Sarcomatoid carcinomas of the gallbladder: clinicopathologic characteristics

• Type of Material: Article
• Authors: Orhun Cig Taskin, Koc University Hospital; Gizem Akkas, Kutahya Evliya Celehi Research & Training Hospital; Bahar Memis, Emory University; Ipek Erbarut Seven, Marmara University; Olca Basturk, Wayne State University; Kee-Taek Jang, Sungkyunkwan University; Juan C. Roa, Pontificia Universidad Catolica de Chile; Juan Carlos Araya, Hospital Dr Heman Henriquez Aravena; Enrique Bellolio, Universidad de La Frontera; Hector Losada, Universidad de La Frontera; Juan Sarmiento, Emory University; Serdar Balci, Emory University; Burcin Pehlivanoglu, Emory University; Michelle Reid, Emory University; Jill Koshiol, National Cancer Institute; Nazmi Adsay, Emory University
• Language: English
• Date: 2019-07-01
• Publisher: Springer
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © Springer-Verlag GmbH Germany, part of Springer Nature 2019.
• Final Published Version (URL): http://dx.doi.org/10.1007/s00428-019-02583-z
• Title of Journal or Parent Work: Virchows Archiv
• Volume: 475
• Issue: 1
• Start Page: 59
• End Page: 66
• Grant/Funding Information: The authors received no specific funding for this work.
• Keywords: Osteoclastic giant cells; Adenocarcinoma; Sarcoma; Carcinoma; Breast; Small intestine; Pathology; Science & Technology; Carsinosarcoma; Features; Gallbladder; Pancreas; Sarcomatoid; Diagnosis; Life Sciences & Biomedicine; Undifferentiated carcinoma
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Oncology; Health Sciences, Epidemiology; Health Sciences, Pathology

Abstract

Sarcomatoid carcinomas recently came into the spotlight through genetic profiling studies and also as a distinct model of epithelial–mesenchymal transition. The literature on sarcomatoid carcinomas of gallbladder is limited. In this study, 656 gallbladder carcinomas (GBC) were reviewed. Eleven (1.7%) with a sarcomatoid component were identified and analyzed in comparison with ordinary GBC (O-GBC). Patients included 9 females and 2 males (F/M = 4.5 vs. 3.9) with a mean age-at-diagnosis of 71 (vs. 64). The median tumor size was 4.6 cm (vs. 2.5; P = 0.01). Nine patients (84%) presented with advanced stage (pT3/4) tumor (vs. 48%). An adenocarcinoma component constituting 1–75% of the tumor was present in nine, and eight had surface dysplasia/CIS; either in situ or invasive carcinoma was present in all cases. An intracholecystic papillary-tubular neoplasm was identified in one. Seven showed pleomorphic–sarcomatoid pattern, and four showed subtle/bland elongated spindle cells. Three had an angiosarcomatoid pattern. Two had heterologous elements. One showed few osteoclast-like giant cells, only adjacent to osteoid. Immunohistochemically, vimentin, was positive in six of six; P53 expression was > 60% in six of six, keratins in six of seven, and p63 in two of six. Actin, desmin, and S100 were negative. The median Ki67 index was 40%. In the follow-up, one died peri-operatively, eight died of disease within 3 to 8 months (vs. 26 months median survival for O-GBC), and two were alive at 9 and 15 months. The behavior overall was worse than ordinary adenocarcinomas in general but was not different when grade and stage were matched. In summary, sarcomatoid component is identified in < 2% of GBC. Unlike sarcomatoid carcinomas in the remainder of pancreatobiliary tract, these are seldom of the “osteoclastic” type and patients present with large/advanced stage tumors. Limited data suggests that these tumors are aggressive with rapid mortality unlike pancreatic osteoclastic ones which often have indolent behavior.