A Case of Primary Leiomyosarcoma of the Gallbladder Associated with Acute Cholecystitis Caused by Intraluminal Hemorrhage

Yoshifumi Katagiri, Atsuyoshi Onitsuka, Yoshihiko Kato, Shigeru Kiyama, Hiromichi Mimoto and Hiroto Shima^*

Department of Surgery, Gifu Red Cross Hospital
Isra Consultant of Pathology^*

We report a case of leiomyosarcoma of the gallbladder associated with acute cholecystitis caused by intraluminal hemorrhage. A 66 year-old-man referred for right hypochondralgia with fever was found in ultrasonography to have a low echoic mass in the gallbladder with thickening of the wall. Computed tomography on admission showed raised attenuation of bile with negative attenuation of the mass in the gallbladder. Twenty days later, bile attenuation became hypodense, corresponding to hemorrhage in the gallbladder. He underwent extended cholecystectomy with lymph node dissection. In postoperative histological examination using immunohisthogical staining, the tumor was found to have spindle-shaped pleomorphic cells arranged in inner lacing bundles with positive response to desmin and smooth muscle actin, leading to a definitive diagnosis of leiomyosarcoma of the gallbladder. Although leiomyosacoma of the gallbladder seldom is radically resected, early diagnosis was enabled due to acute cholecystitis caused by bleeding from the tumor, necessitating radical resection.

Key words
leiomyosarcoma, gallbladder, acute hemorrhagic cholecystitis

Reprint requests
Yoshifumi Katagiri Department of Surgery, Gifu Red Cross Hospital 3-36 Iwakura-cho, Gifu, 502-8511 JAPAN

Accepted
May 27, 2003

To read the PDF file you will need Abobe Reader installed on your computer.