Sarcomatoid carcinoma of the gallbladder with a rhabdoid tumor component.

We report the case of a sarcomatoid carcinoma with a rhabdoid tumor component originating in the gallbladder, along with immunohistochemical and electron microscopic findings. A 61-year-old woman presented with a 5-month history of right upper quadrant pain. Ultrasonography and a computed tomographic scan indicated gallbladder cancer. She underwent a cholecystectomy and a common bile duct resection. A firm mass (4.5 cm in greatest dimension) was present in the neck portion of the gallbladder. The mass was firm, solid, yellowish gray, and granular with areas of necrosis. Microscopically, the tumor was a biphasic sarcomatoid carcinoma and consisted of diffusely arranged pleomorphic cells, focally showing rhabdoid features and neoplastic glands with focal mucin production. Heterologous components such as osteoid, chondroid, and rhabdomyoblastic elements were not identified. By immunohistochemical staining, we demonstrated that the rhabdoid cells coexpressed cytokeratin and vimentin. On electron microscopic examination, the rhabdoid tumor cells showed cytoplasmic whorls of intermediate filaments in the cytoplasm and eccentric nuclei. Two months postoperatively, the follow-up computed tomographic scan showed multiple intrahepatic metastases and omental seedings.

A carcinoid tumor in the gallbladder of a dog.

A cholecystectomy was performed on a 10-year-old spayed female mixed-breed dog with chronic weight loss, persistently increased liver enzyme activities, and cholecystomegaly identified by ultrasonographic examination. A subsequent diagnosis of a biliary carcinoid was made based on a neuroendocrine-type histologic pattern, cytoplasmic argyrophilia by Grimelius staining, immunopositivity for chromogranin A, and the ultrastructural finding of cytoplasmic secretory granules in neoplastic cells. Extrahepatic biliary carcinoid tumors are rare tumors of humans and have not been documented in domestic animals.

Centrosome abnormalities in human carcinomas of the gallbladder and intrahepatic and extrahepatic bile ducts.

During mitosis, 2 centrosomes ensure accurate assembly of bipolar spindles and fidelity of the chromosomal segregation. The presence of more than 2 copies of centrosomes during mitosis can result in the formation of multipolar spindles, unbalanced chromosome segregation, and aneuploidy. Recent studies have provided evidence that centrosome hyperamplification plays a pivotal role in carcinogenesis. Using immunofluorescence analysis with gamma-tubulin and pericentrin antibodies, paraffin-embedded sections from 40 malignant biliary diseases including gallbladder cancers (GC; n = 13), intrahepatic cholangiocellular carcinoma (CCC; n = 19), and extrahepatic bile duct cancers (BDC; n = 8) were examined. Thirty-seven benign biliary diseases including chronic cholecystitis, gallbladder adenoma, hepatolithiasis, and choledochal cyst were included as benign controls. The frequencies of the centrosome abnormalities were 70% for GC, 58% for CCC, and 50% for BDC, respectively. The frequencies of centrosome abnormalities in malignant biliary diseases were significantly higher than in their benign counterparts (GC, CCC, BDC; P =.001,.002, and.001, respectively). The results of current study also indicated that biliary malignancy in the advanced stage (III-IV) displayed a higher frequency of centrosome abnormalities than in the early stage (I-II) (P <.001). We conclude that abnormalities in size, number, and shape of the centrosome are frequently observed in biliary tract malignancy. Centrosome abnormalities started to occur in the early stage of biliary malignancy and became very frequent in the advanced stage. This implies that centrosome abnormality might relate to the transition from early to advanced malignancy in biliary malignancy.

Sarcomatoid carcinoma (carcinosarcoma) of the gallbladder.

We report a case of carcinoma of the gallbladder in a 67-year-old woman. The description comprises the histological, immunohistochemical, ultrastructural and cytogenetical picture of the tumor. The ultrastructural features as well as chromosomal changes may denote the epithelial derivation of the tumor studied.

[US and CT findings of mucinous carcinomas of the gallbladder].

Mucinous carcinomas of the gallbladder are relatively uncommon. Their radiological findings have not been described previously. We describe the CT and US findings of mucinous carcinoma of the gallbladder in 3 cases. Tumors (thickened wall and/or intraluminal polypoid mass) showed hyperechogeneity or isoechogeneity on US and water density on CT. US clearly detected large polypoid lesions, but CT was unable to detect these lesions in 2 cases. Therefore, we stressed the discrepancy between the findings of US and CT. These features can be explained by the fact that a tumor containing a large amount of mucin produces a mass of near-water density in the gallbladder on CT. It is of value to know the radiological findings of these tumors because the diagnosis is easily missed by CT study alone.

Oat cell carcinoma of the gallbladder. A rare and highly lethal neoplasm.

