Chapter 14 Hepatic Tumors, Malignant 1 Well-to-moderately differentiated infiltrating adenocarcinoma from probable gallbladder primary Case 14.26

Clinical Presentation 14 Hepatic Tumors, Malignant 2 Clinical Presentation A 59-year-old woman developed the gradual onset of abdominal pain that was localized and constant. She also experienced a 20 lb weight loss over the past few months. Workup revealed a 10 × 9 cm hepatic mass also involving the gallbladder fossa.

Laboratory Values Course in Hospital Total Protein: 7.0 Albumin: 3.6 14 Hepatic Tumors, Malignant 3 Laboratory Values Total Protein: 7.0 Albumin: 3.6 Serologies: Anti-HAV, HBsAg, anti-HCV: Negative CEA: 616 (NI <3.8) AST: 146 ALT: 209 Alk Phos: 261 Total Bilirubin: 0.9 Course in Hospital The tumor, felt most likely to be originating from the gallbladder, was too large for surgical resection. Chemotherapy was planned after a biopsy was performed to determine the tumor type and grade.

14 Hepatic Tumors, Malignant 4 Pathology A well-to-moderately differentiated adenocarcinoma was present that extended from the gallbladder wall into the liver (a, b). Figure 14.26(a) Figure 14.26(b)

14 Hepatic Tumors, Malignant 5 Pathology The tumor cells were positive on CK7 immunoperoxidase stain (c). Figure 14.26(c)

14 Hepatic Tumors, Malignant 6 Diagnosis Well-to-moderately differentiated infiltrating adenocarcinoma of probable gallbladder primary

14 Hepatic Tumors, Malignant 7 Comment At times it is difficult to determine in the larger tumors whether a duct carcinoma arising in the liver is infiltrating into the gallbladder or whether the tumor originated as a gallbladder primary. Immunoperoxidase stains do not aid in the distinction, as both neoplasms arise from the same cell type in the hepatobiliary system. In this case example the extent of the tumor involvement of the gallbladder favors a gallbladder primary.