Abstract
A 52-year-old woman visited our hospital because of nausea and right dorsal pain. On physical examination, she had a flat abdomen with mild tenderness in the right hypochondriac region, and radiating pain in the right dorsal region. Abdominal plain X-ray film showed a 5.5 × 2.5 cm high density shadow in the right upper quadrant of abdomen of which posture and shape were identical to the gallbladder. Abdominal ultrasonogram showed strong echo with acoustic shadow occupying the whole lumen of the gallbladder and cholecystolithiasis from the stones and limy bile of the gallbladder were diagnosed. After confirming that there was no abnormality in the whole bile duct by drip infusion cholangiographic computed tomography, we performed laparoscopic cholecystectomy. Resected specimens contained mixed stones, limy bile, and multiple small polyps up to 3.5 mm in diameter in the mucosa of the gallbladder. These polyps were pathologically diagnosed as adenoma, and a maximal Ip type polyp was diagnosed as early carcinoma in adenoma, proliferating and containing nuclear and structural atypia. No additional surgery was done because the surgical outcome was determined to be histopathologically curative. The patient is alive without recurrence for 4 years after cholecystectomy. Although the relations between limy bile and adenoma, carcinoma or dysplasia are unclear, it is possible that such intracholecystic condition may induce the development of those aberrances, and then further investigations are required.
