Mucin-producing gallbladder carcinoma.

Abstract

A 54-year-old Japanese woman presented with epigastralgia. Physical examination revealed tenderness in the epigastrium. Laboratory test results showed elevated levels of AST (103 mU/ml), ALT (203 mU/ml), gamma GTP (642 mU/ml), and ALP (2,132 mU/ml). Ultrasonography (US) using a SSD-5500 (Aloka, Tokyo, Japan) showed a hyperechoic protrusion in the fundus of the gallbladder, with diffuse and mild wall thickening (Fig. 1). Spotty and linear hyperechoic contents were seen in the enlarged gallbladder lumen and intraand extrahepatic bile ducts (Fig. 2). Contrast-enhanced CT depicted a papilla-like protrusion with mild enhancement (Fig. 3). Dilatation of the intraand extrahepatic bile ducts was observed. Endoscopic retrograde cholangiopancreatography showed variable filling defects in the gallbladder and common bile duct, suggesting the presence of mucin, and pancreaticobiliary maljunction (Fig. 4). Cytological examination of the bile showed the presence of malignancy. Carcinoma of the gallbladder being diagnosed, gallbladder and bile duct resection, as well as lymph node dissection, was performed. The resected gallbladder contained a massive amount of mucin together with the tumor, which showed a papillary growth pattern. Histopathological examination using immunostaining revealed a papillary tumor consisting of an adenoendocrine cell carcinoma containing mucus. The postoperative course in this patient was uneventful.