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Sarcomatoid carcinomas of the gallbladder: clinicopathologic characteristics

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.

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Acknowledgments

This study has been presented in the USCAP Annual Meeting in 2015, March 21–27 at Boston, MA, USA.

Author information

• Orhun Cig Taskin: Data curation, investigation, validation, writing original draft, and writing review and editing.

• Gizem Akkas: Data curation, investigation, validation, writing original draft, and writing review and editing.

• Bahar Memis: Data curation, investigation, writing original draft, and writing review and editing.

• Ipek Erbarut Seven: Data curation, investigation, and writing review and editing.

• Olca Basturk: Project administration, supervision, writing original draft, and writing review and editing.

• Kee-Taek Jang: Supervision and writing review and editing.

• Juan C Roa: Conceptualization, data curation, investigation, methodology, project administration, and writing review and editing.

• Juan Carlos Araya: Data curation, investigation, and writing review and editing.

• Enrique Bellolio: Data curation, investigation, and writing review and editing.

• Hector Losada: Data curation, investigation, and writing review and editing.

• Juan Sarmiento: Data curation, investigation, and writing review and editing.

• Serdar Balci: Data curation, formal analysis, methodology, and validation.

• Burcin Pehlivanoglu: Data curation, investigation, validation, and writing review and editing.

• Michelle Reid: Writing original draft and writing review and editing.

• Jill Koshiol: Data curation, formal analysis, methodology, and validation.

• Volkan Adsay: Conceptualization, data curation, investigation, methodology, project administration, resources, supervision, writing original draft, and writing review and editing.

Correspondence to Volkan Adsay.

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The Helsinki principles were respected in the making of this study. Moreover, patients’ confidentiality data was kept via their guidelines. The studies were accomplished in agreement with the institutional review board requirements.

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The authors declare that they have no conflict of interest.

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Orhun Cig Taskin and Gizem Akkas are co-contributing first authors.

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Taskin, O.C., Akkas, G., Memis, B. et al. Sarcomatoid carcinomas of the gallbladder: clinicopathologic characteristics. Virchows Arch 475, 59–66 (2019). https://doi.org/10.1007/s00428-019-02583-z

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Keywords

  • Gallbladder
  • Carcinoma
  • Adenocarcinoma
  • Sarcoma
  • Sarcomatoid