PMC2816347_01
Preoperative ultrasound reveals a significantly dilated gallbladder with wall thickening. Several high echogenic foci with low echoic debris (arrow) are present in the dependent portion of the gallbladder.
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F1
Several high echogenic foci with low echoic debris were present in the dependent portion of the gallbladder (Fig. 1).
(A) The wall of gallbladder is replaced by hypercellular spindle cells and the mucosal layer epithelium has been flattened by tumor infiltration (H&E, x40). (B) Spindle cells are interspersed with fascicle patterns (H&E, x100). (C) Higher magnification of spindle cells shows hyperchromasia and prominent nucleoli of nuclei, and mitoses are frequently noted (H&E, x400). (D) Tumor cells are stained diffusely and show moderate intensity for CD117 in the cytoplasm (Immunostain x400).
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F2
Microscopically, tumor cells were present in the entire layer of the gallbladder, and the mucosal layer was flattened due to tumor cells infiltration (Fig. 2A). Most of the tumor cells that were of spindle shape nature with some showing a round to oval appearance arranged in a short fascicle pattern (Fig. 2B). There was increased mitotic activity with mitotic counts being higher than 20/50 HPF (Fig. 2C), and partially tumor necrosis was also observed. Immunohistochemically, these tumor cells were stained diffusely with moderate intensity for CD117 (dilution 1:50, sc-168, Santa Cruz Biotechnology, Santa Cruz, CA, U.S.A.) in the cytoplasm (Fig. 2D) and they were positive for vimentin (dilution 1:25, V9, Signet Laboratories Inc., Dedham, MA, U.S.A.).
Abdominal CT reveals large heterogenously enhanced low density masses with strong evidence metastasis in right hepatic lobe.
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F3