PMC6465751_01
A The liver is enlarged measuring and is severely diffusely fatty infiltrated, demonstrating multiple rounded and wedge-shaped hypodense and hyperdense areas concerning for liver metastases. B Periportal edema within the liver and gallbladder wall edema with hepatic metastases. C H&E stained tissue section showing ulcerated gallbladder mucosa with biliverdin pigment at mucosal surface and a submucosal plasma cell infiltrate (100 magnification; 10x). D H&E closer view of the dense atypical plasma cell infiltrate in gallbladder wall (200 magnification; 20x). E, F Kappa light chain positivity (E) and Lambda light chain negativity (F) by in situ hybridization, confirming a monoclonal Kappa light chain plasma cell infiltrate: plasmacytoma/multiple myeloma (200 magnification; 20x).
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F1
Continuous renal replacement therapy was initiated, and Computed tomography scan of the abdomen and pelvis was obtained which demonstrated distention of the gallbladder with gallstones and mild thickening of the wall concerning for acute cholecystitis (Fig. 1A). She underwent percutaneous cholecystotomy followed by endoscopic retrograde cholangio-pancreatography with balloon sweep since the tube was poorly draining (Fig. 1B). Histopathology of the resected gallbladder demonstrated cholecystitis and plasmacytoma (Fig. 1C-F).
PMC6465751_02
A Distention of the gallbladder with gallstones and mild thickening of the wall. B Cholangiogram during ERCP showing distal bile duct stricture requiring sphincterotomy, balloon sweep, and stent placement. C H&E stained tissue section showing metastatic high grade breast ductal adenocarcinoma in the submucosa of the gallbladder (200 magnification; 20x). D GATA3 immunohistochemically-stained tissue section positive in the metastatic adenocarcinoma, helping to confirm a breast primary (200 magnification; 20x).
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F2
Computed tomography scan and magnetic resonance imaging of the abdomen demonstrated metastatic disease to the liver and bones, Gallbladder wall edema, and Periportal edema within the liver concerning for cholangitis (Fig. 2a, b). Histopathology of the resected gallbladder demonstrated metastatic poorly differentiated adenocarcinoma from the breast (Fig. 2C, D).