Cases reported "Carcinoma, Adenosquamous"

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1/9. A case of primary adenosquamous/squamous cell carcinoma of gallbladder directly invaded duodenum.

    A rare case of primary gallbladder carcinoma is reported. A 67 year-old woman was admitted to our hospital for treatment of suspected duodenal carcinoma. A series of radiographic examinations demonstrated a giant tumor involving the duodenum, gallbladder, pancreatic head, and transverse colon. These extensions made it difficult to identify the primary origin of the carcinoma. Pancreatoduodenectomy, cholecystectomy, and resection of the transverse colon were performed. Macroscopically, ulcerative lesions were seen in both the gallbladder and the duodenum. Microscopic examination revealed adenosquamous cell carcinoma of the gallbladder, invasive of the adjacent organs, including circumferential invasion of the second portion of the duodenum. The patient tolerated the operation well and was discharged 28 days post-operatively, but died of liver metastasis 4 months after surgery. Local invasion of the surrounding tissues is characteristic of adenosquamous/squamous cell carcinoma of the gallbladder. Although surgery for cure is deemed possible, the rapid growth rate of this type of tumor may cast doubt on the value of extensive radical surgery.
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2/9. Advanced adenosquamous carcinoma of the gallbladder with bilio-biliary fistula: an uncommon case treated by hepatopancreatoduodenectomy.

    A 70 year-old female, who presented with jaundice and abdominal pain, was found to have an advanced gallbladder cancer involving the liver parenchyma, duodenum, and transverse colon. This was complicated by a bilio-biliary fistula between the gallbladder and both the right and left hepatic ducts. After obtaining an accurate pre-operative diagnosis, the patient underwent hepatopancreatoduodenectomy (HPD) with lymph node dissection around the hepatic pedicle, celiac trunk, aorta, and inferior vena cava. Histologic examination revealed adenosquamous carcinoma. This rare variant accounts for 3.5% of gallbladder cancers, and is associated with a worse prognosis than adenocarcinoma. The patient is in good condition without any signs of recurrence 42 months after the HPD. In this case report, we discuss the histological type and internal biliary fistula with regard to the literature, and the usefulness of an aggressive surgical procedure such as HPD with extended lymph node dissection which can improve survival and quality of life in selected patients.
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3/9. Long-term survival of a patient with advanced adenosquamous carcinoma of the gallbladder after radical resection.

    patients with adenosquamous carcinoma of the gallbladder tend to present with a bulky tumor that frequently displays involvement with adjacent organs, and diagnosis is usually made at an advanced stage. This may contribute to the poor prognosis of patients with adenosquamous carcinoma of the gallbladder compared to patients with adenocarcinoma. We present herein a patient with advanced adenosquamous carcinoma of the gallbladder who is doing well with no evidence of recurrence more than 5 years after radical resection. A 72-year-old woman complaining of generalized fatigue and loss of appetite was referred to our hospital with suspected cholelithiasis, following ultrasonography done at another hospital. On admission, abdominal ultrasonography and computed tomography revealed an irregularly shaped solid mass extending from the fundus of the gallbladder, and invasion of the stomach was strongly suspected. gallbladder carcinoma was diagnosed, and radical resection, including partial gastrectomy, was performed. Histopathologically, adenosquamous carcinoma was diagnosed, and it was graded as si, hinf0, binf0, pv0, a0, t4, n0, and stage IVa.
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4/9. Squamous and adenosquamous cell carcinomas of the gallbladder.

    Squamous and adenosquamous cell carcinomas (ASC and SCC) are rare subtypes of gallbladder cancer, traditionally considered more aggressive and with a poorer prognosis than adenocarcinoma. We report about two patients affected by an advanced squamous cell carcinoma of the gallbladder. Both had a large tumour in the gallbladder fossa region with infiltration of the liver. Surgical resection was radical in one, but palliative in the other. pTNM was T3 N0 M0, G3, R0 in the former and T3 N0 M0, G2 R1 in the latter. patients died for local recurrence after 12 and 5 months, respectively. natural history, clinical findings, prognosis and outcome of this rare gallbladder tumour are discussed on the basis of a review of the English literature. In conclusion, an aggressive and radical surgical treatment of advanced squamous and adenosquamous cell gallbladder carcinomas seems to be indicated for their low proclivity to distant spreading.
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5/9. gallbladder adenosquamous cell carcinoma: report of two cases.

