Carcinosarcoma of the gallbladder: Report of a case

Abstract

Gallbladder carcinosarcoma is one of the rarest subsets of gallbladder malignancies. To date, only 34 cases have been reported in the English literature. Therefore the knowledge and experience regarding this disease is limited. This report describes a 70-year-old male patient who was diagnosed by documenting the epithelial and mesenchymal components with histopathological and immunohistochemical methods, and treated by a radical cholecystectomy. The pediculated polypoid tumor had filled the lumen, originating from the gallbladder fundus. The tumor infiltrated the surrounding connective and adipose tissue overlapping the muscular layer of its primary site, but had not perforated the serosa nor invaded the liver. The patient, who was treated only surgically, has remained healthy after 54 months of follow-up, which is the longest documented survival for this disease. This case indicates that curative treatment of a tumor confined to the gallbladder without liver or serosa invasion, or lymph node involvement, is therefore possible.

Carcinosarcoma of the Gallbladder: A Case Report and Review of the Literature

“…Carcinosarcoma of the gallbladder is a rare tumour, with only 34 cases being reported in the English literature [2]. It is characterized by a malignant trasformation of both the epithelial and the mesenchymal components of the same tissue.…”

“…The occurrence of the tumour in many different organs which include the uterus, lung, oesophagus, kidney and pancreas is well known [1]. However, the gallbladder is a rare site, with only 34 cases being reported in the English literature till date [2]. A vast majority of the gallbladder (GB) cancers are adenocarcinomas, with carcinosarcomas accounting for fewer than 1% of the tumours [3].…”

Acute Presentation of Gallbladder Carcinosarcoma and Management

“…This is due to the anatomic position of the GB and vague symptoms [4,5]. Although recent studies suggest some causative factors such as multistep genetic alterations, the precise mechanism of GB carcinogenesis remains unclear [6]. Many studies have suggested the presence of cholecystolithiasis is one of the most important risk factors for CGB [7].…”

“…He underwent a radical cholecystectomy and hepatodudodenal ligament lymphadenectomy once it was discovered that he had a malignant mesenchymal tumour on frozen section [6]. On the other hand, an 81 year old male, with CSGB invading the liver, underwent cholecystectomy with liver segmentectomy and lymph node dissection.…”

“…However, he was later readmitted with peritoneal dissemination causing ascites and died 4 months post-operatively [2]. Therefore, this indicates that curative treatment of CSGB without gallbladder serosal or liver invasion or lymph node involvement is possible [6,13]. Furthermore, the 5 year survival was 40% for patients with T2 or T3 tumours [14] [ Table 1], with a simple cholecystectomy and 90%, if a radical cholecystectomy was done [9].…”