PMC9843067_01
(A) Abdominal CT scan demonstrating a gallbladder mass measuring 60 mm in diameter invading segments V and IV of the liver (Blue asterisk). (B) Macroscopically, the tumor had an exophytic growth pattern. It was friable, whitish, extending outward from the gallbladder, and involving the liver. (C) Microscopic examination showing a compact proliferation of malignant spindle cells invading the gallbladder (Hematoxylin and eosin, magnification x200). (D) Microscopic examination showing a spindle cell proliferation of tumor cells invading the gallbladder (Hematoxylin and eosin, magnification x400).
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Abdominal CT scan revealed a gallbladder mass measuring 60 mm in diameter invading segments V and IV of the liver (Figure 1A). Grossly, the tumor was friable, whitish, extending outward from the gallbladder, and involving the liver (Figure 1B). Microscopically, the tumor had a sarcomatous component with atypical spindle cells (Figures 1C,D and 2A) and an adenocarcinoma component with glandular structures (Figure 2B).
(A) The sarcomatous component of the tumor was made of atypical spindle cells with a high mitotic index (Hematoxylin and eosin, magnification x400). (B) Microscopic examination showing a predominant sarcomatous component intricated with an adenocarcinoma component with glandular structures, (Hematoxylin and eosin, magnification x400). (C) Focally, we noted the presence of pleomorphic giant cells with hyperchromatic nuclei and prominent nucleoli, (Hematoxylin and eosin, magnification x400). (D) Osteoid formation was focally noted in the tumor proliferation (Hematoxylin and eosin, magnification x100).
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Microscopically, the tumor had a sarcomatous component with atypical spindle cells (Figures 1C,D and 2A) and an adenocarcinoma component with glandular structures (Figure 2B). Focally, there were pleomorphic giant cells (Figure 2C). Osteoid was identified (Figure 2D).
(A) Immunohistochemistry demonstrating negative staining of the sarcomatous component with cytokeratin (Immunohistochemistry, magnification x200). (B) Immunohistochemical staining showing cytokeratin-positive epithelial component (adenocarcinoma: brown staining), (Immunohistochemistry, magnification x100). (C) Immunohistochemistry demonstrating strong staining with vimentin of the sarcomatous component (brown staining), (Immunohistochemistry, magnification x200). (D) Immunohistochemistry demonstrating focal staining of some tumor cells with smooth muscle Actin (brown staining) (Immunohistochemistry, magnification x400).
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Immunohistochemical study showed positive staining of cytokeratin for the epithelial component (Figure 3A,B) and vimentin for the mesenchymal component (Figure 3C). Some tumor cells expressed SMA (Figure 3D).