Usefullness of contrast-enhanced ultrasonography in the preoperative diagnosis of gallbladder carcinoma with gallbladder adenomyomatosis

Abstract

It is difficult to diagnose polypoid lesions of the gallbladder. We experienced a case of gallbladder carcinoma with adenomyomatosis (ADM) in which contrast-enhanced ultrasonography (CE-US) was useful for the differential diagnosis of a polypoid lesion.
A 58-year-old man was pointed out having a polypoid lesion in the gallbladder by screening US in February 2009, and he was referred to our facility for further examinations. In the laboratory data, CEA was elevated to 8.3ng/ml. Abdominal CT and MRI showed the polypoid lesion but failed to determine whether it was malignant or not. Base line US showed a hypoechoic area in the gallbladder bed suggestive of invasion of the tumor. Since US examination indicated the invasion of the tumor to the gallbladder bed, CE-US was performed. CE-US showed strongly diffused enhancement pattern in the localized papillary lesion adjacent to ADM. This finding strongly suggested the possibility of malignancy and we performed extended cholecystectomy with liver parenchymal resection. Papillary adenocarcinoma of the gallbladder with segmental ADM was identified macroscopically. The pathological diagnosis was tub1>pap s(-), ss, pHinf0, pBilf0, pPV0, pA0, pN0, pBM0, pHM0, pEM0, int INFβ, pn0, ly0, v0, pT2, pN0, and fStageII. We conclude that CE-US is available for making the differential diagnosis of polypoid lesions of the gallbladder. It is important to make a decision of treatment after taking every finding of examinations into consideration.