    adenocarcinoma is the usual histological presentation of the very rare gallbladder carcinoma. Adenosquamous cell carcinoma accounts for less than 3.5% of gallbladder carcinomas, and is characterised by invasive growth, a reduced tendency for lymph node metastasis, an increased tendency for hepatic infiltration or liver metastasis, and a poorer prognosis than adenocarcinoma. We present two cases. The first patient presented to our institution with increased bilirubin levels and dilated intra- and extrahepatic bile ducts. Adenosquamous carcinoma of the gallbladder was diagnosed on the post-operative pathological specimen. After surgery, bilirubin levels decreased, but hepatic metastases occurred that did not respond to conventional chemotherapy. The second patient was admitted to our hospital with jaundice and abdominal pain. Abdominal computed tomography (CT) imaging showed marked thickening of the gallbladder with direct extension of a mass into the left liver lobe. Cytology specimens obtained with an endoscopic retrograde cholangiopancreatography (ERCP) procedure revealed a malignant epithelial tumour. The patient underwent surgery but the tumour was incompletely resected. A regimen of oral UFT (tegafur uracil) chemotherapy was begun. serum bilirubin levels increased due to occlusion in the surgical area 15 weeks after the start of chemotherapy.
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6/9. gallbladder carcinoma with osteoclast-like giant cells.

    Extraskeletal tumors containing multinucleated, osteoclast-like giant cells (OGCs) are uncommon. These neoplasms are most frequently reported in the breast and pancreas. Recently, some authors have suggested that carcinomas containing OGCs may represent a distinct clinicopathological entity with a more favorable prognosis. Occurrence in the gallbladder is extremely rare, with only one previous case. We report here on an additional case of gallbladder carcinoma with an infiltrate of OGCs. A 72-year-old woman presented with postprandial abdominal pain and was found to have a mass in the body of the gallbladder with direct liver invasion. Histological examination showed an adenosquamous carcinoma with an infiltrate of benign OGCs. Immunohistochemical analysis demonstrated that the giant cells were of histiocytic origin. The patient survived for 6 years without evidence of recurrence. This case adds to a small body of literature on gallbladder carcinoma with OGCs. Further studies are required to clearly define the prognostic significance of these giant cells in gallbladder cancer and the differences between adenosquamous carcinoma with OGCs and other gallbladder carcinomas (such as adenocarcinoma and squamous cell carcinoma) with those cells.
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7/9. Subcutaneous periumbilical metastasis of a gallbladder carcinoma after laparoscopic cholecystectomy.

    The frequency of gallbladder carcinoma is 1.2 to 7.4% of all cholecystectomy specimens. In open cholecystectomy for gallstone disease, undetected gallbladder carcinoma is found postoperatively in the histological examination in 0.3%. Tumor cells of these clinically inapparent gallbladder carcinomas can be implanted at the trocar sites during laparoscopic cholecystectomies. We report a case with subcutaneous tumor seeding at the navel trocar insertion site in a 65-year-old woman.
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8/9. Hepatopancreatoduodenectomy for squamous and adenosquamous carcinoma of the gallbladder.

    The characteristics of squamous or adenosquamous cell carcinoma of the gallbladder differ quite markedly from those of adenocarcinoma, although the incidence is extremely low. Recently, we encountered both of the former types of gallbladder carcinoma: a 77-year-old man with squamous cell carcinoma and a 70-year-old man with adenosquamous cell carcinoma of the gallbladder. Both had a large mass in the gallbladder fossa region with infiltration to the liver and invasion of the duodenum. Hepatopancreatoduodenectomy was performed on both of these patients. The TNM stage of the former was IV (T4N0M0) and of the latter IV (T4N0M0) and of the latter IV (T4N1bM0). The former has remained well without recurrence for about 1 year and 4 months after the operation, while the latter died of recurrent disease 6 months after operation. The true reason for the difference in the prognosis of these two patients was not known. However, hepatopancreatoduodenectomy is considered to be a most adaptable operative procedure for squamous or adenosquamous cell carcinoma of the gallbladder in view of their mode of spread, and the presence of lymph node metastasis might be a factor of poor prognosis.
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9/9. MRI findings in adenosquamous carcinoma of the gallbladder.

    In this report, we present the MRI findings of adenosquamous carcinoma of the gallbladder, a rare type of gallbladder malignancy. MRI examination not only helped established the diagnosis but also accurately depicted the extent of involvement of the adjacent liver. The ability to image in multiple planes was also useful in assessing the anatomic location of the tumor and in determining that the patient could be treated with surgical resection.
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