The present study aimed to clarify the endoscopic ultrasonography(EUS)features of nonneoplastic(cholesterol polyps and adenomyomatosis)and neoplastic(adenoma and adenocarcinoma)gallbladder polyps and to evaluate the e...The present study aimed to clarify the endoscopic ultrasonography(EUS)features of nonneoplastic(cholesterol polyps and adenomyomatosis)and neoplastic(adenoma and adenocarcinoma)gallbladder polyps and to evaluate the effectiveness and limitation of EUS in the differential diagnosis of these lesions.We retrospectively compared EUS images with histologic findings in 29 surgical cases with gallbladder polyps with a diameter of 10 to 20 mm.Those cases were indicated for surgery based on the findings of a sessile appearance,a solitary lesion,low echogenicity,and/or a lobulated surface.Six of 10 cholesterol polyps were atypically seen as partially or completely hypoechoic due to predominant proliferation of glandular epithelia.Nine of 10 cholesterol polyps demonstrated an aggregation of hyperechoic spots,which represented multiple granules of cholesterosis.All adenomyomatoses(n = 10)showed multiple microcysts,which corresponded to proliferated Rokitansky-Aschoff sinuses.However,three of nine neoplastic lesions(three adenomas and six adenocarcinomas)showed one of these signs due to concomitant cholesterosis(n = 2)or proliferated Rokitansky-Aschoff sinuses(n = 1).In conclusion,69%(20/29)of gallbladder polyps larger than 10 mm that were preoperatively suspected of malignancy were nonneoplastic.An aggregation of hyperechoic spots and multiple microcysts are considered to be important predictive factors for cholesterol polyps and adenomyomatosis,respectively.However,we should caution that these findings can also occur in neoplastic polyps when they contain a concomitant nonneoplastic component(choleste-rosis or proliferated Rokitansky-Aschoff sinuses).展开更多
Undifferentiated spindle-cell carcinoma (SpCC) of the gallbladder is extremely rare. There is very little information available regarding the characteristics and treatment of this disease. We herein report the unique ...Undifferentiated spindle-cell carcinoma (SpCC) of the gallbladder is extremely rare. There is very little information available regarding the characteristics and treatment of this disease. We herein report the unique case of a 76-year- old female patient with a primary SpCC of the gallbladder that presented as a li ver tumor. Preoperative radiologic examinations showed a 5-cm liver tumor aroun d the gallbladder bed, and irregular thickening of the gallbladderwall. The pati ent underwent en-bloc resection of the gallbladder and segments 4b and 5 of the liver (including the liver tumor). Microscopic findings revealed that both lesi ons consisted mainly of a sarcomatous spindle-shaped component. Small foci of w ell-differentiated adenocarcinoma cells were identified in the gallbladder muco sa. There was a gradual transition between the two different components, thereby implying that these two cell types had a common origin. Immunohistochemical stu dies showed that the spindle-shaped cells were epithelial in nature. The patien t‘s postoperative course was uneventful. However, she died of recurrent liver d isease 6 months after the surgery. In conclusion, we surmised that the sarcomato us spindle cells originated from a carcinomatous component in the gallbladder mu cosa through dedifferentiation. Further studies are needed to better understand the characteristics of this deadly tumor, and to establish an effective therapy for it.展开更多
文摘The present study aimed to clarify the endoscopic ultrasonography(EUS)features of nonneoplastic(cholesterol polyps and adenomyomatosis)and neoplastic(adenoma and adenocarcinoma)gallbladder polyps and to evaluate the effectiveness and limitation of EUS in the differential diagnosis of these lesions.We retrospectively compared EUS images with histologic findings in 29 surgical cases with gallbladder polyps with a diameter of 10 to 20 mm.Those cases were indicated for surgery based on the findings of a sessile appearance,a solitary lesion,low echogenicity,and/or a lobulated surface.Six of 10 cholesterol polyps were atypically seen as partially or completely hypoechoic due to predominant proliferation of glandular epithelia.Nine of 10 cholesterol polyps demonstrated an aggregation of hyperechoic spots,which represented multiple granules of cholesterosis.All adenomyomatoses(n = 10)showed multiple microcysts,which corresponded to proliferated Rokitansky-Aschoff sinuses.However,three of nine neoplastic lesions(three adenomas and six adenocarcinomas)showed one of these signs due to concomitant cholesterosis(n = 2)or proliferated Rokitansky-Aschoff sinuses(n = 1).In conclusion,69%(20/29)of gallbladder polyps larger than 10 mm that were preoperatively suspected of malignancy were nonneoplastic.An aggregation of hyperechoic spots and multiple microcysts are considered to be important predictive factors for cholesterol polyps and adenomyomatosis,respectively.However,we should caution that these findings can also occur in neoplastic polyps when they contain a concomitant nonneoplastic component(choleste-rosis or proliferated Rokitansky-Aschoff sinuses).
文摘Undifferentiated spindle-cell carcinoma (SpCC) of the gallbladder is extremely rare. There is very little information available regarding the characteristics and treatment of this disease. We herein report the unique case of a 76-year- old female patient with a primary SpCC of the gallbladder that presented as a li ver tumor. Preoperative radiologic examinations showed a 5-cm liver tumor aroun d the gallbladder bed, and irregular thickening of the gallbladderwall. The pati ent underwent en-bloc resection of the gallbladder and segments 4b and 5 of the liver (including the liver tumor). Microscopic findings revealed that both lesi ons consisted mainly of a sarcomatous spindle-shaped component. Small foci of w ell-differentiated adenocarcinoma cells were identified in the gallbladder muco sa. There was a gradual transition between the two different components, thereby implying that these two cell types had a common origin. Immunohistochemical stu dies showed that the spindle-shaped cells were epithelial in nature. The patien t‘s postoperative course was uneventful. However, she died of recurrent liver d isease 6 months after the surgery. In conclusion, we surmised that the sarcomato us spindle cells originated from a carcinomatous component in the gallbladder mu cosa through dedifferentiation. Further studies are needed to better understand the characteristics of this deadly tumor, and to establish an effective therapy for it.
