Gallbladder Carcinoma, the Difficulty of Early Detection: A Case Report

Abstract

Gallbladder carcinoma (GBC) is an uncommon malignancy with a high mortality rate. Detecting gallbladder carcinoma in its early stages can be difficult, despite improvements in ultrasound and computed tomography (CT) imaging. Most diagnoses of GBC are made at advanced stages, with the majority being found incidentally during surgery for cholelithiasis. The presented case demonstrates the difficulty of diagnosing GBC preoperatively in its early stages.

Keywords: cancer; carcinoma; cholecystectomy; gallbladder; gallbladder cancer; gallbladder carcinoma.

Figure 1. Initial right upper quadrant ultrasound.

The image demonstrates intraluminal hypoechoic (red arrow) material. Given the appearance and lack of discrete internal flow, it appears to be most likely due to gallstones or tumefactive sludge, which is a benign mimic of a neoplasm.

Figure 2. Initial right upper quadrant ultrasound.

The image demonstrates no discrete internal flow within the gallbladder with blood flow in the adjacent vasculature.

Figure 3. Right upper quadrant ultrasound.

The image demonstrates sludge/stone like material within the lumen of the gallbladder (red arrow) with a rim of hyperemia initially interpreted as outside of the gallbladder given the clinical appearance of acute cholecystitis.

Figure 4. HIDA scan.

The image demonstrates excretion through the biliary system into the duodenojejunal junction (DJJ), but with no uptake within the gallbladder/cystic duct (red arrow).

Figure 5. Companion case. Right upper quadrant ultrasound of a patient who presented a few months after the first patient.

The image demonstrates a hypoechoic lesion near the expected location of the gallbladder (red arrow). Given the suspicious ultrasound finding and recent prior GBC case, leading differential diagnosis was neoplasm. As a result, further evaluation with a CT scan was recommended.

Figure 6. CT scan.

The image demonstrates a coronal CT showing a hypodense mass with direct invasion into the right hepatic lobe (red arrow), with additional small lesion in the left hepatic lobe (yellow arrow). Not shown is portohepatous and peripancreatic lymphadenopathy. The extent of disease suggests an element of patient denial of symptoms prior to clinical presentation.

Figure 7. Preparatory imaging of ultrasound guided biopsy in the companion case.

The image demonstrates the target lesion and the planned route of the needle (red arrow). The biopsy results revealed a primary biliary cancer, most likely gallbladder carcinoma.