Georgian Telemedicine Union (Association)

Patient: 63 years old female

Registration N:1067

Material: gallbladder, rejected tissue of liver’s right lobe (the area of liver side with nodes)

Surgical operation: cholecystectomy

Date of operation: 11.06.2004

Time of operation: 2 p.m.

Histopathologic diagnosis made by Georgian Pathologists: low grade adenomatous-dermoid carcinoma of gallbladder with infiltrative growth and liver micrometastasis.

The embedded material, glass slides and history of the patient was sent to the Klinische Pathologies und Zytologie (Limbach Laboratory, Germany). Here is the description of the sent histological preparations and dignosis, which were written by above mentioned lab: I. 6 pieces of gallbladder tissue with partly condensed walls was received. The size of each of them was approximately 5,5´1,7´1,5 cm.

Microscopically was revealed the wall of gallbladder with the chronic transmural inflammation. On the mucinous surface also was seen solide carcinoma with epidermal differentiation. The cells were focally PAS-positive. Tumor infiltrates the whole wall of gallbladder, serous “break” was not revealed in sent glass slides.

Liver tissue. Here was revealed as chronic cholangitis and pericholangitis so focal carcinomatous infiltration. On tumor were revealed as solide area, so adenomatous and sometimes tubular structure. Nuclei are significantly enlarged and hyperchromatous. Nucleoli are prominent. The invasion in lymph ducts was revealed in the framed areas.

II. 5 tissue particles were embedded in paraffin. We performed deparaffinization of the mentioned tissue particles.

Despite of the common mediocre condition it was revealed liver tissue with tumor areas and also the wall of gallbladder with neoplastic infiltration. Any additional conclusion could not be done upon this material.

Conclusion: low grade adeno-squamous carcinoma of gallbladder with the infiltration of every layer of the wall (although infiltration of serous surface was not confirmed); intramural invasion of lymph ducts or veins, metastasis of liver with chronic intrahepatic cholangitis and pericholangitis.

TNM classification in accordance with sent material: pT2 Nx pM1/G3.

Questions:

1) What is the most appropriate treatment in this concrete case?

2) Is it suitable to perform chemotherapy or radiotherapy?