Kataoka Naoki, Oura Shoji, Furuta Akito
Department of Surgery, Kishiwada Tokushukai Hospital, Kishiwada-city, Japan.
Department of Gastroenterology, Kishiwada Tokushukai Hospital, Kishiwada-city, Japan.
Radiol Case Rep. 2024 May 14;19(8):3152-3156. doi: 10.1016/j.radcr.2024.04.067. eCollection 2024 Aug.
A 44-year-old woman was referred to our hospital for the examination and treatment of a presumed gallbladder tumor. Both ultrasound and computed tomography showed an intracystic tumor but failed to point out the discontinuity between the cystic lesion and the gallbladder. Magnetic resonance imaging, however, could clearly depict the presumed intracystic tumor and the discontinuity between the gallbladder and the target lesion. Both contents of the gallbladder and the cystic lesion showed hypo and hyper intense patterns, though both with slightly different intensities, on T1- and T2-weighted images, respectively. Under the preoperative diagnosis of early gallbladder cancer despite these image findings, laparoscopic cholecystectomy was attempted to the patient. Laparoscopic observation, however, revealed that the target lesion was not continuous with the gallbladder and was located in the round ligament of the liver. Intraoperative findings led us to do cholecystectomy and resection of the adjacent cystic tumor. The intracystic tumor was 3 cm in size and had minute solid component inside the cyst wall. Pathological study of the presumed gallbladder cancer showed epithelioid cells and spindle cells growing in sheet like and storiform fashions, respectively. Cystic walls mainly consisted of hypo cellular fibrous components. Immunohistochemical staining of the tumor was positive for CD117 and negative both for desmin and S100, leading to the diagnosis of gastrointestinal stromal tumor. MIB-1 labelling index of the gastrointestinal stromal tumor was 8%. The patient recovered uneventfully and has been well without any recurrences for 3 months.
一名44岁女性因疑似胆囊肿瘤被转诊至我院进行检查和治疗。超声和计算机断层扫描均显示囊内肿瘤，但未能指出囊性病变与胆囊之间的不连续性。然而，磁共振成像能够清晰地描绘出疑似囊内肿瘤以及胆囊与目标病变之间的不连续性。在T1加权和T2加权图像上，胆囊内容物和囊性病变均分别呈现低信号和高信号模式，尽管两者强度略有不同。尽管有这些影像学表现，但在术前诊断为早期胆囊癌的情况下，尝试为该患者进行腹腔镜胆囊切除术。然而，腹腔镜观察显示目标病变与胆囊不连续，位于肝圆韧带内。术中发现促使我们进行胆囊切除术并切除相邻的囊性肿瘤。囊内肿瘤大小为3 cm，囊壁内有微小实性成分。对疑似胆囊癌的病理研究显示，上皮样细胞和梭形细胞分别呈片状和束状生长。囊壁主要由细胞成分较少的纤维组织构成。肿瘤的免疫组织化学染色CD117呈阳性，结蛋白和S100均呈阴性，从而诊断为胃肠道间质瘤。胃肠道间质瘤的MIB-1标记指数为8%。患者恢复顺利，3个月来情况良好，无任何复发。
