Gallbladder carcinoma in association with polyposis coli

Abstract

Polyposis coli is an autosomal dominant disorder characterised by the development of multiple adenomatous polyps throughout the colon. The propensity of these polyps to undergo malignant change is well known. Gardner's syndrome (Gardner, 1951) originally comprised polyposis of the colon, skeletal osteomas and soft-tissue tumours but many other lesions have been reported, including malignant tumours of the central nervous system and thyroid gland (Bussey, 1972). Periampullary tumours—carcinomas of the pancreas, duodenum and ampulla—are found in as many as 12% of patients with polyposis coli (Harned & Williams, 1982). There have been recent reports of adenocarcinoma of the biliary system occurring in patients with polyposis coli: three cases of bile duct tumours and two cases of gallbladder carcinoma (Burney & Assor, 1976; Lees & Hermann, 1981; Jarvinen et al, 1983; Bombi et al, 1984). This association has not been described previously in the radiological literature. A case of gallbladder carcinoma in a patient with polyposis coli is reported and the ultrasound findings discussed. A 47-year-old woman presented with a 2-day history of right upper quadrant pain, nausea and vomiting. Fourteen years earlier she had undergone total colectomy for polyposis coli. Her sister, two children and cousins were also known to be affected with polyposis coli. Examination showed that she was not jaundiced, was afebrile and had a negative Murphy's sign. Laboratory examination showed a normal white-cell count but mildly abnormal liver function tests (SGOT 77 U/1, alkaline phosphatase 167 U/1). The clinical differential diagnosis included cholecystitis and peptic ulcer disease.