A 70-year-old male was admitted to our hospital due to high level of serum CA19-9 and the presence of major papilla swelling by CT examination. We could not confirm the presence of malignant cells at initial EGD and ERCP. Although serum CA19-9 level was further increased, PET-CT showed no FDG accumulation. Thereafter, serum CA19-9 level was further increased up to 5612.9U/ml, and second CT examination showed minor worsening of gallbladder wall thickness suspected of gallbladder cancer. Then, we could confirm the presence of gallbladder cancer cell by gallbladder bile juice cytology following ENGBD. And, EUS-FNA specimens from swelling lymph node around pancreas head (#13b) showed adenocarcinoma. Finally the patient was diagnosed with unresectable gallbladder cancer.
Therefore, EUS-FNA was considered to be useful to avoid unnecessary surgery in this case.
