An 85-year-old woman with intractable malignant ascites secondary to ovarian carcinoma underwent peritoneovenous shunting (Denver shunt) in an attempt to alleviate the ascites. Implantation of the shunt resulted in massive embolization of tumor cells to the pulmonary vasculature. Postoperatively, she developed increasing hypoxia with progressive rises in pulmonary artery pressure, and died 48 hours after surgery as a result of occlusion of the pulmonary vascular bed by tumor emboli. This is the sixth reported instance of massive tumor embolization to the pulmonary circulation in patients with peritoneovenous shunting for malignant ascites.

A 41-year-old black man presented a clinical picture of acute cholecystitis. At surgery, a histologically proven granular cell tumor was found to be occluding the cystic duct. This case is reported because of the rarity of this tumor, particularly in the biliary tree and in a male.