Carcinosarcoma of the gallbladder: a case report and review of the literature

Comparison of carcinosarcoma and adenocarcinoma of the gallbladder: a study based on SEER population for propensity matching and nomogram analysis

BACKGROUND

Carcinosarcoma of the gallbladder (CSGB) is an uncommon malignancy, and limited literature is available on its clinicopathological features, prognosis, and treatment options.

METHODS

Using the SEER database, we selected 7634 gallbladder adenocarcinoma patients (diagnosed from 2004 to 2015) and 58 carcinosarcoma of the gallbladder patients (diagnosed from 1988 to 2019) based on predetermined criteria. We compared the overall survival (OS) and cancer-specific survival (CSS) before and after propensity score matching in two groups. Cox univariate and multivariate analyses were performed, and a nomogram was further generated to investigate the impact of clinical and pathological variables on the survival of patients with CSGB. Finally, we evaluated the effect of different treatment modalities on the overall survival of CSGB patients.

RESULTS

Notably, CSGB patients had larger tumors and underwent surgery more frequently than gallbladder adenocarcinoma patients, with lower rates of deeper tumor infiltrates, and lymph node infiltrates. Conversely, gallbladder adenocarcinoma patients had a higher proportion of AJCC staging (III-IV). Despite these differences, no significant differences were found in OS and CSS between the two groups before and after propensity score matching. For CSGB patients, AJCC staging, surgery and tumor size were significant prognostic factors, while treatment modalities such as surgery combined with chemotherapy, or combined radiochemotherapy, as well as radical resection, did not significantly prolong patient survival.

CONCLUSION

No significant difference was found in survival rates between CSGB and gallbladder adenocarcinoma patients, while radical surgery and different combined treatment modalities did not provide significant survival benefits.

Carcinosarcoma of the Gallbladder: A Rare Tumor

Malignant tumors of the gallbladder are rare, with adenocarcinoma being the most common histological subtype. Carcinosarcoma of the gallbladder, first described in 1907 by Landsteiner, is an extremely rare tumor which comprises less than 1% of the uncommon gallbladder cancers. This unique type of tumor can develop at any major organ, with the uterus being the most common one. Being a tumor that contains epithelial and mesenchymal components, histopathological diagnosis of such rare tumor is a challenging issue. Up to date, there are less than 100 cases of gallbladder carcinoasarocoma reported in the English literature. Therefore, experience and knowledge regarding this rare disease are very limited. Due to the fact that gallbladder carcinosarcoma is a rare and highly forgotten tumor, this article aims to review the English literature to increase awareness of the treating physician to improve diagnosis, management, as well as overall survival.

Carcinosarcoma of gallbladder: A world review

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.

Gallbladder carcinosarcoma: current perspectives and new development

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.

Gallbladder carcinosarcoma masquerading as a hepatic abscess

Carcinosarcomas of the gallbladder are extremely rare tumors and infrequently reported in the literature. We demonstrate a case of a 64-year-old female who presented with a 2-month history of a right upper quadrant mass, intermittent fevers, and abdominal distension following recent travel to Ghana. A computed tomography (CT) scan of the abdomen and pelvis demonstrated a large hepatic lesion with co-existing gallbladder distension, suggestive of a hepatic abscess. The patient was initially managed with intravenous antibiotics but failed to respond to treatment. A subsequent magnetic resonance imaging (MRI) scan of the liver showed a locally invasive lobulated soft tissue lesion arising from the gallbladder fundus and extending into the liver parenchyma. The lesion was surgically excised with a central hepatectomy. Histopathologic analysis showed a carcinosarcoma of the gallbladder.

Surgical management of gallbladder carcinosarcoma: A case report and review of the Literature

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Gallbladdercarcinosarcoma is a rare disease: The first case of a carcinosarcoma of the gallbladder (CSGB) was reported by Landsteiner in 1907. Up to now less than 100 Cases have been reported in the literature.

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Non-specific signs: the clinical (abdominal pain, weight loss and jaundice, biological (including inflammatory sign, hepatic result), and radiological signs are nonspecific of gallbladder carcinosarcoma, The final diagnosis is anatomopathological of the specimen.

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The diagnosis is delayed: Because of the nonspecific symptoms, a delayed diagnosis is generally associated with CSGB. Only 54 cases have undergone surgical resection as a treatment.

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Surgical treatment remains the only cure for gallbladder carcinosarcoma: Chemotherapy and/or radiotherapy’s roles, they remain unclear because of the limited number of cases described in the literature, as chemotherapy has shown no a significant benefit in terms of morbidity or mortality.

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Prognosis: The prognosis of this disease is normally poor. Most cases present with locally advanced disease and metastasis.

Introduction

Gallbladder Carcinosarcoma is a rare and fatal cancer characterized by the presence of a combination of a cancerous epithelial and mesenchymal components.

