Thread by @TristanRutland7

Gallbladder, female

@ZHOUSEH @MattieFarzin @DrJPLow @pembeoltulu @DrGeeONE @Dr_Brian_Cox @Teclis82 @ariella8 @MAHoureih @TheKarenPinto @Meghna0630 @Divya_Madhala @Kashifhazim

#GIpath #surgpath #pathtwitter

PAS/PASD

CD34

CK7/ CK20

More stains (lost to the sands of time (ie can not find them).

TTF-1 ❌
GATA3 ✅
S100 ❌
PAX8 〰️ (equivocal)

Plus mCEA

Mammaglobin ❌
CDX-2 ❌

Diagnosis:

Metastatic urothelial carcinoma to gallbladder.

(There was a Hx, after digging around).

This was a colleagues case.

#GUpath

1/ Metastatic urothelial carcinoma to the gallbladder is rare.

2/ Metastatic disease in general to the gallbladder is also rare and associated with a poor prognosis.

ncbi.nlm.nih.gov/pmc/articles/P…

3/ Melanoma can occasional be a culprit.

hindawi.com/journals/crigm…

4/ There are a number of different variants of urothelial carcinoma, some of which have associated prognostic implications.

5/ Also, because they can have unusual morphology, they can be difficult to recognise if they metastasis.

pubmed.ncbi.nlm.nih.gov/16949919/

6/ While PAX8 is infrequently positive in urothelial carcinomas, it can be useful in the (benign appearing) nested variant of urothelial carcinoma.

nature.com/articles/s4137…

7/ Lastly, GATA3 by itself, is nonspecific and needs to be utilised with other stains (and clinical history!) to be used correctly.

pubmed.ncbi.nlm.nih.gov/24121175/