Fine needle aspiration cytology of clear cell carcinoma of the gallbladder with hepatic infiltration: a case report

BACKGROUND: Clear cell carcinoma of the gallbladder (CCG) is an unusual histologic variant recognized in the World Health Organ ization classification of tumors of the gallbladder and extrahepatic bile ducts. Although the clinicopathologic features have been documented in a few reports, to our knowledge the cytologic findings have not been described before. We report the fine needle aspiration cytology (FNAC) findings in a case of CCG with hepatic infiltration. CASE: A 72-year-old woman presented with right upper quadrant pain and hepatomegaly. Serum levels of CA19-9 and alpha-fetoprotein were elevated. Computed tomography revealed several hepatic nodules, the larger of which was a mass in contact with the gallbladder, which had a thickened wall. FNAC showed loose sheets and disassociated cells with abundant, clear, finely vacuolated cytoplasm. Atypical bare nuclei, binucleated cells and some multinucleated cells were also found. A simultaneous trucut biopsy from the main hepatic mass confirmed the diagnosis. CONCLUSION: CCG is a clear cell neoplasm that should be considered when clear changes are observed on FNAC. Recognition of the cytologic features, together with adequate clinicoradiologic study, may be sufficient to establish the diagnosis.