Case Report
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World J Gastrointest Oncol. Feb 15, 2013; 5(2): 29-33
Published online Feb 15, 2013. doi: 10.4251/wjgo.v5.i2.29
Gallbladder carcinoma in a pregnant patient with Crohn's disease complicated with gallbladder involvement
Shada Attraplsi, Rima M Shobar, Ihab Lamzabi, Rana Abraham
Shada Attraplsi, Rima M Shobar, Graduate College, Rush University, Chicago, IL 60612, United States
Ihab Lamzabi, Department of Pathology, Rush University, Chicago, IL 60612, United States
Rana Abraham, Department of Gastroenterology and Nutrition, Rush University, Chicago, IL 60612, United States
Author contributions: Attraplsi S and Shobar RM acquired, analyzed and interpreted the data; Lamzabi I prepared and provided the pathology figures; Attraplsi S and Abraham R wrote the paper; Abraham R revised the paper critically for intellectual content; Abraham R gave final approval of the version to be published.
Correspondence to: Rana Abraham, MD, Assistant Professor of Medicine, Department of Gastroenterology and Nutrition, Rush University, 1725 W. Harrison Street, Suite 206, Chicago, IL 60612, United States.
Telephone: +1-312-5634479 Fax: +1-312-5633883
Received: October 26, 2012
Revised: December 29, 2012
Accepted: January 17, 2013
Published online: February 15, 2013

Primary gallbladder (GB) carcinoma and Crohn’s disease (CD) of the GB are individually rare. We present a case of a pregnant woman with CD found to have GB involvement and primary GB carcinoma. A 34-year-old female at 6 wk gestation with a 21 year history of CD of uncertain extent presented with 3 mo of diarrhea, urgency and abdominal pain. During work-up, she was found to have elevated transaminases and an abnormal alkaline phosphatase. Imaging revealed two gallbladder polyps both greater than 1 cm in size. Resection and histological evaluation was consistent with Crohn’s involvement of the GB, poorly differentiated adenocarcinoma of the GB with invasion through the muscularis propria and matted lymph nodes in the porta hepatis positive for metastatic carcinoma (stage pT2N1). Six cases of CD involving the GB, two cases of primary GB carcinoma in CD, and ten cases of cholangiocarcinoma in pregnancy have been published. This is the only case that describes all three factors. Common features in CD of the GB include acute cholecystitis, ileal involvement, and presence independent of active intestinal disease. Common features in CD patients with GB malignancy include younger age of detection, a long history of CD, extensive colonic and ileal involvement of disease, the absence of cholelithiasis, and pre-existing gallbladder disease (primary sclerosing cholangitis and gallbladder polyps). Pregnancy is specific to this case. The role of CD in the development of GB malignancy is not well understood nor is the contribution of pregnancy to the spread of disease. Chronic inflammation and immunosuppression compounded by hormonal influence is implicated.

Keywords: Crohn’s disease, Cholangiocarcinoma, Gallbladder, Gallbladder carcinoma, Inflammatory bowel disease