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Mruthyunjayappa S, Patel CR, Reddy S, Al Diffalha S. Carcinosarcoma with chondroid differentiation and neuroendocrine carcinoma: unusual triphasic tumour arising from intracholecystic papillary neoplasm of the gall bladder. BMJ Case Rep 2022; 15:e245555. [PMID: 35858746 PMCID: PMC9305697 DOI: 10.1136/bcr-2021-245555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 11/03/2022] Open
Abstract
Herein, we report a man in his 70s with gallbladder mass. Microscopically, the tumour demonstrated moderately differentiated adenocarcinoma, sarcoma with focal chondroid differentiation and high-grade neuroendocrine tumour component arising in an intracholecystic papillary neoplasm. The patient did not receive adjuvant chemotherapy in the setting of complete surgical resection. Patient presented with extensive metastasis after 47 months and died 3 months later. Due to the low incidence and poor prognosis of this tumour, it is essential to gather all the individual experience-based information. To our knowledge, this is the first reported case of carcinosarcoma arising from intracholecystic papillary-tubular neoplasm.
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Affiliation(s)
| | - Chirag Rasiklal Patel
- Pathology, The University of Alabama at Birmingham Hospital, Birmingham, Alabama, USA
| | - Sushanth Reddy
- Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Sameer Al Diffalha
- Pathology, The University of Alabama at Birmingham Hospital, Birmingham, Alabama, USA
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2
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Teng TZJ, Chua BQY, Shelat VG. Carcinosarcoma of gallbladder: A world review. World J Clin Oncol 2021; 12:1244-1263. [PMID: 35070742 PMCID: PMC8716988 DOI: 10.5306/wjco.v12.i12.1244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/14/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Gallbladder carcinosarcoma is a rare hepatobiliary tumor comprising of both carcinomatous and sarcomatous components. Due to its rarity, the literature with regards to the topic is scarce and currently lacking, spanning less than 100 cases.
AIM To summarize the current literature on gallbladder carcinosarcoma.
METHODS A literature review was performed on the PubMed database using the keywords “Gallbladder” AND “Carcinosarcoma” from 1970 to 2021. Additionally, similar searches were performed on MEDLINE and Web of Science.
RESULTS Risk factors noted include female gender, gallstones and chronic cholecystitis. In the absence of any diagnostic biochemical testing or tumor markers, imaging modality serves as the key initial impression tool, which can be histologically confirmed only post-resection. While surgery is the only curative option, the use of adjunctive chemotherapy has been considered on top of excision in recent years, with some success.
CONCLUSION While this study has taken steps to bridge the gap in the literature, more cases should be reported to further ascertain the current associations and management potential for gallbladder carcinosarcoma.
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Affiliation(s)
- Thomas Zheng Jie Teng
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
- Undergraduate Medicine, Lee Kong Chian School of Medicine, Singapore 308232, Singapore
| | - Branden Qi Yu Chua
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Singapore 308433, Singapore
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3
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Chen X, Zhou Y, Shu X, Wei G, Qiu M. Gallbladder carcinosarcoma: current perspectives and new development. Expert Rev Gastroenterol Hepatol 2021; 15:1107-1114. [PMID: 33878994 DOI: 10.1080/17474124.2021.1919509] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Gallbladder carcinosarcoma (GBCS) is a rare neoplasm, and previous studies regarding to GBCS were case reports/case series, absence of large retrospective analyses, or systemic review. This review summarizes the current literature on accurate information of GBCS to assist clinicians to accurately diagnose and treat this malignancy.Areas covered: The authors retrieved relevant documents of GBCS from PubMed and Medline. This review elaborates on the knowledge of GBCS covering epidemiology, potential mechanism, clinical manifestation, diagnosis, treatment, and prognosis.Expert opinion: The majority of GBCS patients are easily misdiagnosed as GBC and usually treated as GBC. However, the biological behavior and outcome of GBCS is different from that of GBC. GBCS should be considered as a separate disease.
