PMC5937617_01
Axial unenhanced CT of the abdomen obtained at presentation shows a diffusely thickened and low attenuation gallbladder wall.
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An unenhanced CT scan of the abdomen and pelvis obtained in the emergency department showed a nondistended gallbladder with diffuse wall thickening (Figure 1).
Image obtained during HIDA scan shows early filling of the gallbladder by 30 minutes which was confirmed on delayed 40- and 60-minute images.
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The HIDA scan revealed cystic duct patency (Figure 2).
Grayscale longitudinal sonographic image of the right upper quadrant shows a decompressed gallbladder wall with diffuse wall thickening. The gallbladder wall has a striated appearance without increased vascularity.
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The gallbladder wall had a striated appearance with a central hypoechoic stripe surrounded by an echogenic band on either side (Figure 3).
(a) Axial T1W-VIBE precontrast, (b) axial T1W-VIBE postcontrast, (c) axial T2W-fat suppressed, and (d) coronal T2W-fat suppressed sequences. MR images show diffuse gallbladder wall thickening with increased signal intensity on T2 weighted fat suppressed images. Postcontrast fat suppressed images demonstrate homogeneous mucosal enhancement with no transmural wall enhancement.
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T1 weighted sequences showed no abnormal enhancement or nodularity of the gallbladder wall. The gallbladder did contain a few small stones, but there was no luminal distention, pericholecystic fluid, or lymphadenopathy (Figure 4).
Microscopic images show gallbladder wall thickening and lymphatic ectasia. Several blood vessels in the subserosal fat are infiltrated with large, atypical lymphomatous cells. The mucosa is uninvolved. Immunohistochemical stain with CD79a confirms B-cell origin.
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Histologic evaluation with hematoxylin and eosin stain demonstrated diffuse gallbladder wall thickening with lymphatic ectasia (Figure 5).