PMC4424909_01
Ultrasound of GB: Well defined, irregular heterogeneous mixed hypo- and iso-echoic mass at the gallbladder fossa (arrow) burst the overlying liver parenchyma and with direct invasion of gallbladder wall at fundus (white dot), giving the possibilities of either of hepatic or gallbladder origin.
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An irregular in outline, heterogeneous lesion of mixed echogenicity was found in the right hepatic lobe, adjacently to the GB fossa (Figure 1).
Contrast enhanced CT scan of the abdomen: (A) Enhancing focal wall thickening at GB fundus (white dot), inseparable from multi-loculated liver lesion (arrow), which shows strong peripheral enhancement with central necrosis, GB stones (arrow head). (B) Dilated intrahepatic biliary ducts (arrows).
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The liver showed an irregular, multiloculated, hypodense but marginally enhancing focal lesion surrounding the GB bed (Figures 2 and 3).
T2 axial (A) and coronal (B) MRI of abdomen: Marked wall thickening of GB fundus, impressive of primary gallbladder neoplasm (white dot). Multiple matted liver lesions centered on GB fundus seen moderately hyperintense, impressive of direct hepatic invasion (arrow).
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The liver showed an irregular, multiloculated, hypodense but marginally enhancing focal lesion surrounding the GB bed (Figures 2 and 3).
Microscopic examination of GB biopsy specimen: diffuse cytoplasmic staining for chrmogranin A; x400 magnification immunoperoxidase stain.
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On immunohistochemistry, the tumor was strongly and diffusely positive for neuroendocrine markers Chromogranin A (Figure 4), Synaptophysin and CD56 (Figure 5).
Microscopic examination of GB biopsy specimen: diffuse cytoplasmic staining for CD56; x400 magnification immunoperoxidase stain.
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On immunohistochemistry, the tumor was strongly and diffusely positive for neuroendocrine markers Chromogranin A (Figure 4), Synaptophysin and CD56 (Figure 5).
Microscopic examination of GB biopsy specimen: : High proliferation index (nuclear staining for MIB-1); x400 magnification immunoperoxidase stain.
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TTF-1, HepParl, and RCC. There was a high proliferation index, approximately 60% (Figure 6).