Mirizzi syndrome masquerading as gallbladder carcinoma: a case report on diagnostic challenges and multidisciplinary management

Abstract

Background: Mirizzi syndrome is a rare condition that is frequently misdiagnosed as gallbladder cancer due to overlapping clinical and imaging features. This case underscores the diagnostic challenge of differentiating these two conditions and offers insights into managing such complex presentations.

Case summary: A 45-year-old female presented with obstructive jaundice and elevated liver enzymes. Imaging studies, including CT, PET-CT, and MRCP, revealed gallbladder wall thickening, bile duct obstruction, and a high suspicion of malignancy. Tumor markers were within normal limits. Intraoperatively, extensive adhesions, gallbladder wall oedema, and bile duct compression consistent with Mirizzi syndrome were identified. A partial cholecystectomy and bile duct exploration with stent placement were performed. Histopathological examination confirmed chronic cholecystitis with inflammation, but no evidence of malignancy. The patient had an uneventful recovery, with complete resolution of her symptoms.

Conclusion: Mirizzi syndrome can closely resemble gallbladder cancer, making careful surgical exploration and pathological evaluation essential for accurate diagnosis.

Keywords: Mirizzi syndrome; case report; cholangitis; gallbladder cancer; obstructive jaundice.

Figure 1

Imaging findings of gallbladder and related conditions. (A) Chest and Abdomen Plain CT: Lungs show increased markings and nodules. Post-PTCD, the liver is normal-shaped. The gallbladder is enlarged with high-density nodules, thickened walls, and dilated intrahepatic ducts. Retroperitoneal lymph nodes are present, and intrahepatic duct dilation is reduced compared to before. (B) PTCD Tube Contrast: Post-PTCD, ducts are dilated. The middle common bile duct has poor filling and slow contrast passage, with duodenal delay. (C) Liver Vascular Imaging: The liver looks normal. The gallbladder is enlarged with thickened walls (1.3 cm) and enhanced nodules. Vessels are normal, but the cystic artery is thickened, and there are retroperitoneal lymph nodes. (D) Abdomen MR: The liver has normal signals. The gallbladder has T2-nodular signals and a thickened wall (1.4 cm) with enhancement. The middle common bile duct is thickened, and stenosed, and intrahepatic ducts are dilated. Small retroperitoneal lymph nodes are seen. (E) PET Whole-body: The gallbladder and upper common bile duct have thickened walls with increased metabolism, likely malignancy. Gallbladder stones, lung fibrotic foci, and cervical cysts are also present. (F) Pathology Findings of Gallbladder Specimen: Microscopically, the suture-line marked area and the rest show proliferative fibrous tissue infiltrated by lymphocytes, plasma cells, etc. The biopsy lacks epithelial-lined gallbladder tissue, with no typical images of relevant diseases.

Figure 2

Timeline of key diagnostic and therapeutic events. This timeline highlights the diagnostic challenges in differentiating Mirizzi syndrome with secondary inflammation from gallbladder carcinoma, emphasizing the importance of multimodal evaluation and histopathological confirmation. Furthermore, it underscores the critical role of accurate diagnosis in determining patient prognosis, guiding appropriate therapeutic strategies, and influencing long-term follow-up and surveillance protocols.