Gallbladder adenocarcinoma

Case contributed by Dr Pranav Sharma

Presentation

Right upper quadrant pain

Patient Data

Age: 60 years
Gender: Female
CT

Multiple hepatic lesions occupying segments 4, 5, 6 and 8. The largest lesion in segment 6 measures 70 x 60 mm. The gallbladder is distended with areas of abnormal soft tissue density within it. Hyperdense lesion in the upper pole of the spleen.

Features favoring a gallbladder adenocarcinoma with multiple hepatic metastases. Multifocal hepatocellular carcinoma and metastatic deposit in the spleen are within the differential.

MRI

Appearances favor metastatic gallbladder malignancy with diffuse right lobe invasion but sparing segments 1 through 4A. No convincing local extraphepatic nodal or metastatic spread.

Case Discussion

This 60-year-old lady presented with sudden onset of right sided abdominal pain to our ED. She underwent a CT scan which demonstrated multifocal deposits within the liver and a distended gallbladder with soft tissue mass.

Tumor markers: CA 19-9 5.9, AFP 70, CEA <1.0

The patient underwent a liver biopsy. Histopathology:

  • Features consistent with poorly differentiated adenocarcinoma
  • Gallbladder adenocarcinoma has no specific immunohistochemistry marker
  • Ancillary studies in this case do not suggest any specific tumor type or origin
  • Differentials include gallbladder adenocarcinoma, cholangiocarcinoma as well as metastatic adenocarcinoma

Imaging and biopsy findings consistent with metastatic gallbladder adenocarcinoma (stage IV disease). 

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