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Presented by Dr. Pedram Argani and prepared by Dr. Jason Kern
Case 1: This is a 67 year old female with a history of serous carcinoma of the ovary who has a cholecystectomy.
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Question 1 of 1
1. Question
Week 615: Case 1
This is a 67 year old female with a history of serous carcinoma of the ovary who has a cholecystectomy.
Correct
Answer: Metastatic serous carcinoma and primary gallbladder adenocarcinoma
Histologic Description: The specimen consists of a thickened gallbladder and an enlarged lymph node. The enlarged lymph node contains poorly differentiated metastatic carcinoma which is immunoreactive for PAX8 and not CDX2, consistent with the patient’s reported history of metastatic serous ovarian carcinoma. The thickened gallbladder contains adenocarcinoma, which initially could be written off as metastatic involvement from this patient’s serous ovarian carcinoma. However, on more careful examination, one can see a well-developed in situ carcinoma, evidence of intestinal differentiation, and a cytology which is similar to but slightly different from that of the serous carcinoma. By immunohistochemistry, the tumor in the gallbladder is positive for CDX2 but negative for PAX8, supporting the diagnosis of primary gallbladder adenocarcinoma.
Differential Diagnosis: The presence of an in situ gallbladder carcinoma component as well as the differing immunoprofiles of the two carcinomas supports that these are two distinctive cancers. The presence of an in situ component in the gallbladder excludes the possibility of metastatic pancreatic adenocarcinoma.
Incorrect
Answer: Metastatic serous carcinoma and primary gallbladder adenocarcinoma
Histologic Description: The specimen consists of a thickened gallbladder and an enlarged lymph node. The enlarged lymph node contains poorly differentiated metastatic carcinoma which is immunoreactive for PAX8 and not CDX2, consistent with the patient’s reported history of metastatic serous ovarian carcinoma. The thickened gallbladder contains adenocarcinoma, which initially could be written off as metastatic involvement from this patient’s serous ovarian carcinoma. However, on more careful examination, one can see a well-developed in situ carcinoma, evidence of intestinal differentiation, and a cytology which is similar to but slightly different from that of the serous carcinoma. By immunohistochemistry, the tumor in the gallbladder is positive for CDX2 but negative for PAX8, supporting the diagnosis of primary gallbladder adenocarcinoma.
Differential Diagnosis: The presence of an in situ gallbladder carcinoma component as well as the differing immunoprofiles of the two carcinomas supports that these are two distinctive cancers. The presence of an in situ component in the gallbladder excludes the possibility of metastatic pancreatic adenocarcinoma.
