Gallbladder carcinoma with invasion into colon and duodenum

Case contributed by Dr Kieran Kusel

Presentation

Melaena, lethargy, and weight loss. Non-tender, palpable right upper quadrant mass. Haemoglobin 50 g/L.

Patient Data

Age: 95 years
Gender: Female

An 11.5 cm x 9.5 cm heterogenous mass is seen in the right upper quadrant involving the gallbladder, hepatic flexure, and first part of duodenum. A large calcified gallstone is seen within this mass, which also infiltrates adjacent mesenteric soft tissue and demonstrates areas of necrosis and patchy moderate contrast enhancement. No active extravasation of contrast is seen. There is associated mild intra- and extra-hepatic bile duct dilatation.

There is pericoeliac and central mesenteric lymphadenopathy and small volume ascites.

There is a 17 mm x 14 mm enhancing mass in the left adrenal gland likely representing metastatic disease. There is also a 26 mm x 17 mm right posterior bladder wall mass and bladder calculus. Bilateral renal cysts. Scoliosis is present, but no bony metastases are seen.

Case Discussion

No tissue diagnosis was obtained due to the extent of disease and the patient's advanced age. CA 19-9 was 381, CEA 15, and AFP 3.3.

Primary colorectal carcinoma, cholangiocarcinoma, hepatocellular carcinoma, or duodenal carcinoma extending into the gallbladder were considered as differential diagnoses.

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Case information

rID: 63065
Published: 15th Oct 2018
Last edited: 14th Aug 2019
Inclusion in quiz mode: Excluded

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