Gallbladder carcinosarcoma masquerading as a hepatic abscess

Abstract

Carcinosarcomas of the gallbladder are extremely rare tumors and infrequently reported in the literature. We demonstrate a case of a 64-year-old female who presented with a 2-month history of a right upper quadrant mass, intermittent fevers, and abdominal distension following recent travel to Ghana. A computed tomography (CT) scan of the abdomen and pelvis demonstrated a large hepatic lesion with co-existing gallbladder distension, suggestive of a hepatic abscess. The patient was initially managed with intravenous antibiotics but failed to respond to treatment. A subsequent magnetic resonance imaging (MRI) scan of the liver showed a locally invasive lobulated soft tissue lesion arising from the gallbladder fundus and extending into the liver parenchyma. The lesion was surgically excised with a central hepatectomy. Histopathologic analysis showed a carcinosarcoma of the gallbladder.

Keywords: Abscess; Carcinosarcoma; Gallbladder; Hepatobiliary; Oncology.

Fig. 1

(A) Axial CT abdomen and pelvis scan illustrating a giant 12 × 10 × 13 cm hypoattenuated, fluid-filled lesion within the right lobe of the liver. (B) Coronal CT slice showing the hepatic lesion abutting a grossly distended gallbladder. The gallbladder wall is thin and there is no evidence of gallstones or cholecystitis on CT. A single 16-mm cyst is present superolateral to the main hepatic lesion in segment VIII.

Fig. 2

(A) Large complex cystic mass in the right lobe of the liver depicted on ultrasound, measuring 132 × 97 × 110 mm. (B) A 16-mm right lobe simple cyst also noted with surrounding coarse architecture of liver and irregular contour.

Fig. 3

Axial MRI slice showing (A) central heterogeneous high T2 signal and (B) low/intermediate T1 signal of a large lobulated soft tissue lesion in the right lobe of the liver. (C) Sagittal MRI T2-weighted sequence illustrating a 5.4 cm × 3.3 cm × 6 cm focus of lobulated enhancing soft tissue arising from the anterior wall of the gallbladder fundus causing gallbladder wall destruction and extending into the liver parenchyma. The origin of the lesion appears to be from the gallbladder, thus raising the suspicion of a gallbladder malignancy with local invasion into the liver.

Fig. 4

(A) Low power view of the gallbladder wall demonstrating showing intramucosal adenocarcinoma and sarcoma (hematoxylin and eosin (H&E) stain, 100×). (B) Pan cytokeratin (MNF116, 100×) staining showing strong cytoplasmic and membranous positivity in the intramucosal adenocarcinoma. No staining is seen in the sarcomatous component. (C) High power view demonstrating high-grade spindle cell sarcoma (H&E, 800×). (D) High power view showing an area of chondrosarcomatous differentiation (H&E, 800×).