PMC10228720_01
CT (A) Arrows indicate thickened gallbladder wall and thickened common bile duct; (B) Arrows indicate enlarged pancreatic head; MRI (C) Arrows indicate dilated extrahepatic bile ducts; (D) Arrows indicate thickened gallbladder wall and enlarged pancreatic head; (E) Follow up CT at 4 months after surgery; (F) Subsequent CT performed at 9 months post-surgery revealed no significant abnormalities in the pancreas.
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CA19-9 125.2 U/ml, TBIL 96.3 mumol/L. Contrast-enhanced computed tomography (CT) showed that the common bile duct was thickened ( Figure 1A ) and the head of the pancreas was enlarged ( Figure 1B ), but no abnormal enhancing shadow was found. Magnetic resonance imaging (MRI) showed dilatation of the extrahepatic bile ducts ( Figure 1C ) and thickening of the gallbladder wall. The pancreatic head was enlarged : the maximum transverse diameter was about 3.7 cm, the pancreatic signal was uniform, and no exact abnormal enhancement shadow was found ( Figure 1D ). After 10 months of close follow-up ( Figures 1E, F ), the patient had no symptoms and a good quality of life.
(A). Interstitial fibroplasia of the gallbladder is accompanied by infiltration of foam cells, lymphocytes, and plasma cells. Arrows indicate the location of foam cells and the muscularis layer of the gallbladder from left to right (100x); (B). Left-to-right pointing arrows denote the presence of pancreaticobiliary epithelial atrophy and foam cells, respectively (100x); (C). Nodular aggregates of foam cells are visible, and all foam cells are indicated by the arrows(100x); (D). Foam cell CD68+ (100x).
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Numerous foam cell, lymphocyte, and plasma cell infiltrates were found in the resected mass and gallbladder ( Figures 2A-C ). Immunohistochemical findings showed CD68 (+) ( Figure 2D ), CK (-), VIM (+), CD19 (-), Ki-67 (<1%), ALK1 (-), and p53 (-).