case_images: PMC10688199_01
case_images: A and B - Abdominal CECT Imaging shows a hypodense heterogeneous mass lesion (red arrow) in relation to the gallbladder (green arrow).
case_images: autopsy-13-e2023453-g01.jpg
case_images: PMC10688199_01_autopsy-13-e2023453-g01.jpg
case_images: gf01
case_images: The CECT showed an enlarged liver (17cm span) with an ill-defined mild hypodense lesion in segments IV and V, abutting and engulfing the fundus of the gallbladder (Figures 1A and 1B).
case_images: Photomicrographs of the tumor A - Gross picture of the mass highlighting a solid, homogeneous, and fleshy liver mass with an intact gallbladder; B - Histomorphology of the benign area of BAF highlighting well-circumscribed but non-encapsulated mass (H&E; 40x); C - The tumor is arranged in irregular glands embedded in the hyalinized stroma (H&E; 100x); D - The glands are lined by flat cuboidal non-mucin-secreting epithelia (H&E; 400x).
case_images: autopsy-13-e2023453-g02.jpg
case_images: PMC10688199_01_autopsy-13-e2023453-g02.jpg
case_images: gf02
case_images: The attached gallbladder measured 8cm in its longest axis and showed a velvety mucosa (Figure 2A). The acini were lined by a single layer of non-mucin-secreting epithelia with round nuclei, vesicular chromatin, inconspicuous nucleoli, and eosinophilic to amphophilic cytoplasm (Figures 2B to 2D).
case_images: Photomicrograph of the tumor. A - Scanner view of the BAF showing the transition from the benign area (left side of the dotted line) to the dysplastic/malignant area (right side of the dotted line), the malignant area showing overcrowding and minimal stroma (H&E; 40x). B to D - Malignant and gallbladder-bed-infiltrating foci of BAF highlighting cribriform pattern (B; H&E, 100x), marked pleomorphism (C; H&E, 400x), and infiltrating nests single cells (D; H&E, 200x).
case_images: autopsy-13-e2023453-g03.jpg
case_images: PMC10688199_01_autopsy-13-e2023453-g03.jpg
case_images: gf03
case_images: The architectural changes in the dysplastic/ malignant foci were noted in the form of structural complexity, solidification, and cribriform pattern with a marked reduction in the intervening stroma, while the cytology showed nuclear pleomorphism, enlargement, stratification, overcrowding, and hyperchromasia (Figures 3A to 3C). These foci of dysplasia, brisk mitoses, foci of necrosis, and infiltration of the gallbladder bed in the form of tiny nests, single cells, and islands favored a malignant transformation (Figure 3D).
case_images: Photomicrograph of the tumor. A to C - The malignant focus shows the expression for EMA (A; 400x), CK7 (B; 200x), and p53 (C; 400x). D - Ki-67 labeling index is high in the malignant focus (400x).
case_images: autopsy-13-e2023453-g04.jpg
case_images: PMC10688199_01_autopsy-13-e2023453-g04.jpg
case_images: gf04
case_images: The tumor cells in both benign and malignant foci were immunopositive for EMA (Figure 4A) and CK7 (Figure 4B). High p53 (Figure 4C) immunostaining was noted in the malignant area. Besides, Ki-67 labeling indices in the benign and malignant areas were 1-2% and 30-40% (Figure 4D), respectively.