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Presented by Pedram Argani, M.D. and prepared by Dengfeng Cao, M.D. Ph.D.
Case 4: 45 year old male with a gallbladder tumor.
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1. Question
Week 211: Case 4
45 year old male with a gallbladder tumor. This slide is from a cystic duct lymph node.images/DengfengCao/021405case4a.jpg
images/DengfengCao/021405case4b.jpg
images/DengfengCao/021405case4c.jpg
images/DengfengCao/021405case4d.jpgCorrect
Answer: Small cell carcinoma
Histology: The tumor cells have a nested-to-sheetlike growth pattern with extensive areas of necrosis. There is focal coating of entrapped blood vessels with DNA yielding the Azopardi phenomenon. Tumor cells have an extremely high mitotic rate with extensive apoptosis. Tumor cells have inconspicuous nucleoli, focally spindle, and the nuclei mold to each other. These are the diagnostic criteria of small cell carcinoma.
Discussion: Poorly differentiated carcinoma would lack the classic cytologic features of small cell carcinoma, and lymphona would not show the molding that is seen in the current lesion.
Approximately 1% of all gallbladder carcinomas are small cell carcinomas, and these are morphologically identical to those seen in the lung. Approximately one-third of small cell carcinomas of the gallbladder have an associated adenocarcinoma or in situ adenocarcinoma component which helps establish the primary site as the gallbladder. A subset of patients with small cell carcinoma of the gallbladder have responded to chemotherapy, so identification of this histologic type has clinical implications.
Incorrect
Answer: Small cell carcinoma
Histology: The tumor cells have a nested-to-sheetlike growth pattern with extensive areas of necrosis. There is focal coating of entrapped blood vessels with DNA yielding the Azopardi phenomenon. Tumor cells have an extremely high mitotic rate with extensive apoptosis. Tumor cells have inconspicuous nucleoli, focally spindle, and the nuclei mold to each other. These are the diagnostic criteria of small cell carcinoma.
Discussion: Poorly differentiated carcinoma would lack the classic cytologic features of small cell carcinoma, and lymphona would not show the molding that is seen in the current lesion.
Approximately 1% of all gallbladder carcinomas are small cell carcinomas, and these are morphologically identical to those seen in the lung. Approximately one-third of small cell carcinomas of the gallbladder have an associated adenocarcinoma or in situ adenocarcinoma component which helps establish the primary site as the gallbladder. A subset of patients with small cell carcinoma of the gallbladder have responded to chemotherapy, so identification of this histologic type has clinical implications.
