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A clear cell adenocarcinoma of the gallbladder with hepatoid differentiation: case report and review of literature

View Article: PubMed Central - PubMed

ABSTRACT

An 80-year-old male was referred to our department for a gallbladder mass. He denied any history of alcohol consumption or cholecystitis and smoking. Hepatitis B surface antigen test and antihepatitis C antibody test were found to be negative. Serum carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen were elevated (CA19-9 was 59.92 U/mL and carcinoembryonic antigen was 12.64 ng/mL), whereas alpha-fetoprotein was below the normal limit (2.46 ng/mL). Computed tomography scan revealed a solid mass with measurements of 4.6×5.6×7.1 cm, which nearly filled the whole gallbladder space. Radical cholecystectomy, including segments IV B and V of the liver and lymphadenectomy, was performed. The neoplasm in gallbladder was completely resected, and the patient obtained a negative margin. Histological and immunohistochemical profile suggested a clear cell adenocarcinoma of the gallbladder with hepatoid differentiation. After reviewing the literature, we reported that this case is the first identified case of cell adenocarcinoma of the gallbladder with extensive hepatoid differentiation. However, clinical features of clear cell adenocarcinoma with hepatoid differentiation remain unclear due to the extremely rare incidence. There was no indication of adjuvant chemotherapy and no literature has been reported on the application of chemotherapy. This case showed a promising clinical outcome after curative resection, which indicated that surgical treatment could be potentially considered for suitable patients.

No MeSH data available.


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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f1-ott-9-5797: 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.

Mentions: An 80-year-old male was referred to our department with a gallbladder mass. The patient described a 3-month history of dull pain in the right hypochondrial region (especially after meals), accompanied by a radiating pain to the right back shoulder, tiredness and drowsy, and loss of appetite. Abdominal ultrasonography revealed a neoplastic lesion in his gallbladder, which was confirmed by computed tomography (CT) scan. He denied any history of hepatitis or alcohol consumption. The levels of serum carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) were elevated (CA19-9 was 59.92 U/mL with reference range 0–39 U/mL and CEA was 12.64 ng/mL with reference ranges 0.0–3.4 ng/mL). Liver function tests indicated a slight elevation in conjugated bilirubin (conjugated bilirubin, 8.8 µmol/L, reference range 0–3.4 µmol/L and unconjugated bilirubin, 6.4 µmol/L, reference range 1.7–10.2 µmol/L); the levels of both alkaline phosphatase and γ-glutamyl trans-peptidase were elevated (alkaline phosphatase, 179 U/L, reference range 45–125 U/L and γ-glutamyl transpeptidase, 148 U/L, reference range 10–60 U/L), whereas the levels of alanine transaminase and aspartate transaminase were within normal ranges. A CT scan that was performed at our institution revealed a heterogeneous mass measuring 7.1×5.6×4.6 cm, which nearly occupied the gallbladder. 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, portal venous phase, and delayed phase (Figure 1). The irregular hypodense regions in the unenhanced CT showed no enhancement in the arterial and portal phases. Based on the abovementioned results, we diagnosed it as a gallbladder cancer. At surgery, we found that the mass was located inside the gallbladder and nearly occupied the gallbladder space. The common bile duct was dilatant, and the gallbladder serosa was infiltrated but without any visible or direct hepatic invasion (tumor invades no extension beyond the serosa on naked eye).


A clear cell adenocarcinoma of the gallbladder with hepatoid differentiation: case report and review of literature
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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Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC5036547&req=5

f1-ott-9-5797: 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.
Mentions: An 80-year-old male was referred to our department with a gallbladder mass. The patient described a 3-month history of dull pain in the right hypochondrial region (especially after meals), accompanied by a radiating pain to the right back shoulder, tiredness and drowsy, and loss of appetite. Abdominal ultrasonography revealed a neoplastic lesion in his gallbladder, which was confirmed by computed tomography (CT) scan. He denied any history of hepatitis or alcohol consumption. The levels of serum carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen (CEA) were elevated (CA19-9 was 59.92 U/mL with reference range 0–39 U/mL and CEA was 12.64 ng/mL with reference ranges 0.0–3.4 ng/mL). Liver function tests indicated a slight elevation in conjugated bilirubin (conjugated bilirubin, 8.8 µmol/L, reference range 0–3.4 µmol/L and unconjugated bilirubin, 6.4 µmol/L, reference range 1.7–10.2 µmol/L); the levels of both alkaline phosphatase and γ-glutamyl trans-peptidase were elevated (alkaline phosphatase, 179 U/L, reference range 45–125 U/L and γ-glutamyl transpeptidase, 148 U/L, reference range 10–60 U/L), whereas the levels of alanine transaminase and aspartate transaminase were within normal ranges. A CT scan that was performed at our institution revealed a heterogeneous mass measuring 7.1×5.6×4.6 cm, which nearly occupied the gallbladder. 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, portal venous phase, and delayed phase (Figure 1). The irregular hypodense regions in the unenhanced CT showed no enhancement in the arterial and portal phases. Based on the abovementioned results, we diagnosed it as a gallbladder cancer. At surgery, we found that the mass was located inside the gallbladder and nearly occupied the gallbladder space. The common bile duct was dilatant, and the gallbladder serosa was infiltrated but without any visible or direct hepatic invasion (tumor invades no extension beyond the serosa on naked eye).

View Article: PubMed Central - PubMed

ABSTRACT

An 80-year-old male was referred to our department for a gallbladder mass. He denied any history of alcohol consumption or cholecystitis and smoking. Hepatitis B surface antigen test and antihepatitis C antibody test were found to be negative. Serum carbohydrate antigen 19-9 (CA19-9) and carcinoembryonic antigen were elevated (CA19-9 was 59.92 U/mL and carcinoembryonic antigen was 12.64 ng/mL), whereas alpha-fetoprotein was below the normal limit (2.46 ng/mL). Computed tomography scan revealed a solid mass with measurements of 4.6×5.6×7.1 cm, which nearly filled the whole gallbladder space. Radical cholecystectomy, including segments IV B and V of the liver and lymphadenectomy, was performed. The neoplasm in gallbladder was completely resected, and the patient obtained a negative margin. Histological and immunohistochemical profile suggested a clear cell adenocarcinoma of the gallbladder with hepatoid differentiation. After reviewing the literature, we reported that this case is the first identified case of cell adenocarcinoma of the gallbladder with extensive hepatoid differentiation. However, clinical features of clear cell adenocarcinoma with hepatoid differentiation remain unclear due to the extremely rare incidence. There was no indication of adjuvant chemotherapy and no literature has been reported on the application of chemotherapy. This case showed a promising clinical outcome after curative resection, which indicated that surgical treatment could be potentially considered for suitable patients.

No MeSH data available.