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Special Feature
November 17, 2008

Image of the Month—Quiz Case

Author Affiliations

Author Affiliations: Departments of Medical Imaging (Drs Liu, Yang, and Lee) and Surgery (Dr Yuan), National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei.


Copyright 2008 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2008

Arch Surg. 2008;143(11):1129. doi:10.1001/archsurg.143.11.1129

A female hepatitis B carrier, aged 35 years, had received regular liver screenings by ultrasonography. It had been noted for several years that the gallbladder was difficult to locate, and contracted gallbladder was presumed. More recently, a palpable mass of about 5 cm was detected at the right periumbilical area. Hepatic hilar lymphadenopathy was suspected following ultrasonography. The laboratory data were normal. Further ultrasonography revealed a target mass approximately 4 cm between the liver, right kidney, and duodenal gas. The corresponding enhanced axial computed tomographic scans revealed a hypodense mass with central rim enhancement (Figure 1). The reconstructed coronal computed tomographic images revealed a large gallbladder mass with markedly thickened walls and hypertrophic mucosa. Magnetic resonance imaging clearly demonstrated multiple small cystic lesions within the hypertrophic wall and surrounding the contracted lumen. The gross pathologic specimen is shown in Figure 2.

Figure 1.
Image not available

Ultrasonography revealed a target mass about 4 cm between the liver, right kidney, and duodenal gas. This corresponding enhanced axial computed tomographic scan shows a hypodense mass with central rim enhancement (arrows).

Figure 2.
Image not available

Photograph of the gross pathologic specimen obtained by cholecystectomy reveals hypertrophy of the muscular wall (*) and narrowing of the lumen (L).

What Is the Diagnosis?

A. Gallbladder cancer

B. Gallbladder adenomyomatosis

C. Gallbladder sarcoma

D. Metastatic gallbladder tumor