PMC9379956_01
(A) Initial positron emission tomography/computed tomography (PET/CT) image
demonstrating a mass at the gallbladder fossa with intense
fluorodeoxyglucose (FDG) uptake. (B) Subsequent PET/CT image demonstrating
an increase in size and metabolic activity of the gallbladder mass
approximately 4 months later.
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T9, the vertebral body of L5, and the left iliac spine. There was also a 4 cm mass of hypermetabolic activity at the inferior edge of the liver, which was indistinguishable from the gallbladder (Figure 1A). There was also new metabolic activity within a new left perinephric mass and the posterior left ilium (Figure 1B).
Magnetic resonance imaging (MRI) with gadolinium contrast demonstrating a
7-cm mass at the gallbladder fossa (white arrow).
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Magnetic resonance imaging (MRI) of the liver with gadolinium contrast confirmed a 7 cm mass located at the gallbladder fossa (Figure 2).
An ultrasound of the liver demonstrating a hypoechoic mass at the gallbladder
fossa that was most consistent with a complete filling of the gallbladder
lumen secondary to an obstructive mass.
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An ultrasound of the liver further demonstrated a hypoechoic mass at the gallbladder fossa that was most consistent with a complete filling of the gallbladder lumen with an obstructive soft tissue mass that may reflect gallbladder malignancy (Figure 3).
Hepatobiliary iminodiacetic acid (HIDA) scan demonstrating contrast emptying
into the biliary duct system and into the duodenum without passing into the
lumen of the gallbladder, indicating an obstruction of the cystic duct.
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A hepatobiliary iminodiacetic acid (HIDA) scan could not visualize the gallbladder (Figure 4).
(A) Hematoxylin and eosin (H&E) staining demonstrating atypical plasma
cells with an abundant cytoplasm and eccentric nuclei replacing the normal
liver parenchyma. (B) Immunohistochemical (IHC) staining demonstrating
plasma cells with positivity for CD138.
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Histopathologic evaluation of the CT-guided biopsy sample demonstrated diffuse proliferation of atypical plasma cells with no evidence of liver parenchyma (Figure 5A). CD56, Kappa in-situ hybridization, and CD138. CD3 was highlighted in a few scattered T cells (Figure 5B).
Photograph of the extensive cutaneous lesions manifesting as firm, smooth,
violaceous papules and nodules.
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The patient noted new-onset, rapidly evolving varying sized, violaceous papules and nodules on chest and abdomen (Figure 6).