Abstract
A female in her 70s was admitted to our hospital because of suspected gallbladder carcinoma on abdominal ultrasonography (US) performed by her previous doctor. US showed an approximately 28-mm mild hyperechoic irregular mass and hypoechoic wall thickening at the fundus of the gallbladder. On contrast-enhanced ultrasonography (CEUS), the irregular mass was enhanced rapidly and vividly, and the wall thickening was enhanced slowly and progressively in the arterial phase. CEUS also showed branched blood vessels in the irregular mass and sparse linear blood vessels in the thickened wall. Cholecystectomy, gallbladder bed resection, and lymphadenectomy were performed. The diagnosis was adenosquamous cell carcinoma with foci of well to moderately differentiated papillary adenocarcinoma. The irregular mass and the wall thickening pathologically corresponded to papillary adenocarcinoma and adenosquamous cell carcinoma, respectively. The adenosquamous cell carcinoma showed subserosal invasion with a strong desmoplastic reaction in the stroma. It is suggested that abundant fibrotic stroma and a decrease in capillary blood vessels could have caused the difference in intralesional blood vessel pattern depicted on CEUS between the adenosquamous cell carcinoma and the papillary adenocarcinoma of the gallbladder.