Presentation of case

We present the case of a 66 years old patient with a carcinoma gallbladder carcinoma who received a surgical treatment. The histological assessment revealed two histological components consisting of an adenocarcinoma and a spindle cell sarcoma compatible with the carcinosarcoma.

Discussion

This cancer is known to be extremely severe in that less than 100 cases have been documented in international medical review of literature. surgical treatment remains the only cure for gallbladder carcinosarcoma, The prognosis of this disease is extremely poor because it normally presents at advanced stages.

Conclusion

We present an extremely rare example of carcinosarcoma, and its attributes might be suggestive of a greater malignant potential. Consequently, the later the diagnosed worse is the prognosis.

Surgical outcomes of primary carcinosarcoma of the gallbladder after curative resection: A rare case series

INTRODUCTION

Primary carcinosarcoma is a rare neoplasm of the gallbladder, and is characterized by collision elements of the adenocarcinomatous and sarcomatous components. The tumours comprise both malignant epithelial and mesenchymal elements, and are usually very aggressive, conferring poor prognosis. Adenocarcinomas are the most common neoplasms of the gall bladder, while carcinosarcoma are extremely rare, with a global prevalence rate of less than 1%. The low incidence of carcinosarcoma greatly hinders the understanding of its aetiology.

PRESENTATION OF CASE

Here, we report the surgical outcome of 3 rare cases of gallbladder carcinosarcomas, two of which had a IVB stage disease and in one case the staging was II. Following surgery, the survival in the former was less than 1 year, while in the latter, it extended up to 7 years (86 months), and the patient is alive till date. This study aimed to elucidate the surgical outcomes and prognosis after curable resection for carcinosarcomas of the gallbladder.

DISCUSSION

The findings suggest that carcinosarcomas are associated with a poor prognosis and short survival, particularly in those with tumours of >5 cm. In the absence of effective adjuvant treatment, surgery remains the mainstay of treatment.

CONCLUSION

Complete surgical resection may improve prognosis and extend survival in patients with this rare and aggressive form of gallbladder cancer.

Carcinosarcoma of the gallbladder-an exceedingly rare tumour

Carcinosarcoma of the gallbladder (CSGB) is an extremely rare tumour that presents variable proportions of malignant epithelial and mesenchymal elements. Preoperative diagnosis of CSGB is challenging owing to its non-specific clinical presentation and imaging findings. The final diagnosis requires histopathological confirmation of both the epithelial and mesenchymal components. Owing to the low incidence and poor prognosis of this tumour, it is essential to gather all the individual experience-based information. We report a case of a 52-year-old female who presented with right upper abdominal pain and vomiting for 2 weeks and a painless palpable mass on the right upper quadrant of the abdomen. Imaging studies showed a complex gallbladder mass, which was pathologically confirmed to be CSGB. To our knowledge, this is the first CSGB presented from a radiological perspective. A short literature revision of CSGB is provided.

So-called carcinosarcoma of the duodenum with a chondrosarcomatous component

Carcinosarcoma is a biphasic malignant tumor consisting of both carcinomatous and sarcomatous components, and its occurrence in the duodenum is very rare. In the present report, we describe a case of so-called carcinosarcoma of the duodenum with a chondrosarcomatous component. A 79-year-old man was referred to our hospital because of anorexia, weight loss, and jaundice. A preoperative imaging examination showed a hypovascular mass located in the pancreatic head. Histological examination of specimens obtained through a forceps biopsy revealed anaplastic carcinoma (spindle cell type), and a pancreatoduodenectomy was performed. Histologically, the tumor showed an elevated lesion with a wide base in proximity to duodenal mucosal carcinoma. The tumor was found to be predominantly composed of sarcoma with carcinomatous and chondrosarcomatous components. There was a transitional zone between the carcinomatous and sarcomatous components, and a portion of the sarcomatous component was positive for cytokeratin, and negative for vimentin. As mentioned above, we diagnosed the lesion as so-called carcinosarcoma with a chondrosarcomatous component.

Carcinosarcoma of the gallbladder: a case report and review of the literature

Carcinosarcoma of the gallbladder is a rare malignancy characterized by malignant epithelial and mesenchymal components. The disease usually presents at an advanced stage, and as a result, curative resection is uncommon. This report describes a case that underwent curative resection. We herein declare the case of a patient in a 62-year-old male, with carcinosarcoma of the gallbladder with chondroid differentiation. The patient is treated by a simple cholecystectomy, a wedge resection of the underlying liver tissue and the pericholedochal lymph nodes for a tumor which occupied the entire gallbladder. Histologically, the epithelial component of the tumor was composed of adenocarcinoma and the mesenchymal component was composed of fibrosarcoma. The tumor was identified as extend to the serosa tissue and to have metastasized to no lymph node. The prognosis of carcinosarcoma of the gallbladder remains poor despite curative resection, and thus, the authors recommend that effort should be made to improve surgical outcomes. The patient survived 13 months and is still alive today.