A healthy young woman underwent elective laparoscopic cholecystectomy due to right upper quadrant pain that had been recurring for some time. Ultrasonography done elsewhere (not available) had demonstrated a large calculus within the gallbladder but non-dilated intra- and extrahepatic bile ducts. During the operation, a firm mass was noticed in the hepatic hilum. A 3 cm lymph node was removed along with the gallbladder for histopathology evaluation.
The day after the operation, CT chest-abdomen-pelvis showed massive hilar lymphadenopathy and metastatic spread to many other abdominal and mediastinal lymph node stations, and presumably to the liver and left adrenal as well.

Histopathology:
Gallbladder:
Neuroendocrine carcinoma, metastatic, high grade in multiple foci, the largest one 2 cm in greatest diameter with areas of large cell type, scattered foci of squamous differentiation seen. Immunostains: Positive: Pankeratin, CK7, synaptophysin, chromogranin, CD56, CK20. Negative: TTF.
The tumor invades the entire gallbladder wall, mucosal ulceration. Lymphatic, blood vessel and neural invasion seen. One periserosal lymph node with metastatic carcinoma seen. Cholelithiasis.

Lymph node: (biopsy): Metastatic carcinoma.

PET-CT done 2 weeks after the initial CT and after having received the histopathology report, verified all of the presumed metastases.