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64-year-old woman with a gallbladder mass

Contributed by: 

Karen Trevino, MD

PGY-2 Resident Physician, Anatomic Pathology and Clinical Pathology

Indiana University School of Medicine

Research Publications


Rosen Dimitrov, MD

Assistant Professor of Clinical Pathology & Laboratory Medicine

Indiana University School of Medicine

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Clinical history:

The patient is a 64-year-old female with a history of hypertension who presented to the emergency department with a 1-week history of nausea, vomiting, and abdominal pain. In the emergency department, she was found to have a fever of 39.4oC. A CT scan of the abdomen was performed that demonstrated a 2.8 x 2.2 cm enhancing nodule in the fundus of the gallbladder, intrahepatic and extrahepatic biliary ductal dilatation, and hypodensity of the pancreatic head thought to represent enlarged lymph nodes (Fig. 1). Whipple resection of the pancreatic head, duodenum, and gallbladder was performed.

Fig. 1

Gross description:

The gallbladder was found to have multiple large, black choleliths and a fundus-based mass measuring 4.7 cm in greatest dimension (Fig. 2). The mass was white-tan and solid with central hemorrhage. The pancreas was found to have multiple bulky lymph nodes surrounding the pancreatic head and compressing the parenchyma. Invasion into the actual pancreatic parenchyma was not seen.

Fig. 2

Microscopic description:

The tumor was found to have highly atypical and pleomorphic cells with fine to granular chromatin. These cells demonstrate a high nucleus to cytoplasmic ratio, nuclear molding, and abundant apoptosis and mitoses (Fig 3). These tumor cells were seen to be invading into the gallbladder mucosa (Fig 4). Additionally, multiple peripancreatic lymph nodes were involved without invasion into the pancreatic parenchyma (Fig 5). 

Fig. 3

Fig. 4

Fig. 5

Immunohistochemical staining was performed and demonstrated that the neoplastic cells were strongly positive for synaptophysin (Fig. 6a) and Ki67 stained greater than 95% of tumor cells (Fig. 6b).

Fig 6a                                                                                                                 Fig.6b

February 2018 Final Diagnosis and Discussion

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