Synchronous carcinoma of the gallbladder in a patient with intrahepatic bile duct carcinoma

An 83-year-old woman, diagnosed as having cholelithiasis, was admitted to t he Department of Surgery, Nippon Medical School, with right hypochondrial; pain. Ultrasonography and computed tomography revealed a mass in the gallbl adder fundus and a hypovascular tumor in the anterior segment of the liver. Magnetic resonance imaging showed stenosis of the intrahepatic bile duct a nd dilatation of its proximal portion. She was diagnosed as having intrahep atic bile duct carcinoma combined with gallbladder carcinoma. At laparotomy , there was evidence of multiple peritoneal metastases and intraoperative h istological examination of the gallbladder tumor revealed adenocarcinoma. A ccordingly, only cholecystectomy and needle biopsy of the liver tumor was p erformed. Histological examination of the gallbladder revealed papillary ad enocarcinoma invading the muscularis propria with medullary growth or inter mediate stroma. There was no microvessel invasion, no perineural invasion a nd no lymph node involvement. On the other hand, the liver tumor was a chol angiocarcinoma with a well-differentiated tubular pattern. Therefore, this was a rare case of synchronous carcinoma of the gallbladder associated with intrahepatic bile duct carcinoma.