Pulappadi Vishnu Prasad, Rangarajan Krithika, Kumar Sunil
Interventional Radiology, Kovai Medical Center and Hospital, Coimbatore, IND.
Radiology, All India Institute of Medical Sciences, New Delhi, New Delhi, IND.
Cureus. 2024 Dec 16;16(12):e75790. doi: 10.7759/cureus.75790. eCollection 2024 Dec.
We report a rare case of adenosquamous carcinoma of the gall bladder (GB) causing portal vein tumor thrombus. A 40-year-old gentleman presented with acute-onset right upper abdominal pain. Ultrasonography revealed multiple calculi in the GB with wall thickening, suggesting acute cholecystitis. Intraoperatively, irregular wall thickening of GB with infiltration into the duodenum and stomach was found. Partial cholecystectomy was performed, and a histopathological examination of the resected specimen revealed adenosquamous carcinoma. PET-CT revealed a fluorodeoxyglucose (FDG)-avid lesion in the GB and the main portal vein, suggesting a tumor thrombus. Two weeks later, he developed jaundice, and contrast-enhanced CT (CECT) showed a heterogeneously enhancing mass in the GB fossa, encasing the main portal vein, with an enhancing filling defect within its lumen, suggestive of tumor thrombus. Multiple periportal and peripancreatic lymph nodes were seen, encasing the common bile duct and causing intrahepatic biliary radical dilation. Percutaneous transhepatic biliary drainage was performed, and palliative chemotherapy was started.
我们报告一例罕见的胆囊腺鳞癌导致门静脉肿瘤血栓形成的病例。一名40岁男性因突发右上腹疼痛就诊。超声检查显示胆囊内有多个结石且胆囊壁增厚，提示急性胆囊炎。术中发现胆囊壁不规则增厚并浸润至十二指肠和胃。行部分胆囊切除术，切除标本的组织病理学检查显示为腺鳞癌。正电子发射断层扫描-计算机断层扫描（PET-CT）显示胆囊及门静脉主干有氟脱氧葡萄糖（FDG）摄取增高的病灶，提示肿瘤血栓形成。两周后，患者出现黄疸，增强CT（CECT）显示胆囊窝有一不均匀强化肿块，包绕门静脉主干，管腔内有强化的充盈缺损，提示肿瘤血栓形成。可见多个肝门和胰周淋巴结，包绕胆总管并导致肝内胆管显著扩张。行经皮经肝胆道引流，并开始姑息化疗。
