Presentation
Abdominal pain
Patient Data
There is irregular diffuse thickening observed in the body and fundus of the gallbladder, measuring approximately 11-14 mm. This thickening shows restricted diffusion and heterogeneous enhancement, without any evidence of fatty infiltration in this region. Additionally, intramural cavities are noted in the fundus of the gallbladder, along with a gallstone measuring about 7 x 9 mm.
A retroperitoneal mass is located in the pancreatic head, extending into the hepatic hilum. This mass surrounds various vascular structures, including the inferior vena cava, abdominal aorta, celiac trunk, and right and left renal arteries. It shows an indistinct margin, restricted diffusion, and enhancement. Furthermore, the lesion compresses and narrows the common bile duct, with the narrowest diameter measuring approximately 3 mm.
Additionally, there is a right pleural effusion and a nodal lesion in the left lung.
Duodenal diverticulum is noted.
The CT scan was taken to investigate additional lesions in the lung and mediastinum, but no further lesions were noted. Some slices through the abdominal area show similar imaging findings to those seen in the MRI images
The patient underwent cholecystectomy.
Gross description:
The gallbladder has been cut into multiple pieces with a total size of 8.5 x 3 x 1.5 cm; the wall thickness ranges from 0.5 cm to 1 cm, showing degenerated mucosa. Multiple fragments are transferred to 01 cassette for storage.
Microscopic description:
On one slide prepared from the received specimen and stained with HE, the histology of the gallbladder reveals partially preserved mucosa covered with single-layered epithelium. The mucosa, the submucosa, and the muscular layer of the gallbladder show infiltration of lymphoid cells with relatively large nuclei, irregular nuclear contours, prominent nucleoli, and frequent mitotic figures. Scattered tingible body macrophages are observed, along with small areas of necrosis.
Immunohistochemical staining performed on 11 slides from the specimen shows positivity for CD79a, CD20, Bcl6, Bcl2 (focal), and MUM1 in tumor cells; negativity for CK, CD3, CD5, CD10, Cyclin D1; with a high Ki67 index (+): 80%.
Conclusion:
The histopathological and immunohistochemical findings are consistent with diffuse large B-cell lymphoma, non-germinal center subtype.
Case Discussion
In this case, based on the imaging findings in the gallbladder, our initial diagnosis is gallbladder carcinoma along with adenomyosis. Additionally, the presence of a peritoneal mass, which we suspect to be a lymphatic mass, leads us to include gallbladder lymphoma in the differential diagnosis.
The patient undergoes cholecystectomy. The histopathological and immunohistochemical findings are consistent with diffuse large B-cell lymphoma
Gallbladder lymphoma is exceedingly rare and presents diagnostic challenges due to its imaging characteristics often resembling those of gallbladder adenocarcinoma.
Primary lymphoma of the gallbladder refers to an extranodal lymphoma originating within the gallbladder, predominantly localized to this site. While lymph node involvement and distant spread may occur, the clinical presentation typically centers on the gallbladder, with treatment primarily targeted at this area.
Unable to process the form. Check for errors and try again.