PMC3268145_01
Abdomen computed tomography showed diffuse distension of gallbladder (GB) with irregular intraluminal polypoid masses - possible GB cancer rather than xanthogranulomatous cholecystitis.
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F1
However, abdominal computed tomography (CT) showed diffuse GB distension and an irregular intraluminal polypoid mass with no demonstrable lymph nodes (LNs) in the pericholecystic and upper abdominal regions (Fig. 1).
Microscopic finding. (A) Well differentiated squamous cell carcinoma components (H&E, x200). (B) High-grade spindle cell sarcoma components (H&E, x400).
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F2
The postoperative specimen showed a tumor size of 7.8 x 5.5 x 1.2 cm, and histologically, the tumor was found to contain distinct regions of squamous cell carcinoma and high-grade spindle cell sarcoma (Fig. 2).
Immunohistochemical stain. (A) Strong cytokeratin positivity in malignant glands forming the epithelial component (Cytokeratin, x200). (B) Strong vimentin positivity in the sarcoma component (Vimentin, x200).
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F3
Final diagnosis was made based on immunohistochemical findings, that is, squamous carcinoma components were stained by cytokeratin but not by vimentin, and conversely, sarcoma components were stained by vimentin but not by cytokeratin (Fig. 3).
Abdomen computed tomography showed huge metastatic mass involving liver S4 (A), and duodenum 1st portion (B). Multiple variable sized masses with central necrosis in the dependant portion of the abdominal cavity (C).
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F4
CT performed at the time showed a huge metastatic mass involving S4 of the liver, the 1st portion of the duodenum, and multiple, variably sized, cancerous masses with central necrosis in the dependant portion of the abdominal cavity (Fig. 4). Conservative treatment was initiated but she died a few days later.