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Image of the Month—Quiz Case FREE

Bishwajit Bhattacharya, MD; Umadevi S. Katta, MD; Marcelo Facciuto, MD
[+] Author Affiliations

Author Affiliations: Departments of Surgery (Drs Bhattacharya and Facciuto) and Pathology (Dr Katta), New York Medical College, Valhalla.


Arch Surg. 2011;146(5):627. doi:10.1001/archsurg.2011.99-a.
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A 35-year-old Hispanic man presented to the emergency department with a 5-week history of abdominal pain. The pain radiated from the right upper quadrant to his back. The patient denied any nausea, vomiting, fevers, chills, or changes in bowel habits. His medical history was significant for non–insulin-dependent diabetes for which he takes metformin and pioglitazone. The patient's social history was significant for smoking 5 to 6 cigarettes per day, and he denied alcohol use. Physical examination revealed right upper quadrant tenderness, and findings of ocular examination were negative for sclera icterus. Results of laboratory testing were significant for a total bilirubin level of 1.8 mg/dL and an indirect bilirubin level of 1.0 mg/dL (to convert to micromoles per liter, multiply by 17.104). The remainder of liver function test results were within the reference range. A complete blood cell count demonstrated a white cell count of 5.2 without a left shift. Preoperative gallbladder ultrasound demonstrated a complex heterogeneous mass in the gallbladder fossa measuring 5.4 × 5.1 × 4.6 cm, with no common bile duct dilatation. Magnetic resonance imaging obtained preoperatively is shown (Figure 1) along with a pathology specimen obtained during the operation (Figure 2).

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Figure 1.

Preoperative magnetic resonance imaging shows a gallbladder mass in the right upper quadrant.

Graphic Jump Location

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Figure 2.

Hematoxylin-eosin staining of a cross-section of the gallbladder taken next to the hepatic fossa shows foamy histiocytes with giant cells (original magnification ×4).

Graphic Jump Location

WHAT IS THE DIAGNOSIS?

A.  Cholecystitis

B.  Gallbladder adenocarcinoma

C.  Xanthogranulomatous cholecystitis

D.  Cholangiocarcinoma

Figures

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Figure 1.

Preoperative magnetic resonance imaging shows a gallbladder mass in the right upper quadrant.

Graphic Jump Location
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Figure 2.

Hematoxylin-eosin staining of a cross-section of the gallbladder taken next to the hepatic fossa shows foamy histiocytes with giant cells (original magnification ×4).

Graphic Jump Location

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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