Gallbladder tuberculosis camouflaging as gallbladder cancer - case series and review focussing on treatment

Abstract

Introduction: Gallbladder tuberculosis, in an endemic region, is a common infectious etiology affecting a rare organ. The high prevalence of carcinoma gallbladder in the endemic regions of tuberculosis, like India, poses diagnostic dilemma.

Case series: We are reporting three cases of gallbladder tuberculosis mimicking carcinoma gallbladder of which the first two cases were operated with a presumptive diagnosis of malignancy. The third case presented to us after laparoscopic cholecystectomy elsewhere and on evaluation was found to have disseminated tuberculosis.

Discussion: The lack of pathognomonic clinical and radiological characters results in histological surprise of gallbladder tuberculosis following surgery performed for other indications like malignancy. In preoperatively diagnosed patients medical management plays pivotal role in management. Surgery is required in symptomatic patients. On the other hand, histologically proven cases following surgical resection require antitubercular therapy.

Conclusion: Previous history of tuberculosis or concomitant tuberculosis at other sites may provide clue to the diagnosis of biliary tuberculosis. Antitubercular treatment after surgery plays an important role in preventing further dissemination.

Keywords: antitubercular therapy; carcinoma gallbladder; gallbladder tuberculosis; radical cholecystectomy.

Figure 1.

Panel of contrast-enhanced computed tomographic images. (a and b) Arterial phase axial computed tomographic images. (c–f) Portal venous phase axial computed tomographic images. Asymmetrical hypodense areas are seen along the fundus of gallbladder (long thin white arrow in a, b, d, and e) with contiguous involvement of segment 4B and 5 of liver. Hyperdense calculus within gall bladder lumen (long block arrow in e), subcentimetric lymphnodes in portocaval location (thin short arrow in c), and calcified lymphnode in omentum (block short arrow in f) are seen.

Figure 2.

Case 1 – (a) gross specimen with infiltration of fundal mass into the adjoining liver, (b) solitary pigment gallstone, and (c) thickening present in the body and neck of the gallbladder. Case 2 – (d) gross specimen showing fundal thickening.

Figure 3.

(a) H&E image (40×) showing a well-formed granulomas with central area of caseous necrosis (yellow arrow). The adjacent normal liver parenchyma can also be appreciated (black arrows). (b) H&E image (20×) showing a caseating granuloma with peripheral cuff of lymphocytes. The inset shows Ziehl–Neelsen stain which was negative for acid-fast bacilli. H&E, hematoxylin and eosin.