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Advanced gallbladder cancer misdiagnosis
Digestive and Liver Disease 44 (2012) 798
Contents lists available at SciVerse ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Advanced gallbladder cancer misdiagnosis Salvatore Guarino ∗ , Deborah Maria Giusti, Salvatore Sorrenti, Enrico De Antoni Dipartimento di Scienze Chirurgiche, “Sapienza” Università di Roma, Rome, Italy
a r t i c l e
i n f o
Article history: Received 2 December 2011 Accepted 1 March 2012 Available online 23 April 2012
An 80 year-old male patient, with no major co-morbidities, was admitted to our department via the emergency room with a few hours’ history of right upper quadrant pain and moderate grade fever. On physical examination Murphy’s sign was positive and a mild jaundice was present. Blood tests were normal apart from mild hyperbilirubinemia. Upon admission ultrasonography scan (USS) revealed two large stones within a thick-walled and enlarged gallbladder. A heterogeneous hypoechoic lesion was also seen within the fundus of the gallbladder, invading the surrounding hepatic lobes. Intravenous antibiotics were started. Magnetic Resonance Cholangio-Pancreatography (MRCP) (Fig. 1A) and Computed Tomography (Fig. 1B–D) confirmed the presence of a neoplastic lesion originating from the fundus of the gallbladder and infiltrating the adjacent 4th and 5th hepatic segments (Fig. 1). Thrombosed suprahepatic veins and vena cava up to the right atrium were also present. The decision to start chemotherapy was made; in order to do so, an USS-guided biopsy of the suspected lesion was performed. Histocytopathology studies failed to reveal any cancerous cells/tissues. After 10 days of intravenous antibiotics, abdominal pain and fever both subsided. The patient was discharged home with oral antibiotics. An MRCP repeated two months later revealed the complete radiological resolution of the previously seen image (Fig. 2A and B), and the patient is still asymptomatic.
∗ Corresponding author at: Dipartimento di Scienze Chirurgiche, “Sapienza” Università di Roma, Viale Regina Elena 324, 00161 Rome, Italy. Fax: +39 06 490688. E-mail address: [email protected] (S. Guarino).
Fig. 1.
Fig. 2.
1590-8658/$36.00 Crown Copyright © 2012 Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l. All rights reserved. doi:10.1016/j.dld.2012.03.003
Contents lists available at SciVerse ScienceDirect
Digestive and Liver Disease journal homepage: www.elsevier.com/locate/dld
Image of the Month
Advanced gallbladder cancer misdiagnosis Salvatore Guarino ∗ , Deborah Maria Giusti, Salvatore Sorrenti, Enrico De Antoni Dipartimento di Scienze Chirurgiche, “Sapienza” Università di Roma, Rome, Italy
a r t i c l e
i n f o
Article history: Received 2 December 2011 Accepted 1 March 2012 Available online 23 April 2012
An 80 year-old male patient, with no major co-morbidities, was admitted to our department via the emergency room with a few hours’ history of right upper quadrant pain and moderate grade fever. On physical examination Murphy’s sign was positive and a mild jaundice was present. Blood tests were normal apart from mild hyperbilirubinemia. Upon admission ultrasonography scan (USS) revealed two large stones within a thick-walled and enlarged gallbladder. A heterogeneous hypoechoic lesion was also seen within the fundus of the gallbladder, invading the surrounding hepatic lobes. Intravenous antibiotics were started. Magnetic Resonance Cholangio-Pancreatography (MRCP) (Fig. 1A) and Computed Tomography (Fig. 1B–D) confirmed the presence of a neoplastic lesion originating from the fundus of the gallbladder and infiltrating the adjacent 4th and 5th hepatic segments (Fig. 1). Thrombosed suprahepatic veins and vena cava up to the right atrium were also present. The decision to start chemotherapy was made; in order to do so, an USS-guided biopsy of the suspected lesion was performed. Histocytopathology studies failed to reveal any cancerous cells/tissues. After 10 days of intravenous antibiotics, abdominal pain and fever both subsided. The patient was discharged home with oral antibiotics. An MRCP repeated two months later revealed the complete radiological resolution of the previously seen image (Fig. 2A and B), and the patient is still asymptomatic.
∗ Corresponding author at: Dipartimento di Scienze Chirurgiche, “Sapienza” Università di Roma, Viale Regina Elena 324, 00161 Rome, Italy. Fax: +39 06 490688. E-mail address: [email protected] (S. Guarino).
Fig. 1.
Fig. 2.
1590-8658/$36.00 Crown Copyright © 2012 Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l. All rights reserved. doi:10.1016/j.dld.2012.03.003