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Erschienen in:
08.12.2016 | CE - MEDICAL ILLUSTRATION
Focal disruption in the wall of the porcelain gallbladder: a sign of gallbladder carcinoma
Erschienen in: Internal and Emergency Medicine | Ausgabe 6/2017
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A 76-year-old man presented to his primary care physician with a complaint of generalized weakness and unintentional 25-pound weight loss over 3 months. On physical examination, his vital signs were within normal limits, and his examination was notable only for cachexia, mild jaundice, and a firm, tender liver edge palpable four fingerbreadths below the right costal margin. He was admitted to our institution through the emergency department, and CT scan of the abdomen and pelvis (CTAP) was performed (Fig. 1, panel A). On the CTAP, he was found to have a circumferentially calcified gallbladder wall (porcelain gallbladder) with an associated mass extending through the gallbladder fundus and eroding the calcifications in that region. A biopsy of the mass was performed under ultrasound guidance, and the pathology was positive for carcinoma.
Fig. 1
Panel A First image is a scout radiograph showing circumferential calcification of the gallbladder, with focal disruption in the region of the gallbladder fundus (blue arrow). Corresponding coronal CTAP with intravenous contrast again shows a calcified gallbladder wall, with focal disruption in the wall caused by a large mass extending through the gall bladder fundus (green arrow). Panel B Right upper quadrant ultrasound performed for biopsy of the mass showed a gallbladder (GB) with a calcified wall, causing posterior acoustic shadowing due to the inability of the ultrasound beam to penetrate the calcifications. A heterogeneous mass was seen next to the gallbladder, and was subsequently targeted for biopsy. Panel C a Gallbladder mass biopsy showing a malignant neoplasm with highly atypical cells with prominent cell membranes and moderate amounts of cytoplasm. The surrounding areas show necrosis, but no identifiable liver parenchyma was present, ×200. b Immunohistochemical staining for p63/CK5/6 shows positive nuclear p63 staining (brown) and patchy positive cytoplasmic CK5/6 staining supporting a squamous differentiation of the carcinoma, ×200. Additional immunohistochemical stains that were positive were CK7 and Hep Par1. Immunohistochemical stains for CDX2/CK20 were negative in this tumor
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