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Affiliation(s)
- Xiaorong Chen
- Department of Abdominal Cancer, Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Yuwen Zhou
- Department of Biotherapy, Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xinyao Shu
- Department of Abdominal Cancer, Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Guixia Wei
- Department of Abdominal Cancer, Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Meng Qiu
- Department of Abdominal Cancer, Cancer Center, West China Hospital of Sichuan University, Chengdu, China
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4
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Abstract
Sarcomatoid carcinoma is a rare type of gallbladder cancer with no specific clinical manifestation. The final diagnosis depends on pathological and immunohistochemical examination. Sarcomatoid carcinoma is characterized by early lymphatic metastasis, rapid progression, a high short-term recurrence rate, and a worse prognosis than adenocarcinoma. This report describes a 60-year-old woman with poorly differentiated adenocarcinoma of the gallbladder. She underwent treatment with chemotherapy and surgery. Palliative surgery was performed for treatment of tumor recurrence in April 2018. Postoperative pathology showed infiltration of poorly differentiated carcinomas, most of which were sarcomatoid. After four cycles of chemotherapy, the disease continued to progress. Anlotinib tablets were given from August 2018 to November 2018 but were then stopped because of gastrointestinal bleeding. The patient died in April 2019. This paper reports the whole process of diagnosis and treatment in this case of gallbladder sarcomatoid carcinoma, thus providing a reference for treatment.
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Affiliation(s)
- Yunfu Shi
- Department of Oncology, Tongde Hospital of Zhejiang Province, Hangzhou, China.,The First School of Medicine, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiabin Chen
- Department of Oncology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Hua Chen
- Department of Oncology, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Xiufang Hong
- Department of Geriatrics, Zhejiang Hospital, Hangzhou, China
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5
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Qin Q, Liu M, Wang X. Gallbladder sarcomatoid carcinoma: Seven case reports. World J Clin Cases 2020; 8:3881-3889. [PMID: 32953868 PMCID: PMC7479550 DOI: 10.12998/wjcc.v8.i17.3881] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/21/2020] [Accepted: 08/12/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Gallbladder sarcomatoid carcinoma is a rare and aggressive tumor, and little is known about its clinical behavior, prognosis, and optimal treatment.
CASE SUMMARY From 1997 to 2017, we collected seven cases of gallbladder sarcomatoid carcinoma at our institution. The median patient age was 68.5 years. Six (85.7%) patients were female. Overall, 85.7% (6/7) of the tumors had a maximal diameter greater than 7 cm. Late TNM stage was associated with a significantly poor prognosis. All patients with advanced-stage (III/IV) disease died from metastases or disease progression shortly after surgery. One patient with stage IIIB disease who received adjuvant chemoradiotherapy (gemcitabine and capecitabine) achieved a progression-free survival (PFS) of 12 mo and overall survival of 15 mo, which might be the longest PFS reported among patients who ultimately experienced recurrence or metastasis.
CONCLUSION Sarcomatoid carcinoma is a unique and aggressive gallbladder malignancy. Surgery is suggested as the first and only recognized treatment. There is a significant difference in prognosis between patients with early-stage and advanced-stage disease. Postoperative adjuvant therapy may bring survival benefits for locally advanced patients. Gemcitabine combined with fluorouracil and radiotherapy could be a potential strategy.
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Affiliation(s)
- Qing Qin
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Department of Oncology, Chengdu Shangjin Nanfu Hospital, Chengdu 611730, Sichuan Province, China
| | - Ming Liu
- Department of Medical Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xin Wang
- Department of Abdominal Oncology, Department of Radiation Oncology, Cancer Center, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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6
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Matsubayashi H, Matsui T, Sugiura T, Makuuchi R, Kaneko J, Satoh J, Satoh T, Fujie S, Ishiwatari H, Sasaki K, Ono H. A Large Carcinosarcoma of the Gallbladder Accompanied by Pancreaticobiliary Maljunction: A Case with a Six-year Survival. Intern Med 2019; 58:2809-2817. [PMID: 31243200 PMCID: PMC6815897 DOI: 10.2169/internalmedicine.2783-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Pancreatobiliary maljunction (PBM) is a rare congenital malformation, often associated with adenocarcinoma. However, PBM accompanying gallbladder carcinosarcoma has rarely been reported. A 72-year-old woman was referred to our hospital, complaining of abdominal pain. Computed tomography showed a polypoid mass in the gallbladder. Endoscopic retrograde cholangiopancreatography showed PBM, and aspirated bile demonstrated elevated levels of pancreatic-type amylase (26,780 U/L) and cancer cells. Extended cholecystectomy was performed. Histologically, the tumor had adenocarcinoma, squamous cell carcinoma and sarcoma components. Despite the large tumor size (84 mm) and intra-vessel cancer permeations, this patient has been healthy for 73 months since the surgery.
