PMC5318351_01
T1 magnetic resonance image of gallbladder neoplasm (at arrowhead).
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An abdominal ultrasound revealed the presence of a gallbladder calculi, and a fundic mass which was further investigated with magnetic resonance cholangiopancreatography (MRCP) and computed tomography (CT) imaging for determination of metastatic involvement (Fig. 1).
Specimen image demonstrating gross morphology of the neoplasm. Surgical clips noted at the cystic duct margin.
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The tumor was removed without any complications (Fig. 2).
(A-D) Clear cell adenocarcinoma of gallbladder. A. Lower magnification (H&E, 20x) shows that the lesion grows as a predominantly polypoid mass arising from the mucosal surface of the gallbladder. B. Higher magnification (H&E, 200x) highlights tumor cells with clear cytoplasm, well-defined cytoplasmic borders and hyperchromatic nuclei. C. By immunohistochemistry, the tumor cells are positive for CK7. D. However, they are negative for PAX8, thus ruling out the possibility of metastatic clear cell renal carcinoma.
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Immmunohistochemical evaluation verified that the tumor arose from the mucosal surface of the gallbladder thus ruling out any renal background (Fig. 3A). The tumor cells were characterized by clear cytoplasm, well-defined cytoplasmic borders and hyperchromatic nuclei (Fig. 3B). Additionally, the tumor cells were positive for cytokeratin-7 (CK-7) and negative for cytokeratin-20 (CK-20) and paired box gene 8 (PAX8) thereby eliminating the possibility of metastatic clear cell renal carcinoma (Fig. 3C, D).