Presentation
Right upper quadrant pain
Patient Data
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Multiple hepatic lesions occupying segments 4, 5, 6 and 8. The largest lesion in segment 6 measures 70 x 60 mm. The gallbladder is distended with areas of abnormal soft tissue density within it. Hyperdense lesion in the upper pole of the spleen.
Features favoring a gallbladder adenocarcinoma with multiple hepatic metastases. Multifocal hepatocellular carcinoma and metastatic deposit in the spleen are within the differential.
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Appearances favor metastatic gallbladder malignancy with diffuse right lobe invasion but sparing segments 1 through 4A. No convincing local extraphepatic nodal or metastatic spread.
Case Discussion
This 60-year-old lady presented with sudden onset of right sided abdominal pain to our ED. She underwent a CT scan which demonstrated multifocal deposits within the liver and a distended gallbladder with soft tissue mass.
Tumor markers: CA 19-9 5.9, AFP 70, CEA <1.0
The patient underwent a liver biopsy. Histopathology:
- Features consistent with poorly differentiated adenocarcinoma
- Gallbladder adenocarcinoma has no specific immunohistochemistry marker
- Ancillary studies in this case do not suggest any specific tumor type or origin
- Differentials include gallbladder adenocarcinoma, cholangiocarcinoma as well as metastatic adenocarcinoma
Imaging and biopsy findings consistent with metastatic gallbladder adenocarcinoma (stage IV disease).
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