Spontaneous necrosis of solid gallbladder adenocarcinoma accompanied with pancreaticobiliary maljunction

Figure 1 Plain US. (A) of the GB showing wall thickening of the neck and body (consistent with cholecystitis), a strong echoic level with acoustic shadow at the neck (consistent with stones), and a mass-like lesion of the fundus, and Doppler US (B) revealing no blood flow in the mass-like lesion.

Figure 2 Plain CT. (A) showing a relatively low-density mass of the fundus measuring 5 cm x 4 cm in diameter, contrast-enhanced CT revealing no positive enhancement of this mass-like lesion in its early (B) and late (C) phases, MRI showing a mass in the fundus with a slightly low intensity on T1-weighted images (D) and a slightly high intensity on T2-weighted images (E). White arrow represents the mass-like lesion of the fundus.

Figure 3 MRC. (A) showing irregular defects due to the elevated lesion of the fundus (white arrow) and a round defect due to stone incarceration in the neck (white arrow head), intra-operative cholangiography (B) revealing PBM and a 15 mm long common channel (black arrow).

Figure 4 Low magnification view of the elevated lesion of the fundus showing obvious nodule necrosis. (A, HE, loupe) including non-viable adenocarcinoma cells and remnants of glandular structures and vessel fragments (B, black arrow) (HE, × 40), viable cancer cell nests invading perimuscular connective tissue but not penetrating the serosa in the muscularis propria and subcutaneous layer beneath the necrotic nodule (C, black arrow) (HE, × 20), and a solid adenocarcinoma (D, black arrow) (HE, × 100).