Presentation
Abdominal pain with weight loss and palpable mass in the right upper quadrant.
Patient Data
Large necrotic soft tissue mass surrounding the gallbladder with numerous gallstones, infiltrating the adjacent segments of the liver (4 and 5) as well as the pylorus, duodenum and pancreas. It shows a low signal on T1 and a high signal on T2 with restricted diffusion and heterogeneous peripheral enhancement following IV contrast. There is vascular encasement mainly of the proper hepatic artery and right and left hepatic arteries with partial thrombosis of the portal branch of the segment 4 with area of increased enhancement (Transient hepatic attenuation differences). Subtle dilatation of the intrahepatic biliary radicles.
Multiple lymphadenopathy is noted at the porta hepatis, celiac region, lesser momentum and retroperitoneum.
Mild ascites mainly around the liver, spleen and within the umbilical hernia.
Case Discussion
MRI features of a large gallbladder tumor extending to segments 4 and 5 of the liver and infiltrating the adjacent structures with multiple abdominal lymphadenopathy and ascites.
An ultrasound-guided biopsy was performed with a histopathological exam that confirms the diagnosis of gallbladder adenocarcinoma.