PMC5036547_01
Enhanced CT scan.. Notes: (A) On unenhanced CT, the mass was slightly hypoattenuating and had a fuzzy edge, containing irregular, hypodense regions. On contrast-enhanced CT scan, the mass exhibited moderately inhomogeneous enhancement during the arterial phase (B), portal venous phase, and delayed phase (C).. Abbreviation: CT, computer tomography.
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On contrast-enhanced CT scan, the mass exhibited moderately inhomogeneous enhancement during the arterial phase, portal venous phase, and delayed phase (Figure 1). The fundus of the tumor was located in the body of the gallbladder fossa side (Figure 1).
The sample of the resected CCG.. Note: The tumor consisted of lobulated, golden yellow mucus circumscribed, firm gray-red masses.. Abbreviation: CCG, cell adenocarcinoma of the gallbladder.
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Microscopically, >70% of the tumor was clear cells, which had large and well-defined cytoplasm borders (Figure 2).
Histology of the CCG.. Notes: (A) Approximately 70% of the lesion is composed of clear cell (H&E; original magnification x40). (B) Clear cell adenocarcinoma composed of cells with hepatoid differentiation. The tumor cells are arranged in a nested and trabecular pattern (H&E; original magnification x100). In immunohistochemical stain: (C) in the hepatoid areas, HepPar 1 immunoreactivity shows a coarse granular staining (H&E; original magnification x100), (D) the tumor cells are positive for CK19 (H&E; original magnification x100), (E) the tumor cells are negative for AFP (H&E; original magnification x100), (F) the tumor cells are positive for CK8-18 (H&E; original magnification x100), (G) the tumor cells are positive for GPC-3 (H&E; original magnification x100), and (H) the tumor cells are negative for SMA (H&E; original magnification x100).. Abbreviations: CCG, cell adenocarcinoma of the gallbladder; H&E, hematoxylin and eosin; HepPar 1, Hepatocyte Paraffin 1; CK, cytokeratin; AFP, alpha-fetoprotein; GPC-3, Glypican 3; SMA, smooth muscle actin.
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These cells were indistinguishable from hepatocellular adenocarcinoma and arranged in nests, sheets, and trabeculae (Figure 3). Those cells with features of hepatocyte were diffusely stained for Hepatocyte Paraffin 1 (Figure 3), whereas alpha-fetoprotein (AFP) staining was negative (Figure 3). Glypican 3 was strongly stained (Figure 3), which is usually significantly upregulated in hepatocellular carcinoma. Staining for HMB45 and smooth muscle actin was negative (Figure 3).