Table 2

Summary of case details in problematic cases:


Clinical Presentation


Gross Description

Final Diagnosis


66 yo male

abdominal pain, 4 years post cholecystectomy for ruptured cholecystitis and cholelithiasis

CT: peritoneal carcinomatosis and free fluid

Peritoneal implants with slight granular thickening of peritoneum

Gallbladder wall 5 mm thick no mass, and gallstones in the lumen

Well differentiated adenocarcinoma of the gallbladder and peritoneal metastasis


49 yo female

On routine examination, pelvic mass and gallbladder polyp were found with no remarkable clinical symptoms

CT: an enhancing 2 cm mass in the GB fundus.

US: heterogeneous mass with associated internal flow worrisome for GB malignancy: cholelithiasis

Polypoid mass protruding from a stalk (4.0 × 2.3 × 1.4 cm) gallstones. On cut section the polyp was white tan, homogeneous throughout

Combined adenocarcinoma and neuroendocrine carcinoma, poorly differentiated


86 yo female

Three days of RUQ pain, nausea, fever. History of breast cancer S/P mastectomy 7 years ago, treated with Tamoxifen, squamous cell carcinoma of nose, ovarian cyst removal

US & CT: gallstones and sludge; pancreatic head mass

BG 9.5 × 6.5 × 6.0 cm. seven firm yellow to black multi-faceted calculi. GB wall thickened to 1.5 cm. Mucosa lined by friable pale tan necrotic tissue extruded into lumen. 3.5 cm maximal tumor size, circumferential at neck and filling up to 30% of the luminal volume

Pancreatic biopsy: adenocarcinoma with abundant lymphocytes. GB: Undifferentiated carcinoma of GB with extensive necrosis and acute/chronic inflammation


53 yo female

Increasing abdominal girth over several months

CT & US: moderate volume ascites, 18.5 cm complex right pelvic mass; GB: 1.8 cm polyp

A 5 cm appendix filled with yellow-tan mucoid material.

Gallbladder was 7.3 × 3 cm in greatest dimensions with a flesh colored lesion presenting in the serosa. The mucosa was unremarkable

Low grade mucinous neoplasm/adenocarcinoma of the appendix with peritoneal spread


45 yo female

RUQ pain


Mural thickness 5 mm; no mass; stones up to 2.5 cm

Focally invasive adenocarcinoma; extensive CIS involving RAS

Abbreviations: GB = gallbladder; CT = computed tomography scan; US = ultrasound examination; RAS = Rokitansky-Aschoff sinuses; RUQ = right upper quadrant; CIS = carcinoma in situ; S/P = status-post

Giang et al. Diagnostic Pathology 2012 7:10   doi:10.1186/1746-1596-7-10

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