Rare tumors of the gallbladder: Clear cell carcinoma

Gallbladder Clear Cell Carcinoma: Report of a Rare Case and Literature Review

Carcinoma of the gallbladder is the most common biliary tract cancer. The majority of gallbladder cancers are adenocarcinomas, whereas clear-cell carcinoma of the gallbladder (CCG) is a rarely recorded variant. Usually, diagnosis is established incidentally after cholecystectomy, performed for another reason. Clinically, the different histological types of carcinomas are impossible to be recognized preoperatively, since they present with a wide and common range of symptoms. We present a male patient who underwent an emergency cholecystectomy due to suspected perforation. After an uneventful postoperative period, the histopathological report led to the diagnosis of CCG, but the surgical margins were infiltrated by the tumor. The patient decided not to proceed with any additional treatment and passed away 8 months after the operation. In conclusion, it is of great necessity to record such unusual cases and enriches global knowledge with information clinically and educationally noteworthy.

Primary clear cell carcinoma of gallbladder arising in porcelain gallbladder

Gallbladder carcinomas (GBCs) are the most common carcinomas of the biliary tract. The clear cell variant is encountered rarely, accounting for approximately 1% of all GBCs.Due to its rarity, the exact incidence and pathogenesis of this variant are unknown. Though hyalinising cholecystitis (porcelain gallbladder) is an established risk factor for development of conventional adenocarcinomas of the gallbladder, its role in the pathogenesis of the rare variants of GBC is not well-established. The current case raises the possibility that clear cell carcinoma of the gallbladder may arise through the same pathways as conventional adenocarcinomas of the gallbladder.

Clear-Cell Adenocarcinoma of the Gallbladder with Alpha-Fetoprotein Production: A Case Report and Review of the Literature

Gallbladder tumors are the fifth most common cancers of the gastrointestinal tract with poor prognosis and low survival. The most common type is adenocarcinoma of which the clear cell type is an unusual histologic variant with alpha-fetoprotein (AFP)-producing gallbladder carcinoma, reported extremely rarely, which makes the index case an uncommon entity. AFP secretion by gallbladder carcinomas may occur given the similar embryological origin of liver and gallbladder. Herein we report a case of an incidental carcinoma of the gallbladder in a 60-year-old woman with an elevated serum AFP concentration at presentation, who underwent cholecystectomy for cholelithiasis and was rendered the diagnosis of AFP-producing clear cell carcinoma of the gallbladder through histopathology and immunohistochemistry. Her postoperative laboratory tests showed a decline in AFP levels to normal respectively. The clinical and pathologic importance of AFP production by clear-cell adenocarcinoma of the gallbladder (CCG) has thus far remained completely obscure. However, we must recognize the entity of this tumor because accurate and early diagnosis of CCG is imperative to avoid misdiagnosis as possible secondary metastasis and consequent delay in appropriate surgical intervention. Relevant medical history of a patient, various imaging studies, foci of classical adenocarcinoma within the tumor, and an efficient immunohistochemical panel can be informative and assist in arriving at an accurate diagnosis.

First Report of a Low-Grade Pseudomyxoma peritonei Originating from Gall Bladder

Pseudomyxoma peritonei (PMP) refers to accumulation of mucinous ascites with or without neoplastic cells in the peritoneal cavity. It most commonly originates from a low or a high grade primary appendiceal mucinous neoplasm. Though adenocarcinoma of gall bladder has been reported to give rise to PMP, to the best of our knowledge, this is the first report of a PMP arising from a low grade mucinous tumour of the gall bladder. A 72-year-old patient was diagnosed with PMP 1.5 years after a cholecystectomy. After initial oral TS1 (combination of tegafur, gimeracil and oteracil) and later intraperitoneal (IP) chemotherapy with docetaxel and cisplatin, the patient was operated with the goal of tumour debulking, including removal of 5.5 L of mucinous ascites, an appendectomy, and ovariectomy. The histopathologic report showed a normal appendix and metastasis of PMP to the right ovary. After the exclusion of the 2 most common sites of origin (appendix and ovary), the specimen of the cholecystectomy was reviewed. It showed low grade mucinous tumour in the gall bladder, with immuno-histochemical markers (IHCs) suggestive of CK7, CDX2, MUC 2 positive and CK20, MUC5AC negative. MIB-1 index was 12%. The pathologic report of cytoreductive surgery performed after 7 cycles of IP chemotherapy confirmed the diagnosis of PMP originating from low grade mucinous tumour of the gall bladder. Our case report illustrates a rare disease and highlights that, though peritoneal metastasis from gall bladder cancers are known to have a poor prognosis, the peritoneal dissemination from a low grade mucinous neoplasm of gall bladder (PMP) has a significantly better prognosis due to a better disease biology and improved treatment options currently available for the treatment of PMP.

Gallbladder Cancer in the 21st Century

Gallbladder cancer (GBC) is an uncommon disease in the majority of the world despite being the most common and aggressive malignancy of the biliary tree. Early diagnosis is essential for improved prognosis; however, indolent and nonspecific clinical presentations with a paucity of pathognomonic/predictive radiological features often preclude accurate identification of GBC at an early stage. As such, GBC remains a highly lethal disease, with only 10% of all patients presenting at a stage amenable to surgical resection. Among this select population, continued improvements in survival during the 21st century are attributable to aggressive radical surgery with improved surgical techniques. This paper reviews the current available literature of the 21st century on PubMed and Medline to provide a detailed summary of the epidemiology and risk factors, pathogenesis, clinical presentation, radiology, pathology, management, and prognosis of GBC.