PMC4531600_01
Computed tomographic scan of the abdomen demonstrates multiple thickenings of the gallbladder wall with intramural hypoattenuated nodules (arrows), which were subsequently demonstrated to be the result of a xanthogranulomatous inflammation (A). At the neck of the gallbladder, a focal irregular thickening of the wall is also noted (asterisk). This proved to be a carcinoma (B).
kjim-18-1-53-10f1.jpg
PMC4531600_01_kjim-18-1-53-10f1.jpg
f1-kjim-18-1-53-10
There was no evidence of a gallstone or mass, even if both intrahepatic and extrahepatic bile ducts were slightly dilated (Figure 1).
Ultrasonography of the gallbladder reveals a segmental wall thickening of the neck portion, subsequently proven to be a carcinoma.
kjim-18-1-53-10f2.jpg
PMC4531600_01_kjim-18-1-53-10f2.jpg
f2-kjim-18-1-53-10
An abdominal ultrasonograph also revealed a mild distension of the gallbladder and an approximately 12 mm segmental wall thickening of the neck portion (Figure 2).
Endoscopic retrograde cholangiography reveals a complete obstruction of the cystic duct at the proximal portion. Therefore, the gallbladder does not fill with the contrast medium.
kjim-18-1-53-10f3.jpg
PMC4531600_01_kjim-18-1-53-10f3.jpg
f3-kjim-18-1-53-10
The gallbladder itself did not fill with the contrast medium as a result of a complete obstruction of the cystic duct at the proximal portion (Figure 3).
Photomicrographs show a large xanthogranulomatous nodule (H&E stain, x20), consisting mainly of foamy histiocytes (H&E stain, x400, inset) (A). The adenocarcinoma is noted at the gallbladder neck, which extends to the perimuscular connective tissue on the background of a muscular hypertrophy and a severe desmoplastic reaction (H&E stain, x200) (B).
kjim-18-1-53-10f4.jpg
PMC4531600_01_kjim-18-1-53-10f4.jpg
f4-kjim-18-1-53-10
The other portion of the gallbladder wall showed multifocal different-sized nodules of xanthogranulomatous inflammation, consisting mainly of foamy histiocytes and admixed inflammatory cells (Figure 4).