Primary leiomyosarcoma of the gallbladder

Abstract

Primary leiomyosarcoma is the most infrequent type of primary gallbladder malignancy. We have recently treated a primary leiomyosarcoma of the gallbladder surgically. The patient was a 67-year-old woman who was referred to our hospital under the diagnosis of acute cholecystitis. US and CT showed a markedly enlarged gallblader with thickening of the wall. ERCP demonstrated a few filling defects of the common bile duct but the gallbladder was not opacified. She was diagnosed as haveing stones in the gallbladder and common bile duct, and was operated on under laparoscopy initially. The gallbladder showed marked swelling and wall-thickening. We punctured the gallbladder and aspirated its contents by a syring with a long needle. Cytological examination revealed the presence of malignancy, so we converted to open wide cholecystectomy with wedge resection of the liver and choledocholithotomy with T-tube drainage. Macroscopic examination of the resected gallbladder showed the tumor growing from the tunica muscularis propria of the gallbladder. A microscopic examination revealed that spindle-shaped cells were arranged in inner lacing bundles and mytotic cells. The diagnosis of gallbladder leiomyosarcoma was based upon the highly positive immunostaining with vimentin and α-SMA. One year after the operation, no signs of recurrence were detected. We concluded that during laparoscopic cholecystectomy, when malignancy is suspected, to confirm the diagnosis the appropriate surgical procedure should be performed during or after the operation.