• Soft tissue mass at the neck with local invasion, encasement of the CHA and involving the CHD. The soft tissue thickening involves the whole thickness of the GB wall, including the mucosa. 
• Although benign and malignant disease of the GB can be difficult to disambiguate, and may co-exist, the focal, transmural thickening and local invasion is characteristic of GB carcinoma. 
• The EUS-FNA confirmed adenocarcinoma of HPB origin. 
• The differential would include locally invasive cholangiocarcinoma, although the presence of bulky disease centered on the GB neck, would favor GB origin. 

Case courtesy of Dr Jamie Franklin and Dr Ed Godfrey on behalf of BSGAR.