Gallbladder carcinosarcoma with a poor prognosis: A case report

Figure 1 Enhanced computed tomography scan revealed a polycystic mass of 10. 1 cm × 7.5 cm in size in the right liver and gallbladder fossa with a thick and enhanced cyst wall. Gallbladder was not obvious. No evidence of gallstones were seen.

Figure 2 A month later, computed tomography reexamination revealed that the liver mass had not shrunk significantly and had become a fully solid mass. The common bile duct is not dilated by the pressure.

Figure 3 The resected specimen was a nodular mass with a size of about 9 cm × 8 cm × 6. 5 cm. The section is grayish white, solid tissue, soft texture, and adhesion to the surrounding tissue. The gallbladder was invaded into the liver. The gallbladder contained new fish-like tissue. Necrosis and bleeding were seen in the lesion.

Figure 4 Pathological features of carcinosarcoma of gallbladder. A: High power view of the gallbladder wall show intramucosal adenocarcinoma [hematoxylin and eosin (H&E) stain, 40 ×]; B: High power view show high-grade spindle cell sarcoma (H&E, 40 ×); C: Cytokeratin (CK) (HIC, 40 ×) staining show strong membranous positivity in the intramucosal adenocarcinoma; D: CK-19 (HIC, 10 ×) staining show strong membranous positivity in the intramucosal adenocarcimoma; E: Transducin-like enhancer protein 1 (HIC, 40 ×) staining show strong sarcomatous component positivity in the gallbladder neoplasm; F: Special AT-rich sequence-binding protein 2 (HIC, 40 ×) staining show osteoblastic component positivity in the gallbladder neoplasm.

Figure 5 One month after surgery, the patient had recurrent episodes of nausea and vomiting. Vomiting more stomach contents. Abdominal computed tomography (CT) scan (the patient refused to undergo enhanced CT) revealed a 9 cm × 8 cm × 8 cm mass in the anterior duodenum (indicated by the red arrow), leading to duodenal obstruction. Local recurrence of the tumor is suspected.