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La maladie kystique congénitale de l´arbre biliaire est considérée parmi les facteurs de risque connus du cancer de la vésicule biliaire. Nous rapportons le cas d´un carcinome épidermoïde de la voie biliaire (VB) compliquant une dilatation kystique des voies biliaires chez une femme de 54 ans qui a été hospitalisée pour pancréatite biliaire avec un scanner abdominal montrant un épaississement nodulaire du fond vésiculaire et une dilatation fusiforme du canal cystique et de la voie biliaire principale (VBP) avec une lésion de la queue du pancréas évoquant en premier lieu un cystadénome mucineux. Une cholécystectomie élargie au lit vésiculaire emportant la voie biliaire distale, anastomose cholédoco-duodénal avec une spléno-pancréatectomie caudale + drainage étaient réalisées. L´histopathologie de la masse de la vésicule biliaire a révélé un carcinome épidermoïde modérément différencié invasif sans infiltration du parenchyme hépatique. La patiente a commencé une chimiothérapie adjuvante. Notre patiente ne présentait pas les symptômes typiques du cancer de la vésicule biliaire et la radiologie était nécessaire pour son diagnostic. La chirurgie reste la meilleure option thérapeutique pour le cancer de la vésicule biliaire à un stade précoce, tandis que la chimio-radiation adjuvante peut également être bénéfique. La cholécystectomie et la résection de la dilatation kystique de la voie biliaire chez les patients à haut risque constituent le moyen de prévention le plus performant.

Highlights Through this case report and a review of the literature, we wish to highlight the difficulties of clinical and paraclinical diagnosis as well as the therapy. Malignant phyllodes tumour is a separate entity from breast cancer, it is rare, it is completely different from epithelial cancer and it can exist in man. The three pathological types (benign, borderline and malignant) were reported in men. Very few cases of phyllodes tumour were reported in men. Malignant phyllodes tumour of the breast show clinical and mammographic signs comparable to those of benign lesions. Its epidemiology is particular and it has particular difficulties in clinical and paraclinical diagnosis. The treatment is based on surgery, which may be a large lumpectomy or mastectomy, lymph node removal is unnecessary, and the prognosis depends on several factors, the most important of which are margins of surgical exeresis. Wide local excision is the standard of care for phyllodes tumours (with or without adjuvant radiotherapy in malignant lesions). The combination of adjuvant treatment with radiotherapy or chemotherapy is still under discussion. There is a risk of local relapse and distant metastases, in particular to the lung. The higher rate of distant metastases is found when the resection margins are less than 10 mm. After resection, the prognostic factors for phylloid sarcoma correspond to the histological grade, surgical margins and the presence of tumour necrosis. tumour size may also be a pejorative factor.

IntroductionGallbladder carcinosarcoma [CSGB] is a rare malignant tumor characterized by malignant epithelial and mesenchymal components. Its pathogenesis is unknown and most CSGBs are associated with poor survival because the disease normally presents at an advanced stage and, therefore, curative resection is rare. Case report This report describes the case of a 66-year-old man with pain in the upper right quadrant. The preoperative diagnosis was cancer of the gallbladder [GB], and therefore, a curative radical cholecystectomy was performed. However, pathological examination of the surgical sample revealed that the tumor was made up of two histological components. The first one is the carcinomatous component and the second one corresponds to the sarcomatous component, which was compatible with a diagnosis of carcinosarcoma. ConclusionThe prognosis for CSGB remains poor despite curative resection, and therefore, the authors recommend that efforts be made to improve surgical outcomes.