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Primary Carcinoma in a Functioning Gall Bladder
Vol.-50, No.6 Printed in U.S.A.
GASTROENTEROLOGY
Copyright © 1966 by The Williams & Wilkins Co.
CASE REPORTS PRIMARY CARCINOMA IN A FUNCTIONING GALL BLADDER KEITH RABINOV,
M.D.
330 Brookline Avenue, Boston, Massachusetts
Primary carcinoma of the gall bladder, although a fairly common disease, is rarely demonstrated by cholecystography since
sumed to account for the changes observed. The following case is an example of unusual cholecystographic findings associated with
FIG. 1. Cholecystogram done preoperatively showing the gall bladder to be of normal size. Deformity at fu~dus was interpreted as possibly due to metabolic changes.
such gall bladders do not usually concentrate contrast materiaU Thus, only a few early lesions have been visualized. 2 - 4 When partial function is preserved, disease other than carcinoma in the gall bladder is asReceived December 29, 1965. Accepted January 26, 1966. Address requests for reprints to: Dr. Keith Rabinov, Beth Israel Hospital, 330 Brookline Avenue, Boston, Massachusetts 02215.
808
an advanced infiltrating primary carcinoma of the gall bladder. Case Report An 80-year-old woman complained of recurrent epigastric and substernal pain for many years, thought to be due to angina pectoris and gall bladder disease. There was no history of fatty food intolerance or jaundice. Epigastric tenderness was present, but no abdominal masses
June 1966
CASE REPORTS
were palpable. Recent barium studies were essentially normal. Cholecystogram (9 g of Telepaque in 2 days) (fig. 1) showed the gall bladder to be of normal size. Contrast material was well concentrated and contraction following fatty meal was excellent. The fundal contour had a slight angular deformity and indistinct outline, interpreted as
c
FIG. 2. Diagrammatic representation of the pathological changes. The gall bladder was divided into two compartments by the carcinomatous stricture (8). The distal loculus was packed with calculi (C) and did not fill with contrast material during cholecystography.
809
possibly due to inflammatory or metabolic changes. No adjacent calcification or abnormal mass were seen, but a few tiny stones were visualized within the gall bladder. The ducts were normally outlined. At surgery the gall bladder contained stones. In addition it had an annular constriction of its middle third, apparently neoplastic and densely adherent to the liver bed, making excision difficult. Examination of the specimen (diagrammed in fig. 2) showed the gall bladder to be hourglassshaped, deeply constricted in its mid portion by a thick cuff of neoplastic tissue which markedly narrowed the lumen and extended through the entire gall bladder wall. Numerous calculi were present in the distal half of the gall bladder beyond the stricture. Microscopic examination showed the stricture to be due to adenocarcinoma. There was also evidence of chronic cholecystitis. A cholecystogram (also 9 g of Telepaque in 2 days) done 4 years previously had shown the gall bladder to appear much larger, containing numerous tiny radiolucent calculi (fig. 3). Contrast material was well concentrated and con-
FIG. 3. Cholecystogram done 4 years previously, showing a large gall bladder containing numerous calculi. Deformities on upper and lower margins were inconstant.
810
CASE REPORTS
Vol. 60, No.6
traction following fatty meal was slight. Inconstant deformities were seen on the upper and lower margins of the gall bladder proximal to t he fundus.
since benign strictures are also known to cause this appearance.
Discussion
A case of infiltrating primary carcinoma of the gall bladder with partial visualization on cholecystography is described.
The carcinomatous stricture severely narrowed the midportion of the gall bladder during a 4-year interval and together with the packed calculi below it prevented the entrance of contrast material into the distal loculus, even during contraction . This stricture also caused the deformity shown by cholecystography at the bot tom of the proximal loculus which was apparently still able to concentrate contrast material. Since the stones in the distal loculus were not calcified they were not visible ; indeed no mass was visible here. The several inconstant marginal deformities of the gall bladder seen on the earlier cholecystogram probably represented muscular contraction rather than early signs of carcinoma. The deformity is not thought to be diagnostic of carcinoma,
Summary
REFERENCES 1. Khilnani , M . T., B . S. Wolf, and M. Finkel. 1962. Roentgen features of carcinoma of the
gallbladder on barium meal examination . Radiology 79 : 264-273. 2. Cimmino, C. V. 1958. Carcinoma in a well functioning gallbladder. Radiology 71: 563564. 3. Conlon, P. C., and R. W. Brust. 1962. Cholecystography as an aid in the localization of upper abdominal masses Amer. J. Roentgen . 88 : 756-767 . 4. Schinz, H . R., W . E. Baensch, E. Friedel, and E. Uehlinger. 1954. Roentgen-diagnostics, Vol. 4, pp. 3714-3715. Grune and Stratton, Inc., New York.
