma arising from the lower part of the extrahepatic bile duct and accompanied by bile duct tumor thrombi. We discuss how to differentiate this cancer from neuroendocrine carcinoma immunohistochemically, and review the reported cases of undifferentiated or spindle cell carcinoma arising in the bile duct.…”