Carcinosarcoma of the gallbladder. A case report with immunohistochemical and ultrastructural studies

Abstract

The authors present the histologic features, immunohistochemical findings, and ultrastructure of a carcinosarcoma of the gallbladder containing rhabdomyosarcoma as a mesenchymal element. A pedunculated polypoid tumor protruded into the lumen from the fundus of the gallbladder. The neoplasm contained two divergent components. One was malignant mesenchymal tissue with rhabdomyoblastic differentiation; the other was ordinary adenocarcinoma which was observed predominantly at the base of the polyp. Immunohistochemically, the cytoplasm of the rhabdomyoblasts stained with anti-myoglobin, myosin, and muscle actin antibodies. Ultrastructurally, there were a large number of malignant mesenchymal tissues in which various stages of differentiated rhabdomyoblasts were noted. Ultrastructural study was particularly valuable for the identification of sarcomatous elements.

Surgical management of gallbladder sarcomatoid carcinoma

“…The most common histological type of gallbladder cancer is adenocarcinoma, and sarcomatoid carcinoma is extremely rare [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] . Chao et al [1] have reported the incidence of sarcomatoid carcinoma from gallbladder cancer as 4.1%.…”

“…It has been described that sarcomatoid carcinoma arises from totipotent stromal stem cells [8] and is composed of epithelial and mesenchymal components that contain undifferentiated spindle or stellate cells [3,4,6,8,9,11,[14][15][16][17][18] . The cancer was first reported by Landsteiner in 1907, and until now, only 44 cases have been reported in the English-language literature, with an age range of 45-91 years [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] . However, in our review, patient age was limited to the sixth and seventh decades of life.…”

“…Symptoms may persist from several days to years. Liver function tests are normal, except in patients with obstructive jaundice caused by tumor invasion of the biliar y tract [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] . Most cases have been reported to have normal CEA and CA19-9 levels, and in our series, the CEA level was elevated in one case and CA19-9 level was elevated in two cases.…”

“…Tumors that possess epithelial and mesenchymal components are so-called sarcomatoid carcinomas. Gallbladder sarcomatoid carcinoma is a rare and atypical subset of gallbladder carcinoma, and only 44 cases have been described in the English-language literature worldwide [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] . All of these have been case reports and have little information about the clinical behavior and optimal treatment of these tumors.…”

So-Called Carcinosarcoma of the Gallbladder; Spindle Cell Carcinoma of the Gallbladder: Report of a Case

“…3,7-10 Recently it has been thought that true carcinosarcomas of the gallbladder exist in only a few cases. 3 In the present study, we report a rare case of carcinosarcoma of the gallbladder which was diagnosed immunohistochemically.…”