Man 69 yo, pain at
epigastric area, no fever, no GI tract trouble.
Abdominal ultrasound detected
abnormal gallbladder: thickening
of the wall with one mass at gall bladder fundus
invasion to liver, suggestion of gallbladder abscess ( see 4 ultrasound pictures).
Blood test are normal: WBC not rising, CA 19-9 normal
MRI with CE gado showed this mass in high
enhancement invasion in to liver and
transverse colon, the biliary
system was normal.
With this clinical
situation and blood tests, US first
and MRI, what is your diagnosis ?
Microscopic with imunohistostaining is leiomyosarcoma of the gallbladder..it is very rare case in the word had been published.
DISCUSSION: this case had no clinical signs of acute cholecystisis, no stone
in gallbladder; ultrasound showed
the
wall of the gallbladder perforated and
adherent , invading liver tissue, this mass was hypovascular in protruding into lumen of gallbladder as a tumor and going to extra wall of gallbladder.
Open operation
with diagnosis of
tumor of gall bladder (surgeon removed gallbladder and
resection one part of liver and great omentum). Specimen was
hard and necrosis.
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