A report of sarcomatoid carcinoma of the gallbladder treated with palliative deocetaxel and gemcitabine chemotherapy

Clinical analysis of 12 patients with sarcomatoid carcinoma of the gallbladder

AIM: To investigate the clinical features, diagnosis and treatment of sarcomatoid carcinoma of the gallbladder.

METHODS: The clinical data of 12 patients with sarcomatoid carcinoma of the gallbladder who were admitted to the First Affiliated Hospital of Zhengzhou University from January 1994 to December 2014 were retrospectively analyzed and compared with the data of 216 patients with gallbladder adenocarcinoma.

RESULTS: The ratio of male to female was 1:3, and the mean age was 61.3 years ± 9.6 years. Of the 12 patients, the cases with abnormally high serum carbohydrate antigen 199 (CA-l99), carbohydrate antigen 125 (CA-125), carcinoembryonic antigen (CEA) levels were 9, 7 and 1, respectively. Immunohistochemical examinations showed that the positive rates of cytokeratin (CK), cytokeratin 19 (CK19), AE1/AE3 and Vimentin were all 100% (12/12), and the positive rates of cytokeratin 20 (CK20) and S-100 protein were 66.7% (8/12) and 50% (6/12), respectively. Eight (66.7%) patients had low-differentiation tumors, ten (83.3%) patients had lymphatic metastases, and nine (75%) patients had TNM stage Ⅳ, which were significantly higher than the percentages (26.4%, 34.3%, 23.1%) in patients with gallbladder adenocarcinoma, respectively (P < 0.05 for all). Three patients were treated by radical resection, while the other nine patients were treated by palliative surgery. The 1- and 2-year survival rates for the patients with sarcomatoid carcinoma of the gallbladder were 9.7% and less than 1%, respectively. The median survival time was 155 days. In contrast, the 1-, 2-, and 3- year survival rates for the 216 patients with gallbladder adenocarcinoma were 48.5%, 35.4% and 24.9%, respectively, and the median survival time was 320 d.

CONCLUSION: Sarcomatoid carcinoma of the gallbladder occurs mainly in aged females. The clinical presentations are often non-specific, and the definite diagnosis depends on pathological and immunohistochemical examinations. Sarcomatoid carcinoma of the gallbladder is characterized by high malignant potential, early lymphatic metastasis and rapid progression. The prognosis of sarcomatoid carcinoma of the gallbladder is poorer than gallbladder adenocarcinoma, while surgical resection combined with radiotherapy and chemotherapy can prolong the survival time of these patients.