PMC9979752_01
EUS with an arrow pointing to an ovoid mass that appears to be arising from a choledochocele versus duplicated gallbladder.. EUS, endoscopic ultrasound
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FIG1
An endoscopic ultrasound (EUS) was scheduled for the patient showing the presence of an ovoid mass that appeared to be arising from a choledochocele versus duplicated gallbladder, and no regional lymph nodes were observed (Figure 1).
MRCP with an arrow pointing to the duplicated gallbladder emanating from the proximal right intrahepatic duct takeoff with a filling defect concerning for a mass.. MRCP, magnetic resonance cholangiopancreatography
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FIG2
A magnetic resonance cholangiopancreatography (MRCP) showed a duplicated gallbladder emanating from the proximal right intrahepatic duct takeoff with amorphous filling defect concerning for soft tissue mass with otherwise normal biliary tree (Figure 2), and no regional lymph nodes.
Intraoperative cholangiogram with an arrow pointing to the duplicated gallbladder.
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FIG3
The duplicated gallbladder did opacify signifying a direct connection to the biliary tree consistent with the expected duplicated gallbladder with intra cholecystic opacity consistent with the presumed tumor (Figure 3).
Histological staining with hematoxylin and eosin (H&E) at 40x of the intraoperative frozen section concerning for invasive carcinoma.
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FIG4
The gallbladder and duplicated gallbladder were incised showing a pedunculated and friable soft tissue lesion approximately 2 cm within the duplicated gallbladder that appeared consistent with invasive carcinoma microscopically (Figure 4).
Histological staining with hematoxylin and eosin (H&E) at 200x showing ICPN with high grade intraepithelial neoplasia.. ICPN, intracholecystic papillary neoplasm
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FIG5
From a final pathological standpoint, the tumor size was 2 cm by gross measurement and histopathology showed focal adenocarcinoma arising in the intra-cholecystic papillary neoplasm (ICPN) with high grade intraepithelial neoplasia (Figure 5).
Intraoperative image showing the duplicated gallbladder with black arrow pointing to the tumor in the posterior gallbladder and white arrow to the anterior normal gallbladder.
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FIG6
Histologic grade was well-differentiated adenocarcinoma (g1) and the tumor site was the body of the posterior duplicated gallbladder (Figure 6).