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Affiliation(s)
| | - Toru Matsui
- Division of Endoscopy, Shizuoka Cancer Center, Japan
| | - Teichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Japan
| | - Rie Makuuchi
- Division of Gastric Surgery, Shizuoka Cancer Center, Japan
| | | | - Junya Satoh
- Division of Endoscopy, Shizuoka Cancer Center, Japan
| | | | - Shinya Fujie
- Division of Endoscopy, Shizuoka Cancer Center, Japan
| | | | - Keiko Sasaki
- Division of Pathology, Shizuoka Cancer Center, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Japan
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7
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Carcinosarcoma (adenocarcinoma, neuroendocrine carcinoma, undifferentiated carcinoma and chondrosarcoma) of the gallbladder. Clin J Gastroenterol 2019; 13:110-115. [PMID: 31264080 DOI: 10.1007/s12328-019-01012-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 06/26/2019] [Indexed: 02/07/2023]
Abstract
We present an extremely rare case of carcinosarcoma with 4 different tumor components in an 88-year-old female. After a diagnosis of acute cholecystitis, we performed percutaneous transhepatic gallbladder drainage in the patient without success, followed by a cholecystectomy and choledocholithotomy. The mass was a 60 × 25 mm polypoid lesion of the gallbladder identified histologically as a carcinosarcoma with adenocarcinoma, neuroendocrine carcinoma, undifferentiated carcinoma and chondrosarcoma components. The biliary-type adenocarcinoma portion exhibited acinar growth patterns with columnar cells having large and markedly hyperchromatic nuclei. These tumor cells were immunohistochemically positive for MUC1 and CDX2. The neuroendocrine carcinoma, small cell type, cells were densely packed and small, with scant cytoplasm, finely granular nuclear chromatin and absence of nucleoli. The mitotic index was high. These tumor cells were immunohistochemically positive for synaptophysin, Ki-67 (index 40%), MUC1, CDX2 and c-Kit. The undifferentiated carcinoma consisted exclusively of spindle cells containing large, markedly hyperchromatic nuclei with a high mitotic index. These tumor cells were immunohistochemically positive for AE1/AE3. The chondrosarcoma was composed of blue-gray chondroid matrix and atypical chondrocytes containing large, hyperchromatic nuclei. These tumor cells were immunohistochemically positive for S100. Its attributes might be suggestive of a greater malignant potential and pathogenesis of carcinosarcoma.
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Taskin OC, Akkas G, Memis B, Seven IE, Basturk O, Jang KT, Roa JC, Araya JC, Bellolio E, Losada H, Sarmiento J, Balci S, Pehlivanoglu B, Reid MD, Koshiol J, Adsay V. Sarcomatoid carcinomas of the gallbladder: clinicopathologic characteristics. Virchows Arch 2019; 475:59-66. [PMID: 31177317 DOI: 10.1007/s00428-019-02583-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 04/16/2019] [Accepted: 05/07/2019] [Indexed: 11/28/2022]
Abstract
Sarcomatoid carcinomas recently came into the spotlight through genetic profiling studies and also as a distinct model of epithelial-mesenchymal transition. The literature on sarcomatoid carcinomas of gallbladder is limited. In this study, 656 gallbladder carcinomas (GBC) were reviewed. Eleven (1.7%) with a sarcomatoid component were identified and analyzed in comparison with ordinary GBC (O-GBC). Patients included 9 females and 2 males (F/M = 4.5 vs. 3.9) with a mean age-at-diagnosis of 71 (vs. 64). The median tumor size was 4.6 cm (vs. 2.5; P = 0.01). Nine patients (84%) presented with advanced stage (pT3/4) tumor (vs. 48%). An adenocarcinoma component constituting 1-75% of the tumor was present in nine, and eight had surface dysplasia/CIS; either in situ or invasive carcinoma was present in all cases. An intracholecystic papillary-tubular neoplasm was identified in one. Seven showed pleomorphic-sarcomatoid pattern, and four showed subtle/bland elongated spindle cells. Three had an angiosarcomatoid pattern. Two had heterologous elements. One showed few osteoclast-like giant cells, only adjacent to osteoid. Immunohistochemically, vimentin, was positive in six of six; P53 expression was > 60% in six of six, keratins in six of seven, and p63 in two of six. Actin, desmin, and S100 were negative. The median Ki67 index was 40%. In the follow-up, one died peri-operatively, eight died of disease within 3 to 8 months (vs. 26 months median survival for O-GBC), and two were alive at 9 and 15 months. The behavior overall was worse than ordinary adenocarcinomas in general but was not different when grade and stage were matched. In summary, sarcomatoid component is identified in < 2% of GBC. Unlike sarcomatoid carcinomas in the remainder of pancreatobiliary tract, these are seldom of the "osteoclastic" type and patients present with large/advanced stage tumors. Limited data suggests that these tumors are aggressive with rapid mortality unlike pancreatic osteoclastic ones which often have indolent behavior.
