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Sarcomatoid cholangiocarcinoma with osteoclast-like giant cells associated with hepatolithiasis: A case report.

Kim HM, Kim H, Park YN - Clin Mol Hepatol (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

A 67-year-old woman was referred to our hospital for right upper quadrant abdominal pain for 3 weeks. She had no history of alcohol ingestion or smoking, and no remarkable medical history. A computed tomography scan was performed to evaluate the cause of abdominal pain, and revealed distal common bile duct stone or sludge with dilatation of the common bile duct and bilateral intrahepatic ducts and a 6 cm-sized heterogeneous lobulated mass in the left lateral segment of the liver, suggestive of intrahepatic CC with multiple left intrahepatic duct stones (Fig. 1A, B). There was no definite evidence of hepatic artery or portal vein invasion or intrahepatic metastasis. Initial laboratory findings showed normal liver function tests: aspartate aminotransferase 16 IU/L, alanine aminotransferase 22 IU/L, total bilirubin 0.4 mg/dL, direct bilirubin 0.1 mg/dL and elevated gamma-glutamyl transpeptidase 97 IU/L and alkaline phosphatase 151 IU/L. Tumor marker tests revealed elevated carbohydrate antigen 19-9 (1598.0 U/mL) and carcinoembryonic antigen (109.60 ng/mL) levels. Testing for hepatitis B and hepatitis C virus were negative. Under the impression of mass-forming intrahepatic CC, she underwent a left lobectomy of the liver.

No MeSH data available.


Related in: MedlinePlus

Immunohistochemical finding. Microscopic feature of sarcomatoid cholangiocarcinoma shows intermingled carcinomatous and sarcomatous component (A. H-E, ×100). Carcinomatous component shows strong expression of cytokeratin 19, but sarcomatous component shows no expression of cytokeratin 19 (B. CK19, ×200). E-cadherin shows total loss in the sarcomatous portion and no loss in the carcinomatous portion (C. E-cadherin, ×200). uPAR is positive in the sarcomatous portion but negative in the carcinomatous portion (D. uPAR, ×200). Sarcomatous component shows diffuse and strong expression of vimentin (E. vimentin, ×200). Many scattered osteoclast-like giant cells shows positive expression of CD68 (PG-M1) (F. H-E and CD68 (PG-M1), ×400).
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Figure 4: Immunohistochemical finding. Microscopic feature of sarcomatoid cholangiocarcinoma shows intermingled carcinomatous and sarcomatous component (A. H-E, ×100). Carcinomatous component shows strong expression of cytokeratin 19, but sarcomatous component shows no expression of cytokeratin 19 (B. CK19, ×200). E-cadherin shows total loss in the sarcomatous portion and no loss in the carcinomatous portion (C. E-cadherin, ×200). uPAR is positive in the sarcomatous portion but negative in the carcinomatous portion (D. uPAR, ×200). Sarcomatous component shows diffuse and strong expression of vimentin (E. vimentin, ×200). Many scattered osteoclast-like giant cells shows positive expression of CD68 (PG-M1) (F. H-E and CD68 (PG-M1), ×400).

Mentions: On gross examination, the cut surface revealed a single, firm, whitish to tan mass (4.5×4.0 cm) with periductal infiltration around the dilated left intrahepatic duct. The duct lumen was distended to about 2 cm in diameter with 3 cm sized black stone impaction (Fig. 2). Microscopically, the tumor showed two distinct components; carcinomatous component and sarcomatous component (Fig. 3A, 4A). In the carcinomatous component, the malignant cells formed irregular papillae or fused glands in a prominent fibrous stroma, consistent with features of a typical well-to-moderately differentiated adenocarcinoma. The columnar-to-cuboidal epithelial neoplastic cells had atypical nuclei with some prominent nucleoli, slightly eosinophilic and granular cytoplasm, and some mitosis (Fig. 3B). In the sarcomatous component, there were pleomorphic cells and atypical spindle cells with vesicular nuclei and prominent nucleoli (Fig. 3C). The two components were intermingled. In addition, there were many scattered osteoclast-like giant cells: large multinucleated giant cells containing 10-25 nuclei and about 150-200 µm in diameter (Fig. 4F). Perineural invasion and microvessel invasion were seen. In surrounding liver, hepatolithiasis with chronic proliferative cholangitis and microabscess formation was noted (Fig. 3D). The immunohistochemical staining results also demonstrated two distinct patterns. The carcinomatous portion was positive for cytokeratin 19 (Fig. 4B) and negative for vimentin. The sarcomatous portion was positive for vimentin (Fig. 4E) and negative for cytokeratin 19. Both were negative for hepatocyte antigen and alpha-fetoprotein. The osteoclast-like giant cells were positive for CD68 (PG-M1) (Fig. 4F). The immunohistochemical staining with EMT-related markers, E-cadherin and uPAR was conducted. E-cadherin showed total loss in the sarcomatous portion and no loss in the carcinomatous portion (Fig. 4C). uPAR was positive in the sarcomatous portion and peritumoral stroma but negative in the carcinomatous portion (Fig. 4D).


Sarcomatoid cholangiocarcinoma with osteoclast-like giant cells associated with hepatolithiasis: A case report.

