The important teaching point in this case is the dissociation between intrahepatic and extrahepatic biliary dilatation which leads to the diagnosis of porta hepatis malignant obstruction.

The gallbladder diffuse mural thickening would be mistaken for cholecystitis, particularly xanthogranulomatous type. Many studies and case reports evoked the difficult differentiation between xanthogranulomatous cholecystitis and gallbladder carcinoma; however in such case the non-uniform thickening and relative hypoenhancement at gallbladder neck and the associated biliary dilatation should raise the suspicion of malignant transformation.