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The polyp is consisted of clear cells sheets (), nests and cords separated by a delicate capillary vascular network (HEx50).
Source publication
Introduction:
Metastatic tumors to the gallbladder are uncommon. Metastases from renal cell carcinoma (RCC) to the gallbladder are exceptional. Frequencies of less than 0.6% reported in large autopsy reviews and few cases have been reported in the literature.
Presentation of case:
Herein we present a case of a 50-year-old man that developed four...
Context in source publication
Context 1
... cholecystectomy specimen had a 3 × 2.5 cm polypoid mass protruding in the lumen located 4 cm from the fundus of the gallbladder. Cut surface of the mass was homogenous, yellowish and soft, with foci of hemorrhage. Microscopically, the polyp consisted of clear cell sheets, nests, and cords separated with a delicate capillary vascular network (Fig. 2). Some areas of solid and alveolar pattern were seen. Tumor cells had an abundant, clear cytoplasm surrounded by a distinct cell membrane. The nucleus was round and uniform (Fig. 3). The diagnosis of metastatic RCC was confirmed by immunohistochemical stains, which showed strong positivity for vimentin and PAX8, patchy positivity for ...
Citations
... 3,4 Also, after nephrectomy, approximately 25% to 50% of patients will develop metastasis metachronously. 1,4 Usual metastasis sites are lung, bone, and liver. 3,5 The gallbladder is an unusual site for renal cell carcinoma metastasis; only a few cases have been reported, and most of them (48%) are located at fundus as our patient. ...
... 3,5 The gallbladder is an unusual site for renal cell carcinoma metastasis; only a few cases have been reported, and most of them (48%) are located at fundus as our patient. [1][2][3][4][5][6][7][8][9] To our knowledge, only 1 case has been reported with 18 F-FDG PET/CT findings. 6 Throughout the available follow-up of solitary gallbladder metastatic patients for 1.1 years, none of them had the remaining disease. ...
Gallbladder metastasis from renal cell carcinoma is a rare condition. To our knowledge, only 1 case has been reported with 18F-FDG PET/CT findings. Herein, we report the case of a 53-year-old man with renal cell carcinoma, having gallbladder metastasis revealed with restaging 18F-FDG PET/CT.
... Some neoplasms, including melanoma and carcinoma, can metastasize to the gallbladder and frequently form a polypoid lesion [41] covered by the normal gallbladder epithelium [42], which is occasionally observed in IgG4-CC. Many metastatic neoplasms take over the characteristics of original neoplasms and suggest similar vascularities on CT and other vascular imaging, which can be clues for a diagnosis [41]. ...
Since autoimmune pancreatitis (AIP) was established as a new disease entity, sclerosing change with abundant immunoglobulin-4 (IgG4)-positive plasma cells, storiform fibrosis, and obliterative phlebitis are main pathological features in IgG4-related diseases. Regarding IgG4-related sclerosing cholecystitis (IgG4-CC), which is occasionally associated with AIP cases and is rarely isolated, there are no diagnostic criteria and insufficient perceptions of the image findings. Although there have been some reports on IgG4-CC, differentiation between IgG4-CC and gallbladder cancer is very difficult in some cases with a localized lesion. In this review, we especially focused on image findings of IgG4-CC and summarized its image features for diagnostic assistance. The ultrasonography and CT findings of IgG4-CC could be classified into diffuse and localized types. Based on these findings, the presence of wall thickening with an intact or smooth mucosal layer, followed by a homogenously thickened outer layer, would be a helpful morphological finding to distinguish IgG4-CC from gallbladder cancer.
... The majority of cases included in the literature review utilized contrast enhanced CT scans, often displaying hyper-vascular and strongly enhancing lesions within the tumor [10,11]. ...
... This is in line with other previously published studies [1,6,11]. ...