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Affiliation(s)
- Orhun Cig Taskin
- Department of Pathology, Koç University Hospital, Istanbul, Turkey
| | - Gizem Akkas
- Department of Pathology, Kutahya Evliya Celebi Research and Training Hospital, Kutahya, Turkey
| | - Bahar Memis
- Emory University, Atlanta, GA, USA.,TC.SBU, Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanlıurfa, Turkey
| | - Ipek Erbarut Seven
- Department of Pathology, Marmara University Pendik Research and Training Hospital, Istanbul, Turkey
| | - Olca Basturk
- Wayne State University, Detroit, MI, USA.,Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kee-Taek Jang
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Juan C Roa
- Department of Pathology, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Juan Carlos Araya
- Department of Pathology, Hospital Dr. Hernan Henriquez Aravena, Temuco, Chile
| | - Enrique Bellolio
- Anatomic Pathology Department, Universidad de La Frontera, Claro Solar 115, Temuco, Chile
| | - Hector Losada
- Department of Surgery and Traumatology, Universidad de La Frontera, Temuco, Chile
| | | | | | | | | | - Jill Koshiol
- Division of Cancer Epidemiology & Genetics, National Cancer Institute, Infections and Immunoepidemiology Branch, NCI, NIH, Rockville, MD, USA
| | - Volkan Adsay
- Department of Pathology, Koç University Hospital, Istanbul, Turkey.
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9
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Takamura K, Ogi T, Yamamoto M, Kikuchi K. Extraskeletal osteosarcoma of the lung following treatment of primary small-cell lung carcinoma with chemoradiotherapy: A case report. Mol Clin Oncol 2017; 8:99-102. [PMID: 29399350 DOI: 10.3892/mco.2017.1500] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 11/15/2017] [Indexed: 11/05/2022] Open
Abstract
Primary pulmonary osteosarcoma is a rare entity, with only a few cases reported in the literature to date. Moreover, secondary extraskeletal osteosarcoma of the lung following chemoradiotherapy is extremely rare and, to the best of our knowledge, this is the first reported case. We herein present the case of an 80-year-old male patient with small-cell lung cancer (SCLC), who developed what it was initially considered as recurrence of the tumor after chemoradiotherapy. The patient eventually succumbed to the disease, and on autopsy it was discovered that the lung tumor was not in fact SCLC, but rather a secondary osteosarcoma. Osteosarcoma metastasis to the lung is very rare, but must be considered in the differential diagnosis when there is relapse following treatment for primary SCLC.
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Affiliation(s)
- Kei Takamura
- First Department of Medicine, Obihiro Kosei General Hospital, Obihiro, Hokkaido 080-0016, Japan
| | - Takahiro Ogi
- First Department of Medicine, Obihiro Kosei General Hospital, Obihiro, Hokkaido 080-0016, Japan
| | - Makoto Yamamoto
- First Department of Medicine, Obihiro Kosei General Hospital, Obihiro, Hokkaido 080-0016, Japan
| | - Keisuke Kikuchi
- Department of Pathology, Obihiro Kosei General Hospital, Obihiro, Hokkaido 080-0016, Japan
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10
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Feng F, Cheng Q, Yang L, Zhang D, Ji S, Zhang Q, Lin Y, Li F, Xiong L, Liu C, Jiang X. Guidance to rational use of pharmaceuticals in gallbladder sarcomatoid carcinoma using patient-derived cancer cells and whole exome sequencing. Oncotarget 2017; 8:5349-5360. [PMID: 28029662 PMCID: PMC5354913 DOI: 10.18632/oncotarget.14146] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 11/22/2016] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Gallbladder sarcomatoid carcinoma is a rare cancer with no clinical standard treatment. With the rapid development of next generation sequencing, it has been able to provide reasonable treatment options for patients based on genetic variations. However, most cancer drugs are not approval for gallbladder sarcomatoid carcinoma indications. The correlation between drug response and a genetic variation needs to be further elucidated. EXPERIMENTAL DESIGN Three patient-derived cells-JXQ-3D-001, JXQ-3D-002, and JXQ-3D-003, were derived from biopsy samples of one gallbladder sarcomatoid carcinoma patient with progression and have been characterized. In order to study the relationship between drug sensitivity and gene alteration, genetic mutations of three patient-derived cells were discovered by whole exome sequencing, and drug screening has been performed based on the gene alterations and related signaling pathways that are associated with drug targets. RESULTS It has been found that there are differences in biological characteristics such as morphology, cell proliferation, cell migration and colony formation activity among these three patient-derived cells