Primary undifferentiated spindle-cell carcinoma of the gallbladder presenting as a liver tumor

Abstract

Undifferentiated spindle-cell carcinoma (SpCC) of the gallbladder is extremely rare. There is very little information available regarding the characteristics and treatment of this disease. We herein report the unique case of a 76-year-old female patient with a primary SpCC of the gallbladder that presented as a liver tumor. Preoperative radiologic examinations showed a 5-cm liver tumor around the gallbladder bed, and irregular thickening of the gallbladder wall. The patient underwent en-bloc resection of the gallbladder and segments 4b and 5 of the liver (including the liver tumor). Microscopic findings revealed that both lesions consisted mainly of a sarcomatous spindle-shaped component. Small foci of well-differentiated adenocarcinoma cells were identified in the gallbladder mucosa. There was a gradual transition between the two different components, thereby implying that these two cell types had a common origin. Immunohistochemical studies showed that the spindle-shaped cells were epithelial in nature. The patient's postoperative course was uneventful. However, she died of recurrent liver disease 6 months after the surgery. In conclusion, we surmised that the sarcomatous spindle cells originated from a carcinomatous component in the gallbladder mucosa through dedifferentiation. Further studies are needed to better understand the characteristics of this deadly tumor, and to establish an effective therapy for it.

Undifferentiated carcinoma of the gallbladder with endothelial differentiation: A case report and literature review

“…The results of the analysis, which are shown in Table I, showed that the patients' mean age was 66.6 years and that a high percentage of affected patients were female (female-to-male ratio, 1.57-7.00). Of note, in group A, the prognostic data in more recent studies (5-7) tended to be improved compared with those in earlier studies (2)(3)(4). Among the more recent studies, no significant difference between the prognostic data in groups A (5-7) and B (13,14) was present; however, the tumor size in group B was slightly larger compared with that in group A.…”

“…The implementation of diagnostic methods, including CT, US and magnetic resonance imaging to detect small-sized tumors, the development of extended radical surgery may have accounted for the abovementioned findings. The differences in the malignant potential between groups A and B may be based on the fact that the cells have different origins: True carcinosarcoma is derived from totipotent stem cells, which separately differentiate into epithelial and sarcomatous cells, while undifferentiated carcinoma is a morphological variant of carcinoma, which is transformed to exhibit sarcomatous features (4). The prognosis of patients with undifferentiated carcinoma of the gallbladder may be identical or slightly worse compared with that of patients with carcinosarcoma; however, this requires further assessment by future meta-analyses of data from patients worldwide.…”

“…Undifferentiated carcinoma of the gallbladder predominantly comprising sarcomatous admixed with carcinomatous elements has been referred to as 'sarcomatoid carcinoma', 'so-called carcinosarcoma' and 'spindle-cell carcinoma', and is at times considered to be carcinosarcoma, while the terminology remains to be unified (1)(2)(3)(4)(5)(6)(7)(8)(9). Undifferentiated carcinoma of the gallbladder is now classified into four types, according to the World Health Organization (WHO) classification (10), in addition to the diagnostic classification of carcinosarcoma.…”

Gallstone Disease: Epidemiology, Risk Factors, Clinical Features, Prevention

“…Однако в последние несколько десятилетий отмечается тен-денция к расширению возрастного диапазона [24,27], уже не нонсенс выявление холелитиаза в детском возрасте с частотой около 5% [12,21,30,39,40].…”

“…Одни авторы ЖКБ счи-тают самым распространенным среди заболеваний пищеварительной системы [14,28], другие авторы, отдавая первое место язвенной болезни, позициони-руют ЖКБ как вторую проблему в гастроэнтерологии [26]. В связи с этим, проблема ЖКБ, образно назван-ной «болезнью благополучия», является одной из наи-более актуальных для современной медицины [3,4,30,36], существенным бременем для здравоохране-ния многих стран, включая и Россию [20,39].…”