Adenocarcinoma of Gall Bladder, Imitator in Clinical Manifestations, Radiological and Histopathological Findings

Abstract

Gall bladder adenocarcinoma is a rare malignancy with female predominance. Main patients are in the fifth to seventh decades. Clinical findings of gall bladder adenocarcinoma can be non-specific and the same as cholecystitis .The imaging is also non-specific with considerable overlap between benign and malignant lesions. Gall bladder adenocarcinoma may be overdiagnosed in histopathology by considering Rokitansky-Aschoff sinuses as malignant. It may be underdiagnosed in the cases of well-differentiated minimally invasive carcinoma. Incidental tumors are mainly in fundus and body of gall bladder. The first case was 80-year-old female with right upper quadrant pain, nausea and vomiting. Ultrasound was in favor of emphysematous cholecystitis. Postoperative diagnosis was acute gangrenous cholecystitis with tumor lesion suspicious for malignancy. Pathologist reported, moderately differentiated gall bladder adenocarcinoma extended to serosa in the neck of gall bladder. The second case was 58-year-old female with right upper quadrant severe pain, odynophagia, dysphagia, nausea and vomiting. Ultrasound examination showed gall bladder mass in the fundus and suggested gall bladder cancer. Pathologist reported, Poorly differentiated adenocarcinoma of gall bladder extended full wall thickness. Precise macroscopic evaluation is very important for finding of cases of gall bladder carcinoma even without clinical suspicion. For detection of malignancy, microscopic evaluation of all cholecystectomy samples is recommended. We suggest careful examination of cholecystectomy specimens especially in females more than forty with careful sampling of body and fundus.