although they are derived from the same patient. Their sensitivities to the chemotherapy drugs-Fluorouracil, Doxorubicin, and Cisplatin are distinct. Moreover, none of common chemotherapy drugs could inhibit the proliferations of all three patient-derived cells. Comprehensive analysis of their whole exome sequencing demonstrated that tumor-associated genes TP53, AKT2, FGFR3, FGF10, SDHA, and PI3KCA were mutated or amplified. Part of these alterations are actionable. By screening a set of compounds that are associated with the genetic alteration, it has been found that GDC-0941 and PF-04691502 for PI3K-AKT-mTOR pathway inhibitors could dramatically decrease the proliferation of three patient-derived cells. Importantly, expression of phosphorylated AKT and phosphorylated S6 were markedly decreased after treatments with PI3K-AKT-mTOR pathway inhibitors GDC-0941 (0.5 μM) and PF-04691502 (0.1 μM) in all three patient-derived cells. These data suggested that inhibition of the PI3K-AKT-mTOR pathway that was activated by PIK3CA amplification in all three patient-derived cells could reduce the cell proliferation. CONCLUSIONS A patient-derived cell model combined with whole exome sequencing is a powerful tool to elucidate relationship between drug sensitivities and genetic alternations. In these gallbladder sarcomatoid carcinoma patient-derived cells, it is found that PIK3CA amplification could be used as a biomarker to indicate PI3K-AKT-mTOR pathway activation. Block of the pathway may benefit the gallbladder sarcomatoid carcinoma patient with this alternation in hypothesis. The real efficacy needs to be confirmed in vivo or in a clinical trial.
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Affiliation(s)
- Feiling Feng
- Department of Biliary I, Third Affiliated Hospital of PLA Second Military Medical University, Shanghai, China
| | - Qingbao Cheng
- Department of Biliary I, Third Affiliated Hospital of PLA Second Military Medical University, Shanghai, China
| | - Liang Yang
- Department of Biliary I, Third Affiliated Hospital of PLA Second Military Medical University, Shanghai, China
| | - Dadong Zhang
- Division of Translational Medicine, 3D Medicines Corporation, Shanghai, China
- Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Shunlong Ji
- Division of Translational Medicine, 3D Medicines Corporation, Shanghai, China
| | - Qiangzu Zhang
- Division of Translational Medicine, 3D Medicines Corporation, Shanghai, China
| | - Yihui Lin
- Division of Translational Medicine, 3D Medicines Corporation, Shanghai, China
| | - Fugen Li
- Division of Translational Medicine, 3D Medicines Corporation, Shanghai, China
| | - Lei Xiong
- Division of Translational Medicine, 3D Medicines Corporation, Shanghai, China
| | - Chen Liu
- Department of Biliary I, Third Affiliated Hospital of PLA Second Military Medical University, Shanghai, China
| | - Xiaoqing Jiang
- Department of Biliary I, Third Affiliated Hospital of PLA Second Military Medical University, Shanghai, China
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11
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Abstract
Sarcomatoid carcinoma of the gallbladder, composed of epithelial and sarcomatous components, is a rare malignant tumor with a poor prognosis. A 61-year-old man was admitted because of abdominal distention for 2 weeks. Enhanced CT showed a large gallbladder tumor with central necrosis. The tumor measuring 18 cm in maximum diameter showed intense peripheral FDG uptake with SUVmax of 15.4. The specimen of the resected tumor revealed tubular adenocarcinoma and sarcomatoid tissue with chondroid differentiation. Immunohistochemical staining showed the sarcomatoid tissue was positive for EMA, CD10, and VIM, with proliferation index of 80%. These pathologic findings were consistent with sarcomatoid carcinoma.
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12
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Rao P, Sikora SS, Narayanaswamy S, Ghosal N, Kini D. Ampullary carcinosarcoma with osteosarcomatous, small cell neuroendocrine carcinoma and conventional adenocarcinoma components; First report. Pathol Res Pract 2016; 212:1071-1075. [PMID: 27640104 DOI: 10.1016/j.prp.2016.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 07/30/2016] [Accepted: 08/09/2016] [Indexed: 12/16/2022]
Abstract
Caracinosarcomas are tumours with diverse epithelial and mesenchymal differentiation. They most commonly occur in the female reproductive organs and upper aero digestive tract. They are relatively rare in the gastrointestinal tract and affect the oesophagus most commonly. Ampullary carcinosarcomas are exceptionally rare. We report a case of ampullary carcinosarcoma in a 67-year-old male, with osteosarcomatous, small cell carcinoma and conventional adenocarcinoma components. To the best of our knowledge, this is the first reported case of its kind.
