A case of undifferentiated carcinoma of the gallbladder with severe inflammation and difficult preoperative chemotherapy

Undifferentiated carcinoma (UC) is relatively rare among gallbladder cancers, and the prognosis is poor compared to gallbladder adenocarcinoma. We report a 64-year-old man with gallbladder UC who underwent radical surgery and achieved long-term survival. He presented with a chief complaint of abdominal distension and loss of appetite. An abdominal computed tomography (CT) scan revealed a gallbladder tumor with a major axis of 120 mm that appeared to directly infiltrate the hepatic bed. No major vascular infiltration was noted, but the left and right intrahepatic bile ducts were dilated. On admission, the serum CRP level was 16.5 mg/dL; cholangitis and cholecystitis were suspected. He was hospitalized, treated with antibiotics, and underwent bile duct drainage; however, inflammation recurred and chemotherapy was not possible. Thus, three right liver areas, the caudate lobe, and the gallbladder were extirpated. Histopathologic examination showed a 130 × 90 mm tumor with extensive infiltration, hemorrhage, and necrosis in the liver. In the area occupied by the tumor, multinucleated cell proliferation, and polygonal and spindle-shaped tumor cells were noted. Based on the above findings, a diagnosis of UC was established. Postoperatively, gemcitabine and cisplatin were continued as adjuvant chemotherapy. No tumor recurrence has been detected after 24 months of follow-up care.