Clear cell renal cell carcinoma, accounts for approximately 70% of all adult renal tumors. This disease is well known for its high metastatic potential, with estimates of 25-50% of patients reporting metastasis to distant structures. However, there have only been several reported cases in medical literature describing hematogenous spread to the gallbladder, with the majority occurring metachronously, in males, and with multiple metastases. This case report follows an extremely unique presentation in a 60-year-old female. Although the patient did not exhibit the usual signs and symptoms or meet the typical demographics seen with metastatic renal cell carcinoma, it should find a place on the differential diagnosis list when a gallbladder lesion is detected on imaging during the initial staging and/or restaging in patients with renal-cell carcinoma.
... The majority of these have been found in autopsies though still representing only 0.58% of cases with metastatic RCC [2]. We were able to identify 59 case reports presenting metastatic RCC to the gallbladder [4]. ...
... In the review of the published cases, there are several notable aspects for clinicians to be aware of. In contrast to what we present here, most metastatic lesions to the gallbladder are metachronous [4]. Rarely they are identified symptomatically, but rather incidentally, on surveillance imaging, or frequently postmortem. ...
... Identification and resection of solitary metastatic lesions in addition to the primary has a known survival benefit, and in particular, successful outcomes have been published following resection of gallbladder metastases when R0 resections are performed [4,8,9]. While rare, identification of a gallbladder lesion in a patient with a history of RCC should prompt consideration of renal metastasis and subsequent cholecystectomy. ...
Renal cell carcinoma (RCC) classically metastasizes to the lungs, bones, adrenals, lymph nodes, liver, and brain. RCC metastasis to the gallbladder is rare occurring in less than 1% of metastases. We present a case of a 60-year-old male who at initial diagnosis of his large left renal mass was incidentally found to have a gallbladder mass. He underwent simultaneous open radical nephrectomy and cholecystectomy with pathology confirming solitary metastatic clear cell RCC (ccRCC). The patient chose surveillance and was without evidence of disease for three years. At three years, imaging showed a 2 cm contralateral renal mass which was cryoablated percutaneously. This case demonstrates not only the importance of a thorough review of initial and surveillance imaging but also of maintaining a broad differential for other solid organ masses in the setting of a primary RCC of the kidney.
... It has a 1.5:1 predominance in men over women and an increasing prevalence due to several factors, such as smoking, obesity, hypertension and having a first-degree relative with RCC. 1 RCC has a highly metastatic rate that reaches one-third of patients at the time of diagnosis. 4 The behaviour of metastatic RCC is often unpredictable. The rich vascular proliferation noticed in RCC is thought to be the reason for the multiple synchronous or metachronous metastatic lesion sites that have been reported, which are (by frequency) the lungs, liver, brain, adrenal glands and lymph nodes. ...
... Disease-free interval and single-site metastasis are prognosis factors. 4 Gallbladder tumours are usually adenocarcinomas with a polypoid mass appearance. Metastases are rare; the main cause is malignant melanoma, followed by carcinomas of the digestive system, such as stomach tumours. ...
... 5 The gallbladder is not among the usual sites of RCC metastasis: fewer than 65 relevant cases have been reported, and it is present in less than 0.6% of autopsies. 4 Metastasis often occurs metachronously, with a median interval of four years after nephrectomy. 3 The development of RCC metastasis is thought to be via the invaded blood vessels, by systemic dissemination of the disease rather than contiguity, as its occurrence happens late. ...
Renal cell carcinoma (RCC) accounts for approximately 3% of all adult malignancies. A third of people with RCC have metastatic lesions when diagnosed, and another third develop metachronous metastasis during follow-up or after surgical treatment. We report a case of gallbladder metastasis from clear-cell RCC in a 71-year-old woman 13 years after RCC of her right kidney. Preoperative imaging studies showed a suspicious, progressively enlarged gallbladder polyp. The patient underwent open cholecystectomy and lymph node dissection along the hepatoduodenal ligament. The pathology report was compatible with metastatic disease from the kidney that was previously resected. Gallbladder metastasis can occur from RCC several years after initial management. Physicians should be aware of this rare pathology, and intensive follow-up is essential after surgery for RCC.