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Affiliation(s)
- Pallavi Rao
- Department of Histopathology, Sakra World Hospital, Sy No. 52/2 & 52/3, Deverbeesanahalli Varthur Hobli, Bangalore, 560103, India.
| | - Sadiq S Sikora
- Department of Surgical Gastroenterology, Sakra World Hospital, Sy No. 52/2 & 52/3, Deverbeesanahalli Varthur Hobli, Bangalore, 560103 India, India
| | - Srikanth Narayanaswamy
- Department of Radiology, Sakra World Hospital, Sy No. 52/2 & 52/3, Deverbeesanahalli Varthur Hobli, Bangalore, 560103, India
| | - Nandita Ghosal
- Department of Histopathology, Sakra World Hospital, Sy No. 52/2 & 52/3, Deverbeesanahalli Varthur Hobli, Bangalore, 560103, India
| | - Dinesh Kini
- Department of Medical Gastroenterology, Sakra World Hospital, Sy No. 52/2 & 52/3, Deverbeesanahalli Varthur Hobli, Bangalore, 560103, India
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13
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Chang XW, Ma XX, Li J, Shen HX, Qiao ZT, Wan JH. Clinical analysis of 12 patients with sarcomatoid carcinoma of the gallbladder. Shijie Huaren Xiaohua Zazhi 2016; 24:2063-2069. [DOI: 10.11569/wcjd.v24.i13.2063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
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.
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14
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Lee SY, Shia J, Kingham TP, Jarnagin WR. Carcinosarcoma of the bile duct: a case report and review of literature. Hepatobiliary Surg Nutr 2016; 5:72-8. [PMID: 26904559 DOI: 10.3978/j.issn.2304-3881.2015.06.09] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Carcinosarcomas of the bile ducts are very rare tumors consisting of both epithelial and mesenchymal elements. We report a case of bile duct carcinosarcoma and its clinical, radiological and pathological features and a brief review on this rare condition.
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Affiliation(s)
- Ser Yee Lee
- 1 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore ; 3 Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Jinru Shia
- 1 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore ; 3 Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - T Peter Kingham
- 1 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore ; 3 Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - William R Jarnagin
- 1 Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA ; 2 Department of Hepatopancreatobiliary and Transplant Surgery, Singapore General Hospital, Singapore ; 3 Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
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15
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Carcinosarcoma of the Gallbladder with Heterologous Differentiation: a Case Report. J Gastrointest Cancer 2015; 46:175-7. [DOI: 10.1007/s12029-015-9692-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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16
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Okabayashi T, Shima Y, Iwata J, Iiyama T, Sumiyoshi T, Kozuki A, Tokumaru T, Hata Y, Noda Y, Morita M. Surgical outcomes for 131 cases of carcinosarcoma of the hepatobiliary tract. J Gastroenterol 2014; 49:982-91. [PMID: 24162331 DOI: 10.1007/s00535-013-0882-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 08/18/2013] [Indexed: 02/07/2023]
Abstract
Carcinosarcoma of the hepatobiliary tract is highly aggressive and has a poor prognosis even after curative resection. The purpose of this study was to collate and analyze published data to clarify the surgical outcome of carcinosarcoma of the hepatobiliary tract and the relationships between potential prognostic factors and survival after surgery. We surveyed worldwide literature from 1970 to 2012 and obtained clinicopathological data for 131 patients who had undergone surgical resection for carcinosarcoma of the hepatobiliary tract, including one patient from our clinic. The relationships between potential prognostic factors and survival rates were examined using the Kaplan-Meier method and the log-rank test. The overall 1-, 3-, and 5-year survival rates for patients with carcinosarcoma of the hepatobiliary tract after surgery were 44.0, 29.3, and 27.0 %, respectively. In univariate analyses, age and gender were not significant prognostic factors; however, advanced stage according to the classification of the Union for International Cancer Control in resected specimens was significantly associated with a shorter survival time after surgery. Although carcinosarcoma of the hepatobiliary tract remains a rare disease worldwide, its poor prognosis, even after curative resection, demands further epidemiological and pathological study that could lead to the development of new management strategies.