Oat cell carcinomas arising in the gallbladder are an extremely rare and aggressive form of gallbladder cancer. These neoplasms are morphologically identical to their pulmonary counterparts, contain neurosecretory granules on ultramicroscopic examination, and demonstrate immunohistochemical staining for cytokeratin, neuron-specific enolase, and other neuroendocrine markers. Oat cell carcinomas typically occur in elderly women with cholelithiasis, and pursue a fulminant course with extensive metastases, especially to the liver. The mean survival is less than 7 months. We present a well-documented case of oat cell carcinoma of the gallbladder and review the literature on this unusual entity.

Cultured human gallbladder epithelia. Methods and partial characterization of a carcinoma-derived model.

BACKGROUND: Gallstone disease remains a leading cause of morbidity and mortality in humans. Despite extensive research into the physiology of the gallbladder, little is known about mucosal events that precede and contribute to stone formation. Here, we describe and partially characterize a cultured epithelial model of human gallbladder mucosa. EXPERIMENTAL DESIGN: Cells originally obtained from a well-differentiated gallbladder mucosal carcinoma were cultured in modified Eagle's minimum media (supplemented with fetal calf serum and antibiotics) on polycarbonate supporting matrices. RESULTS: Cell cultures were observed to come to confluence with 6 to 9 days. Light and transmission electron microscopy demonstrated the resultant epithelia to be predominantly one cell thick, to be polar in orientation, and to have apical villi. Epithelia exhibited cytokeratin markers consistent with their epithelia origin, functionally acidified the mucosal bathing solutions, and secreted mucin. Further experiments demonstrated transepithelial potential differences, mucosal-to-serosal transfer of sodium which could be inhibited with amiloride and 4-acetamido-4'-isothiocyanatostilbene-2-2'-disulfonic acid, and paracellular movement of neutral molecular probes inversely related to size. CONCLUSIONS: This culture model of human gallbladder mucosal carcinoma cells exhibits parameters consistent with native gallbladder and may offer a convenient new research tool for the study of the pathophysiology of gallstone formation.

Silver-binding argyrophilic nucleolar organizer regions (AgNOR) in gall-bladder cancer: correlations with malignant grading and prognosis.

Silver-binding nucleolar organizer regions (AgNOR) were investigated and compared in 43 cases of gall-bladder cancers and 10 normal gall-bladder samples using an image analyzer. The mean numbers of AgNOR per nucleus (AgNOR number) were 3.28 +/- 1.38 in the gall-bladder cancers and 1.86 +/- 0.20 in the normal gall-bladder cases. The respective mean areas of AgNOR per nucleus (AgNOR area) were 6.96 +/- 3.78 microns2 and 1.89 +/- 0.21 microns2. The differences were statistically significant (P < 0.0001) for both parameters. In addition, increased frequency and enlargement were both apparently correlated with poor prognosis (P < 0.011 and P < 0.046, respectively), with AgNOR number and AgNOR area showing tendencies for increase in cases of histologically high grade malignancy, advanced cancer and regional lymph node involvement. In conclusion, AgNOR number and AgNOR area appear to be useful indicators for the grading of malignancies and for the prediction of gall-bladder cancer prognosis.

Small cell (endocrine cell) carcinoma of the gallbladder with squamous and adenocarcinomatous components.

Small cell (endocrine cell) carcinoma of the gallbladder in a 62-year-old woman is reported. The palliative cholecystectomy specimen revealed a submucosally invading tumor with extensive hemorrhagic necrosis. At autopsy, performed five months after surgery, a huge tumor measuring 14 x 12 x 8 cm was located at the liver hilus. No signs or symptoms related to overproduction of hormones were recorded throughout her illness. Neither lung lesions nor gall stones were identified. Histologically, diffuse proliferation of small, spindle-shaped atypical tumor cells with numerous mitoses was evident. Intraepithelial tumor cell proliferation in the gallbladder mucosa was seen focally. The neuroendocrine nature of the tumor cells was confirmed by the histologic pattern of growth with pseudo-rosette formation, positive reaction for Grimelius' argyrophilia, neuron-specific enolase and Leu 7, and ultrastructural demonstration of neuroendocrine-type granules. Immunostaining for a variety of hormones was all negative. Characteristically, foci with squamous and adenocarcinomatous differentiation were identified in the tumor tissue. The glandular components were immunoreactive for carcinoembryonic antigen, secretory component, epithelial membrane antigen and CA19-9. The histogenesis and totipotentiality of the neoplasm were discussed.

Unusual case of granular lymphocytes (GL) proliferation: simultaneous reactive and neoplastic proliferation.

We report a case of a 55-year-old male with lymphoproliferative disease of granular lymphocytes. In the first year of follow-up reactive expansion of granular lymphocytes was observed during infectious episodes additionally to malignant proliferation. Histopathological studies revealed malignant lymphocytic infiltrations of the liver and gallbladder walls. The number of GL varied from 1.1 G/l to 17.8 G/l. Immunophenotyping studies showed surface phenotype CD3+, CD8+. There was markedly reduced NK cell function. The patient exhibited lack of severe parenchymal involvement, moderately increased white cell count (up to 21.0 G/l), severe neutropenia (0.06 G/l - 0.8 G/l) and recurrent infectious episodes.

Osteoclast-like giant cell tumour of the gallbladder.

