A CASE OF SIGNET-RING CELL CARCINOMA OF THE GALLBLADDER

Abstract

We report a case of signet-ring cell carcinoma of the gallbladder. A 71-year-old man was seen at another hospital because of right hypochondric pain. The patient was referred to the hospital for close examination with a diagnosis of cholecystolithiasis with cholecystitis. Abdominal CT scanning and ultrasonography revealed wall thickness and a calculus. Under a preoperative diagnosis of cholecystolithiasis with cholecystitis, a laparotomy was performed. During surgery an expanding gallbladder with adhesion to the surrounding tissues was seen. Cholecystectomy was performed. The resected specimen showed wall thickness in the entire gallbladder and an impacted calculus in the neck. Histological findings showed signet-ring cell carcinoma spreading at the muscularis propria in the entire gallbladder which invaded the subserosa. The diagnosis of gallbladder carcinoma was made and the liver bed and choledochus were resected with regional lymph node dissection to R1 extent for the purpose of curative operation. Signet-ring cell carcinoma of the gallbladder is very rare, and few cases have been reported in Japan. It is believed that the carcinoma with a high biological malignant potential has a poor prognosis. The diffuse infiltrative type of gallbladder carcinoma with inflammation like this case presents difficulty in preoperative diagnosis. When we encounter a case of cholecystolithiasis with cholecystitis, intraoperative frozen section diagnosis should be carried out by entertaining a possible complication of such carcinoma.