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Affiliation(s)
- Takehiro Okabayashi
- Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi, Kochi, 781-8555, Japan,
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17
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Mixed large cell neuroendocrine carcinoma and adenocarcinoma with spindle cell and clear cell features in the extrahepatic bile duct. Case Rep Pathol 2014; 2014:347949. [PMID: 24804133 PMCID: PMC3988708 DOI: 10.1155/2014/347949] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 03/11/2014] [Indexed: 01/19/2023] Open
Abstract
Mixed adenoneuroendocrine carcinomas, spindle cell carcinomas, and clear cell carcinomas are all rare tumors in the biliary tract. We present the first case, to our knowledge, of an extrahepatic bile duct carcinoma composed of all three types. A 65-year-old man with prior cholecystectomy presented with painless jaundice, vomiting, and weight loss. CA19-9 and alpha-fetoprotein (AFP) were elevated. Cholangioscopy revealed a friable mass extending from the middle of the common bile duct to the common hepatic duct. A bile duct excision was performed. Gross examination revealed a 3.6 cm intraluminal polypoid tumor. Microscopically, the tumor had foci of conventional adenocarcinoma (CK7-positive and CA19-9-postive) surrounded by malignant-appearing spindle cells that were positive for cytokeratins and vimentin. Additionally, there were separate areas of large cell neuroendocrine carcinoma (LCNEC). Foci of clear cell carcinoma merged into both the LCNEC and the adenocarcinoma. Tumor invaded through the bile duct wall with extensive perineural and vascular invasion. Circumferential margins were positive. The patient's poor performance status precluded adjuvant therapy and he died with recurrent and metastatic disease 5 months after surgery. This is consistent with the reported poor survival rates of biliary mixed adenoneuroendocrine carcinomas.
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18
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Carcinosarcoma, an atypical subset of gallbladder malignancies. J Med Ultrason (2001) 2014; 41:487-90. [DOI: 10.1007/s10396-014-0534-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Accepted: 02/20/2014] [Indexed: 12/17/2022]
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19
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Gallbladder carcinosarcoma accompanied with bile duct tumor thrombi: A case report. Oncol Lett 2013; 5:1809-1812. [PMID: 23833646 PMCID: PMC3700959 DOI: 10.3892/ol.2013.1289] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 03/26/2013] [Indexed: 11/10/2022] Open
Abstract
Gallbladder carcinosarcoma is one of the rarest subsets of gallbladder malignancies. The first case of carcinosarcoma of the gallbladder was reported in 1907. To date, <100 cases have been reported in the English literature. The present study reports a case of gallbladder carcinosarcoma accompanied with tumor thrombi, presenting as a soft tissue mass in the common bile duct and resulting in the obstruction and inflammation of the biliary tract. Initially, the patient was diagnosed with a gallbladder tumor and choledocholithiasis. No cases of carcinosarcoma of the gallbladder accompanied with bile duct tumor thrombus formation have been reported to date. A cholecystectomy with liver segmentectomy (S4a+S5) and a lymph node dissection were performed. The presence of a tumor thrombus in the common bile duct was confirmed by analysis of a frozen section during surgery. Resection of the extrahepatic bile duct and Roux-en-Y type hepatic cholangiojejunostomy were also performed. In addition, the gallbladder carcinosarcoma was observed to produce α-fetoprotein. The patient underwent an uneventful post-operative recovery and, to date, no clinical or radiological evidence of disease recurrence or metastasis has been identified. Carcinosarcoma of the gallbladder accompanied with tumor thrombi is extremely rare. Tumor thrombi in the common bile duct may easily be misdiagnosed as choledocholithiasis. The treatment and prognosis of gallbladder carcinosarcoma is similar to that of gallbladder carcinoma.
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20
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Kim HH, Hur YH, Jeong EH, Park EK, Koh YS, Kim JC, Kim HJ, Kim JW, Cho CK. Carcinosarcoma of the gallbladder: report of two cases. Surg Today 2012; 42:670-5. [PMID: 22391981 DOI: 10.1007/s00595-012-0160-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 06/17/2011] [Indexed: 12/28/2022]
Abstract
Adenocarcinoma is the predominant histological type of carcinoma of the gallbladder, accounting for more than 80% of all gallbladder carcinomas. In contrast, carcinosarcoma of the gallbladder is an extremely atypical subset of gallbladder malignancies. It is characterized by the presence of both epithelial and mesenchymal components. Currently, fewer than 100 cases have been reported in the English literature. Therefore, knowledge and experience regarding this disease are limited. Recently, we experienced two cases of gallbladder carcinosarcoma, which were diagnosed as gallbladder carcinoma based on the preoperative clinical and radiological examinations. Cholecystectomies were performed in both cases, and the malignant tumor cells included carcinomatous and sarcomatous components histologically. The final pathological diagnoses were carcinosarcoma of the gallbladder. We herein report these two cases of gallbladder carcinosarcoma and review the previous pertinent literature.
