PMC8481662_01
Magnetic resonance imaging (MRI) findings of the patient. T2-weighted (A,B, coronal; C, axial) imaging showed low signal intensity as an irregular filling defect in the gallbladder fundus and long signal in segment IV of the near liver (arrow). DWI (D) showed a hyperintense signal, and ADC map (E) showed reduced diffusion (arrow). MRCP (F) showed gallbladder enlargement with local filling defect (arrow).
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F1
MRI revealed a gallbladder space-occupying lesion with an abnormal signal in segment IV of the liver, considered gallbladder cancer including liver invasion (Figure 1).
Visualization of the tumor and biliary tree under real-time NIRF imaging. (A,B) Pale green fluorescence detected in the extrahepatic biliary tree (arrow). (C) Green fluorescence accumulated into the gallbladder bed (arrow). (D) Residual green fluorescence observed after wedge liver resection (arrow). (E) Resected gallbladder and liver under the natural light. (F) Dense green fluorescence of the opened gallbladder under the NIFR imaging.
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F2
The hepatic arteries and portal veins were then isolated and protected (Figures 2A,B). Accumulation of fluorescence was identified along the gallbladder bed with the incorporation of NIRF imaging, which indicated a tumor invasion of the liver (Figure 2C). The cross-section of the reserved liver was explored and viewed under NIRF imaging, and local green fluorescence was observed (Figure 2D). The tumor showed a dense green fluorescence under NIRF imaging (Figures 2E,F).
Histologic features in gallbladder adenocarcinoma and liver sections. (A, B) Stromal infiltration of gallbladder adenocarcinoma. (A) Atypical glands were observed in a low to moderately differentiated gallbladder adenocarcinoma (A, H&E, x40). (B) Distorted glands invaded the muscularis propria layer of the gallbladder (B, H&E, x100). (C,D) Vascular invasion in gallbladder adenocarcinoma. (C) part of the dysplastic glands were sieve-like with mucus (C, H&E, x40). (D) Dysplastic glands invaded the vascular walls (D, H&E, x100). (E,F) A large number of lymphocytes infiltrated in the portal area of the liver; milder hepatic steatosis was observed in some areas (E, H&E, x40; F, H&E, x100).
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F3
Finally, a pathological report revealed a 5 x 2.5 x 1 cm, low to moderately differentiated adenocarcinoma (Figure 3).
The timeline of patient information.
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The detailed timeline of patient information in this episode of care can be seen in Figure 4.