... About 20-50% of patients with RCC develop metachronous disease [3] and the most common sites of metastasis are lung, liver, adrenal gland, contralateral kidney, bone and brain [4]. An extremely rare site of metastasis is the gallbladder, accounting for about less than 1% of metastatic sites of RCC [5]. The 5-year overall survival (OS) of patients with ccRCC diagnosed in the early stage is superior to 90%. ...
... The 5-year overall survival (OS) of patients with ccRCC diagnosed in the early stage is superior to 90%. However, the prognosis for metastatic ccRCC is poor, with a 5-year OS of 12% [5]. Usually, RCC relapses in the first five years from diagnosis, but some cases of relapse after a long period of time have been described. ...
Long noncoding RNAs play an important regulatory role in the development and progression of tumors. Our study found that LINC00478 was upregulated in clear cell renal cell carcinoma (ccRCC), so we made an in‐depth exploration into its mechanism. In Caki‐2 cells, we established the oe‐LINC00478 cell line overexpressing LINC00478, and established underexpressing sh‐LINC00478 cell line by short hairpin RNA silencing. The abilities of oe‐LINC00478 cell invasion and metastasis were significantly enhanced, and the cell proliferative potential was also improved. The cellular expressions of PBX3, CDCA8, and CDK2 were upregulated, while in the sh‐LINC00478 cells, the proliferative potential and metastatic and invasive abilities were weakened. Similarly, we established the PBX3‐overexpressing oe‐PBX3 cell line and the PBX3‐underexpressing sh‐PBX3 cell line, finding that the PBX3 overexpression enhanced the metastatic and invasive abilities of Caki‐2 cells. When we overexpressed LINC00478 in PBX3‐knockout Caki‐2‐PBX3−/− cells, no significant changes were noted in the metastatic or invasive ability. Through RNA pull‐down and RNA‐binding protein immunoprecipitation assays, we found that LINC00478 could facilitate the transcription–translation processes of PBX3 by binding to it, thus further promoting the expression of downstream cyclins to exert its action. In animal experimentation, the oe‐LINC00478 and sh‐LINC00478 Caki‐2 cells were separately seeded, revealing that the tumor volume was significantly larger in the oe‐LINC00478 group than in the sh‐LINC00478 group. This study finds that by promoting the PBX3 transcription, LINC00478 can further regulate the expressions of downstream cyclins, thereby facilitating the metastasis and invasion of ccRCC.
Gallbladder is a common surgical pathology specimen. However, carcinomas of the gallbladder are relatively rare in most western countries. Hence, general surgical pathologists may not be that familiar and comfortable diagnosing these tumors. In this review, we discuss the morphological and immunohistochemical characteristics of gallbladder carcinomas, provide updates on tumor classification and staging of these tumors as per the most recent WHO classification and focus on practical considerations that would be most relevant to diagnosis and clinical management of these tumors.
Hepatopancreatobiliary system carcinomas are problematic tumors in terms of both diagnosis and treatment options. Among the diagnostic biomarkers that can be used for the diagnosis of hepatocellular carcinoma, arginase-1 and hepatocyte-A immunohistochemistry and also albumin ISH stand out, while DNAJB1-PRKACA fusion is accepted as specific for the fibrolamellar subtype. FGFR2 fusions and IDH1/IDH2 mutations are considered as specific for intrahepatic cholangiocarcinomas (iCCA) among other pancreatobiliary system carcinomas and as the most promising targets for alternative treatment options. For pancreatic ductal adenocarcinomas, KRAS mutations, p53 mutations, p16 abnormalities, and SMAD4 loss are characteristics, although they are not useful for distinction from carcinomas of other primary sites. The most problematic issue for pancreatic neuroendocrine neoplasms is the distinction between grade 3 neuroendocrine tumor and neuroendocrine carcinoma in cases where morphological findings are insufficient. Immunohistochemical ATRX or DAXX loss is in favor of grade 3 neuroendocrine tumor, while p53 overexpression and Rb loss support the diagnosis of neuroendocrine carcinoma.