We describe a rare carcinoma of the gallbladder containing osteoclast-like giant cells. Well-differentiated adenocarcinoma was found in the mucosa of the fundus, and osteoclast-like giant cells were present mainly in a haemorrhagic mass protruding from the mucosal surface. The metastatic hepatic tumour was composed chiefly, if not exclusively, of osteoclastoma-like cells, but minute carcinomatous elements were also present. There was an apparent transition between the giant cells and tubular structures in both the gallbladder tumour and hepatic tumour. However, ultrastructural study did not reveal any evidence of epithelial differentiation in the giant cells. Immunohistochemical studies suggested that the mononuclear and giant cells were mesenchymal and histiocytic in nature (vimentin and factor XIIIa positive). A few exceptional giant cells transforming from the fine tubular structure were positive for epithelial membrane antigen. In conclusion, the osteoclast-like giant cell tumour component was thought to represent mesenchymal metaplasia in pre-existent adenocarcinoma.

[Morphological analysis of 40 polypoid lesions of the gallbladder and their clinical significance].

For the purpose of studying the histological types of gallbladder polyps and their relations to the clinical features, 40 specimens of postoperative polypoid lesions of the gallbladder collected from Changhai Hospital were observed by means of light and electron microscopy. The results demonstrated that the histological types of gallbladder polyps might be divided into: cholesterol polyp, inflammatory polyp, mixed-type polyp and adenomatoid polyp. Cholesterol polyp was the most frequently encountered and the next was inflammatory polyp. A mixed-type polyp is proposed. The adenomatoid polyp might have atypical hyperplasia and potential malignancy. The cholesterol polyp had no relationship with cholesterolosis of the gallbladder.

Small-cell carcinoma of gallbladder. An immunocytochemical and ultrastructural study.

An unusual carcinoma of the gallbladder in a seventy-one-year-old woman displayed features of a well-differentiated adenocarcinoma, atypical carcinoid and small cell undifferentiated carcinoma. The patient died from progressive hepatic failure four months after surgery. Autopsy showed bulky liver masses and several peritoneal nodules exclusively composed of small, hyperchromatic cells. The neuroendocrine nature of the small cell component of the tumor was documented by the presence of neurosecretory granules at the ultrastructural level and by immunocytochemical positivity to NSE and Synaptophysin. The epithelial markers, cytokeratin and CEA, were also positive in the carcinoid and in the undifferentiated portions of the tumor. A common endodermal origin is suggested for carcinoid and small cell carcinoma of the gallbladder.

Malignant melanoma of the biliary tract: a case report.

A 58-year-old man was seen with obstructive jaundice and discomfort in the upper abdomen. Computed tomographic and ultrasound examinations revealed a soft-tissue mass in the gallbladder. Cholecystectomy and choledochotomy revealed a soft black mass in the gallbladder and a second one in the intrapancreatic portion of the common bile duct. Each was diagnosed as malignant melanoma. Subsequently, a Whipple resection of the pancreas, duodenum, and distal bile duct revealed a melanoma circumferentially invading and obstructing the distal common duct. No lymph node or distant metastasis was identified. Repetitive searches for another primary site have been negative. The tumor apparently originated in the biliary tract. The patient remains almost well 2 years after diagnosis.

Ultrastructure of well-differentiated adenocarcinoma of the gallbladder.

The ultrastructure of four well-differentiated adenocarcinomas of the gallbladder was investigated by scanning and transmission electron microscopy and compared with the ultrastructure of nonneoplastic mucosa in the same specimens and of the mucosa of gallbladders with gallstones. The tumor cells seen by scanning electron microscopy had severe disorganization of the regular arrangement of columnar cells. They were bizarre in shape and size and were covered with less developed pleomorphic microvilli that were irregularly distributed. No such findings appeared in the control specimens. The tumor cells seen by transmission electron microscopy exhibited pleomorphic microvilli, well-developed cytoplasmic organelles, various mucus granules, abundant lysosomes, and nuclear changes. These findings suggest increased secretory and metabolic activity in the tumor cells. Gobletlike cells, Paneth-like cells, and endocrine cells were scattered in two of the carcinomas. These cells were also noted in the nonneoplastic mucosa of the carcinoma specimens but were rare in the mucosa when cholelithiasis was present.

Alteraciones epiteliales en colecistopatías / Epithelial changes in diseased gallbladders

Una revisión de 3,517 vesículas biliares extirpadas, del Hospital No. 1, CNSS en 10 años, mostró 249 casos con alteraciones epiteliales de diverso tipo, excluyendo metaplasia. La hiperplasia simple se presentó en 75.10%, tanto en el epitelio superficial como glandular de la mucosa vesicular. Displasia se vió en un 20.88% de las vesiculas extirpadas, 54% de las cuales se asociaron a cáncer de diferente variedad histológica. El carcinoma in situ, se encontró en 3.21% en zonas vecinas a un carcinoma vesicular. Se hallaron sólo 2 casos de adenoma uno con la variedad papilar y otro no papilar.

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

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.