@article{oai:u-ryukyu.repo.nii.ac.jp:02016159,
 author = {Hanashiro, Naoji and Tamaki, Satoshi and Naka, Tsunemori and Muto, Yoshihiro},
 issue = {2},
 journal = {琉球医学会誌 = Ryukyu Medical Journal},
 note = {We herein report a case of carcinosarcoma (sarcomatoid carcinoma) of the gallbladder with a cholecystocolic fistula and evidence of marked leukocytosis in a 77-year-old Japanese man. The patient presented with episodes of right upper quadrant pain and fever in April 2000. The physical examination revealed a painful, palpable mass in the right upper quadrant. Routine laboratory findings showed leukocytosis (18.000/mm^3). Abdominal sonography showed an echogenic mass occupying the entire gallbladder lumen. Abdominal CT demonstrated a solid mass lesion measuring 8×7 cm in size with a clear, hypodense asterisk configuration, suggesting a communication between the gallbladder and the gastrointestinal tract. At exploratory laparotomy, a large solid gallbladder tumor showed direct invasion into the transverse colon and regional lymph node metastasis. The tumor was evaluated to be Stage IV. With the intention of performing cytoreductive surgery, a cholecystectomy together with a partial transverse colectomy was thus performed. The gallbladder tumor showed penetration into the transverse colon, forming a cholecystocolic fistula. On a cut section analysis, the tumor occupied the entire gallbladder lumen and measured 7×5 cm in size. No gallstones were observed. The tumor was composed of two different histologic features: an adenocarcinomatous feature that was composed of moderately differentiated adenocarcinoma and a sarcomatous feature that consisted primarily of pleomorphic, spindle cells. Immunohistochemically, the adenocarcinoma cells were positive for keratin, EMA and CEA whereas the sacomatous spindle cells were positive for vimentin and CEA. However, both the carcinoma cells and sarcomatous cells were negative for G-CSF. Postoperatively, the patient's WBC counts increased from 26.9×10^3/mm^3 to 103.0×10^3/mm^3. Finally, the patient died with clinical manifestations of peritonitis carcinomatosa one month after surgery., 論文},
 pages = {77--80},
 title = {[症例報告]Carcinosarcoma (sarcomatoid carcinoma) of the Gallbladder Presenting with a Cholecystocolic Fistula and a Marked Leukocytosis : A Case Report},
 volume = {20}
}