Dr Christoph Paasch and colleagues from the Department of General, Visceral and Cancer Surgery, Helios Klinikum Berlin-Buch, Berlin, Germany recently reported an unusual case of leiomyosarcoma when diagnosing a tumor of the gall bladder.
The study is published in the International Journal of Surgery Case Reports.
Primary sarcomas of the gallbladder (GB) are a rare disease that was first described by Griffon and Segall in 1897. Women are more often affected than men. In the majority of published cases, primary sarcomas of the GB appear between the 6th and the 7th decade of life. Leiomyosarcomas (LMS) is considered a major subgroup. The majority of the patients are female with an average age of 65.95 years, as documented in the literature.

The authors studied a 62-year-old female who was referred to the hospital with intermittent right upper quadrant pain. On an ultrasound, a 45 mm mass arising from the neck of the GB was diagnosed. However, no distant metastases were revealed.

Paasch and the team successfully removed the GB and the surrounding liver tissue. They also performed a lymphadenectomy of the hepatoduodenal ligament. The histopathological and immunohistochemical examination revealed an R0 resected epithelioid LMS of the GB.

In a non-metastasized stage, a cholecystectomy with a wedge resection of the surrounding liver tissue, accompanied by a lymphadenectomy of the hepatoduodenal ligament is described as a successful surgical approach, describes Paasch.

The authors discussed that the primary sarcomas of the GB are a rare malignancy. The majority of these sarcomas are leiomyosarcomas. An incidence is estimated as 1.4 per 1000 malignancies of the GB.

As a diagnostic approach, an ultrasound examination, a CT scan, as well as a PET-CT scans is recommended. The LMS may occur as a polypoid mass protruding into the lumen with an irregularly thickened wall. Nevertheless, the lack of specific radiological features makes the differentiation from an adenocarcinoma challenging, they further added.

Similar radiological, histological and immunohistochemical features make the adenocarcinoma, the rhabdomyosarcoma, the liposarcoma, the Kaposi sarcoma, and angiosarcoma an important differential diagnosis to consider.

Hence, the authors concluded that "particularly when diagnosing a tumor of the GB in elderly women, a leiomyosarcoma should be taken under consideration. In a non-metastatic stage, the cholecystectomy with a wedge resection of the surrounding liver tissue, as well as a lymphadenectomy of the hepatoduodenal ligament is described as a sufficient surgical approach."