BACKGROUND: Cytologic descriptions of the diagnosis of the rare primary carcinoma of the gallbladder are sparse. The obstacles to the diagnosis are ascribed to vague symptoms and inaccessibility of the gallbladder to biopsy. We describe two cases of primary squamous cell carcinoma of the gallbladder that were diagnosed using fine needle aspiration (FNA) cytology. CASES: Both patients were elderly females with vague symptoms of abdominal pain, jaundice, loss of weight, anorexia and mild fever. Imaging studies showed enlargement of the gallbladder with a soft tissue mass in the fundus and abnormally thickened wall, indicative of a tumor. Also, in case 1, gallstones and enlarged, matted paraaortic and porta hepatis lymph nodes were present. FNA of the gallbladder was done after selection of a suitable puncture site and needle positioning, which was confirmed by computed tomography. The aspirated material was collected as needle and syringe washings, and from half the material filter preparations were made and stained for cytologic study, while the remainder was used for making cell blocks for histologic study. Both cases showed cytohistologic features of a moderately well differentiated, necrotizing squamous cell carcinoma characterized by keratinizing malignant cells with orangeophilic cytoplasm. In both cases immunostaining for high-molecular-weight keratins (AE1/AE3) and cytokeratin (CAM 5.2) was positive, while staining for carcinoembryonic antigen, B72.3 and other markers was negative. CONCLUSION: This study further confirmed that with the widespread use of more-sophisticated imaging techniques, the gallbladder is becoming more readily accessible to visualization. In view of this, FNA cytodiagnosis holds promise as a noninvasive technique in the diagnosis of gallbladder neoplasms.
BACKGROUND: Cytologic descriptions of the diagnosis of the rare primary carcinoma of the gallbladder are sparse. The obstacles to the diagnosis are ascribed to vague symptoms and inaccessibility of the gallbladder to biopsy. We describe two cases of primary squamous cell carcinoma of the gallbladder that were diagnosed using fine needle aspiration (FNA) cytology. CASES: Both patients were elderly females with vague symptoms of abdominal pain, jaundice, loss of weight, anorexia and mild fever. Imaging studies showed enlargement of the gallbladder with a soft tissue mass in the fundus and abnormally thickened wall, indicative of a tumor. Also, in case 1, gallstones and enlarged, matted paraaortic and porta hepatis lymph nodes were present. FNA of the gallbladder was done after selection of a suitable puncture site and needle positioning, which was confirmed by computed tomography. The aspirated material was collected as needle and syringe washings, and from half the material filter preparations were made and stained for cytologic study, while the remainder was used for making cell blocks for histologic study. Both cases showed cytohistologic features of a moderately well differentiated, necrotizing squamous cell carcinoma characterized by keratinizing malignant cells with orangeophilic cytoplasm. In both cases immunostaining for high-molecular-weight keratins (AE1/AE3) and cytokeratin (CAM 5.2) was positive, while staining for carcinoembryonic antigen, B72.3 and other markers was negative. CONCLUSION: This study further confirmed that with the widespread use of more-sophisticated imaging techniques, the gallbladder is becoming more readily accessible to visualization. In view of this, FNA cytodiagnosis holds promise as a noninvasive technique in the diagnosis of gallbladder neoplasms.