A CASE OF GALLBLADDER CANCER HISTOLOGICALLY CONFIRMED BY DIRECT BIOPSY OF THE GALLBLADDER WALL UNDER LAPAROSCOPY

Abstract

A 81-year-old female complained of abdominal fullness and pain and low grade fever for 2 months due to cholecystitis and/or cholelithiasis. US demonstrated mild dilatation of the intrahepatic bile duct and thickening of the gallbladder wall with a gallstone. Gallbladder wall was 11 mm thick. Laboratory data on admission showed mild anemia and abnormal liver function tests : AST/ALT 628/461 IU/1, LDH 917 IU/1, biliary enzymes 4-8 times as high as the upper normal limit. AFP and CEA were within normal limits and CA 19-9 was 4 times as high as the upper normal limit. CT revealed the same findings as US. ERCP was tried in failune to disclose the fine structure of the biliary system. Laparoscopy showed cholestatic left lobe of the liver with multiple yellowish spots suggestive of metastases. Two metastatic foci of the ligamentum teres ware observed, one of which being histologically diagnosed as poorly differentiated adenocarcinoma after forceps biopsy. Gallbladder adhered to the adjacent tissue. Direct forceps biopsy was carried out to the gallbladder wall. Histology was the same as that of ligamentum teres.