Gall Bladder Carcinoma: A Case of Clear Cell Variant

Gall Bladder Carcinoma (GBC) is the fifth most common malignancy of the gastrointestinal tract and the most common malignancy of the extrahepatic biliary tract. The most frequent sites of occurrence are in the fundus, body, and neck. The overall incidence is approximately three per 100,000 people, varying depending on geography and ethnicity. The occurrence of the clear cell variant is rare, while adenocarcinoma is the most common occurring subtype. This form was first recognised by Albores-Saavedra and Henson. The incidence of GBC varies due to geographic and ethnic differences. The majority of cases are usually diagnosed incidentally after cholecystectomy or at an advanced stage. The authors present a case of a 40-year-old female who presented to the tertiary care center with a classical complaint of chronic cholecystitis for one month, accompanied by elevated total bilirubin and mildly elevated alkaline phosphatase. Radiological investigations revealed a mildly distended Gall Bladder (GB), thickening of the wall of the fundus, and multiple small calculi. After undergoing cholecystectomy, a histopathological examination revealed adenocarcinoma with a clear cell type, characterised by tumour cells arranged in nests with abundant clear cytoplasm. This led to a provisional diagnosis of GBC clear cell variant. The diagnosis was then confirmed by immunohistochemical stains. The clear cell carcinoma variant of the gall bladder is rare, and not much has been reported about it. It is important to differentiate between a primary and a metastatic tumour, with the possibility of clear cell renal carcinoma metastasis being one concern. This differentiation is crucial to avoid misdiagnosis and prevent delays in appropriate therapy.