Kim HM, Kim H, Park YN - Clin Mol Hepatol (2015)

Immunohistochemical finding. Microscopic feature of sarcomatoid cholangiocarcinoma shows intermingled carcinomatous and sarcomatous component (A. H-E, ×100). Carcinomatous component shows strong expression of cytokeratin 19, but sarcomatous component shows no expression of cytokeratin 19 (B. CK19, ×200). E-cadherin shows total loss in the sarcomatous portion and no loss in the carcinomatous portion (C. E-cadherin, ×200). uPAR is positive in the sarcomatous portion but negative in the carcinomatous portion (D. uPAR, ×200). Sarcomatous component shows diffuse and strong expression of vimentin (E. vimentin, ×200). Many scattered osteoclast-like giant cells shows positive expression of CD68 (PG-M1) (F. H-E and CD68 (PG-M1), ×400).
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Related In: Results  -  Collection

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Figure 4: Immunohistochemical finding. Microscopic feature of sarcomatoid cholangiocarcinoma shows intermingled carcinomatous and sarcomatous component (A. H-E, ×100). Carcinomatous component shows strong expression of cytokeratin 19, but sarcomatous component shows no expression of cytokeratin 19 (B. CK19, ×200). E-cadherin shows total loss in the sarcomatous portion and no loss in the carcinomatous portion (C. E-cadherin, ×200). uPAR is positive in the sarcomatous portion but negative in the carcinomatous portion (D. uPAR, ×200). Sarcomatous component shows diffuse and strong expression of vimentin (E. vimentin, ×200). Many scattered osteoclast-like giant cells shows positive expression of CD68 (PG-M1) (F. H-E and CD68 (PG-M1), ×400).
Mentions: On gross examination, the cut surface revealed a single, firm, whitish to tan mass (4.5×4.0 cm) with periductal infiltration around the dilated left intrahepatic duct. The duct lumen was distended to about 2 cm in diameter with 3 cm sized black stone impaction (Fig. 2). Microscopically, the tumor showed two distinct components; carcinomatous component and sarcomatous component (Fig. 3A, 4A). In the carcinomatous component, the malignant cells formed irregular papillae or fused glands in a prominent fibrous stroma, consistent with features of a typical well-to-moderately differentiated adenocarcinoma. The columnar-to-cuboidal epithelial neoplastic cells had atypical nuclei with some prominent nucleoli, slightly eosinophilic and granular cytoplasm, and some mitosis (Fig. 3B). In the sarcomatous component, there were pleomorphic cells and atypical spindle cells with vesicular nuclei and prominent nucleoli (Fig. 3C). The two components were intermingled. In addition, there were many scattered osteoclast-like giant cells: large multinucleated giant cells containing 10-25 nuclei and about 150-200 µm in diameter (Fig. 4F). Perineural invasion and microvessel invasion were seen. In surrounding liver, hepatolithiasis with chronic proliferative cholangitis and microabscess formation was noted (Fig. 3D). The immunohistochemical staining results also demonstrated two distinct patterns. The carcinomatous portion was positive for cytokeratin 19 (Fig. 4B) and negative for vimentin. The sarcomatous portion was positive for vimentin (Fig. 4E) and negative for cytokeratin 19. Both were negative for hepatocyte antigen and alpha-fetoprotein. The osteoclast-like giant cells were positive for CD68 (PG-M1) (Fig. 4F). The immunohistochemical staining with EMT-related markers, E-cadherin and uPAR was conducted. E-cadherin showed total loss in the sarcomatous portion and no loss in the carcinomatous portion (Fig. 4C). uPAR was positive in the sarcomatous portion and peritumoral stroma but negative in the carcinomatous portion (Fig. 4D).

View Article: PubMed Central - PubMed

Affiliation: Department of Pathology, Yonsei University College of Medicine, Seoul, Korea.

ABSTRACT

A 67-year-old woman was referred to our hospital for right upper quadrant abdominal pain for 3 weeks. She had no history of alcohol ingestion or smoking, and no remarkable medical history. A computed tomography scan was performed to evaluate the cause of abdominal pain, and revealed distal common bile duct stone or sludge with dilatation of the common bile duct and bilateral intrahepatic ducts and a 6 cm-sized heterogeneous lobulated mass in the left lateral segment of the liver, suggestive of intrahepatic CC with multiple left intrahepatic duct stones (Fig. 1A, B). There was no definite evidence of hepatic artery or portal vein invasion or intrahepatic metastasis. Initial laboratory findings showed normal liver function tests: aspartate aminotransferase 16 IU/L, alanine aminotransferase 22 IU/L, total bilirubin 0.4 mg/dL, direct bilirubin 0.1 mg/dL and elevated gamma-glutamyl transpeptidase 97 IU/L and alkaline phosphatase 151 IU/L. Tumor marker tests revealed elevated carbohydrate antigen 19-9 (1598.0 U/mL) and carcinoembryonic antigen (109.60 ng/mL) levels. Testing for hepatitis B and hepatitis C virus were negative. Under the impression of mass-forming intrahepatic CC, she underwent a left lobectomy of the liver.

No MeSH data available.


Related in: MedlinePlus