Wang Hong, Ling Wenwu, Luo Yan
Department of Ultrasound, The West China Hospital of Sichuan University, Chengdu, China.
Medicine (Baltimore). 2018 May;97(21):e10773. doi: 10.1097/MD.0000000000010773.
Gallbladder adenocarcinoma is the most common subtype of malignant tumor in gallbladder carcinoma; its incidence is quite low. Preoperative diagnosis of gallbladder adenocarcinoma appears to be very difficult because they are normally asymptomatic and are often found incidentally. Adenocarcinoma with sarcomatoid carcinoma of gallbladder is exceedingly rare with no case reported in the literature to date.
A 69-year-old male was referred to our hospital due to right upper quadrant pain. To further diagnosis, he received laboratory tests, gray-scale US, and contrast-enhanced ultrasound (CEUS). In this present study, ethical approval was not necessary, as this article is a case report, which is based on the clinical information of the patient. The patient gave his permission for publication of the case.
Gray-scale abdominal ultrasound image demonstrated a hypoechoic intraluminal mass of gallbladder and a heterogeneous mass at the inferior segment of the right anterior liver lobe. In CEUS, the lesion of gallbladder was hyper-enhanced in the arterial phase, and hypo-enhanced in the later arterial phase. On liver, the hepatic lesion appeared heterogenous mild enhancement in the arterial phase. In portal and parenchymal phase, the hepatic lesion displayed hypo-enhancement, which conformed to the hepatic metastasis.
The patient received cholecystectomy, right hepatectomy, and lymphadenectomy.
He had an uneventful recovery from the procedure.
We presented a case report with gallbladder adenocarcinoma with sarcomatoid carcinoma accompanied by intrahepatic metastasis, focusing on the ultrasound imaging features of this tumor, especially its enhancement pattern on CEUS. CEUS provided helpful information for diagnosis. Herein, we report the case; and the associated literature is further reviewed.
胆囊腺癌是胆囊癌中最常见的恶性肿瘤亚型；其发病率相当低。胆囊腺癌的术前诊断似乎非常困难，因为它们通常没有症状，常常是偶然发现的。胆囊腺癌伴肉瘤样癌极为罕见，迄今为止文献中尚无病例报道。
一名69岁男性因右上腹疼痛转诊至我院。为进一步诊断，他接受了实验室检查、灰阶超声及超声造影（CEUS）检查。在本研究中，由于本文是基于患者临床信息的病例报告，无需伦理批准。患者同意发表该病例。
灰阶腹部超声图像显示胆囊腔内低回声肿块以及右前肝叶下段不均匀肿块。在CEUS检查中，胆囊病变在动脉期呈高增强，在动脉晚期呈低增强。肝脏上的病变在动脉期呈不均匀轻度增强。在门静脉期和实质期，肝脏病变呈低增强，符合肝转移表现。
患者接受了胆囊切除术、右肝切除术及淋巴结清扫术。
他术后恢复顺利。
我们报告了一例胆囊腺癌伴肉瘤样癌并伴有肝内转移的病例，重点关注该肿瘤的超声成像特征，尤其是其在CEUS上的增强模式。CEUS为诊断提供了有用信息。在此，我们报告该病例，并对相关文献进行进一步回顾。