GASTROENTEROLOGY
Copyright © 1966 by The Williams & Wilkins Co.
CASE REPORTS PRIMARY CARCINOMA IN A FUNCTIONING GALL BLADDER KEITH RABINOV,
M.D.
330 Brookline Avenue, Boston, Massachusetts
Primary carcinoma of the gall bladder, although a fairly common disease, is rarely demonstrated by cholecystography since
sumed to account for the changes observed. The following case is an example of unusual cholecystographic findings associated with
FIG. 1. Cholecystogram done preoperatively showing the gall bladder to be of normal size. Deformity at fu~dus was interpreted as possibly due to metabolic changes.
such gall bladders do not usually concentrate contrast materiaU Thus, only a few early lesions have been visualized. 2 - 4 When partial function is preserved, disease other than carcinoma in the gall bladder is asReceived December 29, 1965. Accepted January 26, 1966. Address requests for reprints to: Dr. Keith Rabinov, Beth Israel Hospital, 330 Brookline Avenue, Boston, Massachusetts 02215.
808
an advanced infiltrating primary carcinoma of the gall bladder. Case Report An 80-year-old woman complained of recurrent epigastric and substernal pain for many years, thought to be due to angina pectoris and gall bladder disease. There was no history of fatty food intolerance or jaundice. Epigastric tenderness was present, but no abdominal masses
June 1966
CASE REPORTS
were palpable. Recent barium studies were essentially normal. Cholecystogram (9 g of Telepaque in 2 days) (fig. 1) showed the gall bladder to be of normal size. Contrast material was well concentrated and contraction following fatty meal was excellent. The fundal contour had a slight angular deformity and indistinct outline, interpreted as
c
FIG. 2. Diagrammatic representation of the pathological changes. The gall bladder was divided into two compartments by the carcinomatous stricture (8). The distal loculus was packed with calculi (C) and did not fill with contrast material during cholecystography.
809
possibly due to inflammatory or metabolic changes. No adjacent calcification or abnormal mass were seen, but a few tiny stones were visualized within the gall bladder. The ducts were normally outlined. At surgery the gall bladder contained stones. In addition it had an annular constriction of its middle third, apparently neoplastic and densely adherent to the liver bed, making excision difficult. Examination of the specimen (diagrammed in fig. 2) showed the gall bladder to be hourglassshaped, deeply constricted in its mid portion by a thick cuff of neoplastic tissue which markedly narrowed the lumen and extended through the entire gall bladder wall. Numerous calculi were present in the distal half of the gall bladder beyond the stricture. Microscopic examination showed the stricture to be due to adenocarcinoma. There was also evidence of chronic cholecystitis. A cholecystogram (also 9 g of Telepaque in 2 days) done 4 years previously had shown the gall bladder to appear much larger, containing numerous tiny radiolucent calculi (fig. 3). Contrast material was well concentrated and con-
FIG. 3. Cholecystogram done 4 years previously, showing a large gall bladder containing numerous calculi. Deformities on upper and lower margins were inconstant.
810
CASE REPORTS
Vol. 60, No.6
traction following fatty meal was slight. Inconstant deformities were seen on the upper and lower margins of the gall bladder proximal to t he fundus.
since benign strictures are also known to cause this appearance.
Discussion
A case of infiltrating primary carcinoma of the gall bladder with partial visualization on cholecystography is described.
The carcinomatous stricture severely narrowed the midportion of the gall bladder during a 4-year interval and together with the packed calculi below it prevented the entrance of contrast material into the distal loculus, even during contraction . This stricture also caused the deformity shown by cholecystography at the bot tom of the proximal loculus which was apparently still able to concentrate contrast material. Since the stones in the distal loculus were not calcified they were not visible ; indeed no mass was visible here. The several inconstant marginal deformities of the gall bladder seen on the earlier cholecystogram probably represented muscular contraction rather than early signs of carcinoma. The deformity is not thought to be diagnostic of carcinoma,
Summary
REFERENCES 1. Khilnani , M . T., B . S. Wolf, and M. Finkel. 1962. Roentgen features of carcinoma of the
gallbladder on barium meal examination . Radiology 79 : 264-273. 2. Cimmino, C. V. 1958. Carcinoma in a well functioning gallbladder. Radiology 71: 563564. 3. Conlon, P. C., and R. W. Brust. 1962. Cholecystography as an aid in the localization of upper abdominal masses Amer. J. Roentgen . 88 : 756-767 . 4. Schinz, H . R., W . E. Baensch, E. Friedel, and E. Uehlinger. 1954. Roentgen-diagnostics, Vol. 4, pp. 3714-3715. Grune and Stratton, Inc., New York.