Case Report
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Oct 14, 2008; 14(38): 5933-5937
Published online Oct 14, 2008. doi: 10.3748/wjg.14.5933
Spontaneous necrosis of solid gallbladder adenocarcinoma accompanied with pancreaticobiliary maljunction
Tomohide Hori, Takashi Wagata, Kenji Takemoto, Takanobu Shigeta, Haruko Takuwa, Koichiro Hata, Shinji Uemoto, Naoki Yokoo
Tomohide Hori, Takashi Wagata, Kenji Takemoto, Takanobu Shigeta, Haruko Takuwa, Koichiro Hata, Naoki Yokoo, Department of Surgery, Takayama Red Cross Hospital, 3-11 Tenman-cho, Takayama City, Gifu Prefecture, 506-8550, Japan
Shinji Uemoto, Department of Hepato-pancreato-biliary and Transplant Surgery, Kyoto University Hospital, 54 Shogoinkawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
Author contributions: Hori T performed the laparoscopic and radical surgery, and wrote the paper; Wagata T, Takemoto K, Shigeta T, Takuwa H, Yokoo N were surgical assistants of the operations; Wagata T and Yokoo N provided the intra-operative suggestive advices for surgical treatment; Uemoto S and Hata K provided the meaningful technical advices for this case.
Correspondence to: Tomohide Hori, Department of Hepato-pancreato-biliary and Transplant Surgery, Kyoto University Hospital, 54 Shogoinkawara-cho, Sakyo-ku, Kyoto, 606-8507, Japan. horit@kuhp.kyoto-u.ac.jp
Telephone: +81-75-7513651 Fax: +81-75-7513106
Received: July 8, 2008
Revised: August 26, 2008
Accepted: September 3, 2008
Published online: October 14, 2008
Abstract

A 71-year-old Japanese man with acute cholecystitis and an incarcerated gallbladder (GB) stone was admitted. Plain ultrasonography (US) incidentally detected a mass-like lesion in the fundus. Doppler US revealed that this elevated lesion had no blood flow. Computed tomography showed a relatively low-density mass, measuring 5 cm x 4 cm in diameter, with no positive enhancement. Magnetic resonance imaging showed a mass in the fundus with a slightly low intensity on T1-weighted images and a slightly high intensity on T2-weighted images. We were agonized in making the qualitative diagnosis of mass-like lesions of the fundus, such as a benign tumor, cancer, or debris. We performed laparoscopic cholecystectomy, because the incarcerated GB stone clearly caused acute cholecystitis. Intra-operative cholangiography clearly revealed pancreaticobiliary maljunction. Amylase levels in the common bile duct and gallbladder were quite high. The elevated lesion in the fundus clearly showed severe necrosis. Although this necrotic nodule included non-viable adenocarcinoma cells, viable cancer cell nests were located in the muscularis propria and subcutaneous layer. Histopathological examination confirmed a solid adenocarcinoma. Thus, we diagnosed it as a gallbladder cancer, based on histopathological analysis of the resected specimen. We therefore undertook radical surgery, including wedge resection of the liver, radical dissection of regional lymph nodes, and resection of the extrahepatic bile duct. Histopathological findings revealed no cancer, hyperplasia or dysplasia in the additionally resected specimens. The patient was finally staged as T2, N0, H0, P0, M(-), stage II. We present the first case of spontaneous necrosis of solid gallbladder adenocarcinoma, with a review of previous studies.

Keywords: Gallbladder carcinoma; Pancreaticobiliary maljunction; Spontaneous necrosis