Spontaneous necrosis of solid gallbladder adenocarcinoma accompanied with pancreaticobiliary maljunction

Abstract

A 71-year-old Japanese man with acute cholecystitis and an incarcerated gallbladder (GB) stone was admitted. Plain ultrasonography (US) incidentally detected a mass-like lesion in the fundus. Doppler US revealed that this elevated lesion had no blood flow. Computed tomography showed a relatively low-density mass, measuring 5 cm x 4 cm in diameter, with no positive enhancement. Magnetic resonance imaging showed a mass in the fundus with a slightly low intensity on T1-weighted images and a slightly high intensity on T2-weighted images. We were agonized in making the qualitative diagnosis of mass-like lesions of the fundus, such as a benign tumor, cancer, or debris. We performed laparoscopic cholecystectomy, because the incarcerated GB stone clearly caused acute cholecystitis. Intra-operative cholangiography clearly revealed pancreaticobiliary maljunction. Amylase levels in the common bile duct and gallbladder were quite high. The elevated lesion in the fundus clearly showed severe necrosis. Although this necrotic nodule included non-viable adenocarcinoma cells, viable cancer cell nests were located in the muscularis propria and subcutaneous layer. Histopathological examination confirmed a solid adenocarcinoma. Thus, we diagnosed it as a gallbladder cancer, based on histopathological analysis of the resected specimen. We therefore undertook radical surgery, including wedge resection of the liver, radical dissection of regional lymph nodes, and resection of the extrahepatic bile duct. Histopathological findings revealed no cancer, hyperplasia or dysplasia in the additionally resected specimens. The patient was finally staged as T2, N0, H0, P0, M(-), stage Ⅱ. We present the first case of spontaneous necrosis of solid gallbladder adenocarcinoma, with a review of previous studies.

Diagnosis and management of gallbladder cancer

“…GBC presenting as gallstone ileus,[ 46 ] gallbladder perforation,[ 47 ] duodenal ulcus,[ 48 ] gastroduodenal dysmotility,[ 49 ] malnutrition,[ 50 ] venous thromboembolism,[ 51 ] gynecologic symptoms,[ 52 ] skin disorders,[ 53 ] paraneoplastic symptoms,[ 54 ] and even neuropathy[ 55 ] have been reported.…”

Surgical resection of solid gallbladder adenocarcinoma presenting as a large mass: report of a case

“…However, detailed review of the radiological and intraoperative findings showed that the tumor had not invaded to nearby tissues, indicating that radical surgery was an appropriate management option. Such expansive tumor growth with a well-demarcated margin is a characteristic feature of solid gallbladder adenocarcinoma, as described in several reports and presentations [ 12 , 13 ].…”

Adenocarcinoma of the Gallbladder: Risk Factors and Pathogenic Pathways

“…In Eastern countries, specifically in Japan, anomalous pancreaticobiliary junction is considered to be an important risk factor for CG (Kimura et al 1985;Lin et al 1988;Ozmen et al 1991;Chijiiwa et al 1993;Tseng et al 1993;Hanada et al 1996;Uetsuji et al 1996;Yang et al 1997;Egami et al 1998;Chao et al 1999;Yoshida et al 1999;Ng 2000;Elnemr et al 2001;Nakayama et al 2001;Sakurai et al 2001;Yano et al 2001;Takayashiki et al 2002;Hu et al 2003;Kang et al 2007;Noda et al 2007;Hori et al 2008;review: Tsuchida et al 2003). In an investigation of the Japanese Study Group of Pancreaticobiliary Maljunction (PBM), PBM was found in 52 (3 %) of 1,722 patients investigated with ERCP, and of these, 14 patients had developed CG (Egami et al 1998).…”