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Affiliation(s)
- Ho-Hyun Kim
- Department of Surgery, Chonnam National University Medical School, 160, Ilsim-ri, Hwasun-eup, Hwasun-gun, Jellanam-do, Gwangju, 519-809, Korea
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21
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Abstract
Gallbladder carcinosarcoma is a rare gastrointestinal tract malignant tumour, which contains both epithelial cancer component and mesenchymal sarcoma component. Because of its unique anatomic location and unspecific medical presentation, preoperative diagnosis is difficult. The prognosis of gallbladder carcinoma is poor with median survival time of 5.5 months. T- and N-staging system has no role in cancer prognostic stratification. Currently, we still have limited experience in managing this form of notorious cancer. Surgical resection is the common practice in treating gallbladder carcinoma though recurrence rate is high (80%). Here, we report a 59-year-old female with new diagnosed gallbladder carcinosarcoma. She was found to have a carcinosarcoma masse at gallbladder extending into proximal bile ducts with no metastatic lesion. She underwent a radical cholangiocholecystocholedochectomy and Roux-en-Y hepatocholangioduodenostomy. Postsurgery, she received six cycles of adjuvant chemotherapy consisting of oxaliplatin and 5-fluorouracil. She maintains in complete remission 6 months after adjuvant chemotherapy.
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Affiliation(s)
- Jeffrey J Pu
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine, Baltimore, Maryland, USA.
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22
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Okabayashi T, Sun ZL, Montgomey RA, Hanazaki K. Surgical outcome of carcinosarcoma of the gall bladder: A review. World J Gastroenterol 2009; 15:4877-82. [PMID: 19842216 PMCID: PMC2764963 DOI: 10.3748/wjg.15.4877] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Carcinosarcoma, which comprises less than one percent of all gall bladder neoplasms, is characterized by the presence of variable proportions of carcinomatous and sarcomatous elements. Recently, several reports have described patients suffering from carcinosarcoma of the gall bladder. However, there are no large studies regarding the clinicopathologic features, therapeutic management, and surgical outcome of this disease because the number of patients who undergo resection of gall bladder carcinosarcoma at a single institution is limited. A Medline search was performed using the keywords ‘gall bladder’ and ‘carcinosarcoma’. Additional articles were obtained from references within the papers identified by the Medline search. Optimal adjuvant chemotherapy and/or radiotherapy protocols for carcinosarcoma of the gall bladder have not been established. Curative surgical resection offers the only chance for long-term survival from this disease. The outcome of 36 patients who underwent surgical resection for carcinosarcoma of the gall bladder was poor; the 3-year overall survival rate was only 31.0% and the median survival time was 7.0 mo. Since the postoperative prognosis of carcinosarcoma of the gall bladder is worse than that of adenocarcinoma, new adjuvant chemotherapies and/or radiation techniques are essential for improvement of surgical outcome.
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Abstract
AIM: To study the behavior as well as optimal treatment of gallbladder sarcomatoid carcinoma, we reviewed the results of treatment of gallbladder sarcomatoid carcinoma from Chang Gung Memorial Hospital.
METHODS: From 1987 to 2005, six patients were diagnosed with gallbladder sarcomatoid carcinoma and treated at our institution. Tumor staging was based on 2002 revised tumor-node-metastasis (TNM) staging for gall bladder cancer from the American Joint Committee on Cancer. The clinical presentation, laboratory data and preoperative workup were reviewed retrospectively.
RESULTS: Five patients were female and one was male. The age ranged from 51 to 66 years (median, 58 years). Surgical procedures included three curative resections, two palliative resections and one biopsy. There were two surgical complications (33.3%) and one case of surgical mortality (16.7%). The follow-up time ranged from 30 d to 5 mo. The median survival was 2.5 mo. The prognosis was extremely poor, even after curative resection and postoperative chemotherapy.
CONCLUSION: The prognosis of gallbladder sarcomatoid carcinoma was not dependent on TNM stage and was always dismal. The clinicopathological features were different from those of gall bladder cancer.
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Uzun MA, Koksal N, Gunerhan Y, Celik A, Guneş P. Carcinosarcoma of the gallbladder: report of a case. Surg Today 2009; 39:168-71. [PMID: 19198999 DOI: 10.1007/s00595-008-3805-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2008] [Accepted: 05/16/2008] [Indexed: 12/21/2022]
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.
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Affiliation(s)
- Mehmet Ali Uzun
- Second Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
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