MACROSCOPY: Labelled "Gallbladder": 130 x 52 mm. The serosal surface is smooth and grey/purple. The cyst wall is less than 1 mm thick. The mucosa is flattened and tan with less than 1 mm white flecks and a 3 mm white/pale tan polyp. The lumen contains thick, tenacious mucoid material containing occasional small calculi. The cystic duct node is not identified.
MICROSCOPY: Sections through the gallbladder wall show two intramural tumour deposits comprised of a population of epithelioid cells with round, hyperchromatic nuclei, small round nucleoli and moderate to abundant cleared cytoplasm arranged in sheets and nests about a fine calibre, capillary-sized vasculature. There is an accompanying lymphocytic infiltrate. One deposit lies within a shave section from the cystic duct resection margin. Tumour cells immunoreactive with antibodies against cytokeratins AE1/AE3 and PAX8 and are negative with antibodies against S100. Surrounding gallbladder parenchyma shows pyloric epithelial metaplasia, transmural chronic inflammation and adenomyosis.
CONCLUSION: Gallbladder: Two intramural deposits of metastatic clear cell renal cell carcinoma, one present in a shave section of the cystic duct resection margin, chronic cholecystitis and adenomyosis.