PMC10307192_01
Preoperative investigations. (a, b) Ultrasonography of abdomen showed a heteroechoic gallbladder mass with suspected liver invasion. (c, d) CT whole abdomen revealed a hypodensity mass replacing the gallbladder, invading segment 4, 5 of the liver (asterisk), right-sided colon (triangle) and suspected duodenal invasion. (e) EGD findings showed no mucosal-invading lesions in stomach and duodenum.
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Ultrasonography of the abdomen showed a hetero-echoic gallbladder mass invading the liver (Figures 1(a) and 1(b)). There was no significant lymph node enlargement or distant metastasis (Figures 1(c) and 1(d)). For evaluation of gastrointestinal tract involvement, upper and lower gastrointestinal tract endoscopies were carried out, revealing no mucosa invasion (Figure 1(e)).
Intraoperative findings. (a) Surgical specimen (b) diagram demonstrating parts of the specimen. The specimen consisted of the gallbladder, the right lobe of the liver, extrahepatic bile duct, part of the 2nd part of the duodenum (arrow), and right-sided colon. An ill-defined inhomogeneous firm mass with whitish and yellowish fleshy cut surface originated from the contracted gallbladder (asterisk), invading segment 4, 5 of the liver, 2nd part of the duodenum, proximal part of the transverse colon, and the common hepatic duct.
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A surgical specimen showed an ill-defined inhomogeneous firm mass with whitish and yellowish cut surfaces occupying over the fundus and body of the gallbladder (Figure 2).
Micrographs. (a-c) H&E stain showed fibroblast-liked spindle cells, small lymphocytes, and plasma cells (arrow) in the adventitia of the gallbladder. (d, e) CD3 and CD20 were scatter stained, indicating a reactive condition. (f, g) Kappa and Lambda were diffusely stained indicating no hematologic malignancy. (h) ALK stain was negative.
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Histopathology revealed fibroblast-like spindle cells, small lymphocytes and plasma cells (arrow) in the adventitia of the gallbladder (Figure 3(a)-3(c)), whereas mucosa and muscularis propria appeared normal. On immunohistochemical studies, CD3, CD20, Kappa and Lambda were scatter stained (Figures 3(d)-3(g)). Anaplastic lymphoma kinase (ALK) stain was negative (Figure 3(h)).