Presentation
Obstructive jaundice
Patient Data
The gallbladder shows diffuse mural thickening being more pronounced and non-uniform at its neck.
Marked bi-lobar intrahepatic biliary radicle dilatation. Common bile duct is of normal caliber near the pancreas.
Gallbladder dense stones were also noted.
Axial T2 fat-saturated images confirmed the marked intrahepatic biliary radicle dilatation with signs suggestive of bile leak and small perihepatic biloma.
The CBD is not dilated denoting obstruction at porta hepatis which is consistent with infiltrative central lesion.
Gallbladder showed diffuse thickening with few cystic foci of its wall.
Tumor markers were elevated particularly CA19.9 >4000 U/mL highly suspicious for carcinoma.
Histopathology showed gallbladder neck carcinoma on top of chronic xanthogranulomatous cholecystitis.
Case Discussion
The important teaching point in this case is the dissociation between intrahepatic and extrahepatic biliary dilatation which leads to the diagnosis of porta hepatis malignant obstruction.
The gallbladder diffuse mural thickening would be mistaken for cholecystitis, particularly xanthogranulomatous type. Many studies and case reports evoked the difficult differentiation between xanthogranulomatous cholecystitis and gallbladder carcinoma; however in such case the non-uniform thickening and relative hypoenhancement at gallbladder neck and the associated biliary dilatation should raise the suspicion of malignant transformation.
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