Presentation
Right upper quadrant pain. Elevated ESR, CRP, and liver enzymes.
Patient Data
The gallbladder is distended, and a 45-mm enhancing mass is noted in the fundus. A few stones less than 16 mm are also seen within the gallbladder.
Multiple ill-defined low-enhancing masses are seen in the liver. There is also a sizable necrotic mass with irregular thick peripheral enhancement in the right liver lobe, lateral to the gallbladder.
Multiple enlarged lymph nodes in the porta-hepatis with SAD less than 40 mm are also present.
The patient underwent an ultrasound-guided core needle biopsy and confirmed gallbladder adenocarcinoma. Then, she went to have neoadjuvant chemotherapy.
A 23 mm enhancing mass is noted in the gallbladder fundus, accompanied by a few gallstones less than 16 mm. Several ill-defined low-enhancing masses are seen in the liver less than 30 mm, consistent with metastases. There are also several lymphadenopathy in the porta hepatis with SAD less than 20 mm.
With respect to the prior CT images, the gallbladder mass, hepatic metastases, and regional lymphadenopathy are significantly decreased in size due to neoadjuvant chemotherapy.
Case Discussion
This case demonstrates pathology-proven gallbladder adenocarcinoma, multiple hepatic metastases and porta hepatis lymphadenopathy in initial and post-neoadjuvant chemotherapy CT images with good response.
On CT or MR images, gallbladder adenocarcinomas typically appear as heterogeneous masses that may have engulfed gallstones or areas of necrosis. Advanced disease features include invasion of adjacent structures and intrahepatic biliary dilatation, regional and para-aortic lymphadenopathy, peritoneal carcinomatosis, and hepatic and other distant metastases.
Unable to process the form. Check for errors and try again.