Ann Hepatobiliary Pancreat Surg.  2021 Nov;25(4):566-570. 10.14701/ahbps.2021.25.4.566.

Gallbladder paraganglioma with hemorrhage: A case report and literature review

Affiliations
  • 1Department of Surgery, Chonnam National University Medical School, Gwangju, Korea
  • 2Department of Surgery, Mokpo Jung-Ang Hospital, Mokpo, Korea

Abstract

Gallbladder paraganglioma (GP) is a rare tumor, with only 12 cases reported in the literature to date. Due to its rarity, clinical information of GP is insufficient. We present a case of GP in a 48-year-old female along with a literature review of all GP cases described to date. A 48-year-old female presented with intermittent right upper abdominal pain. Preoperative imaging revealed a hematoma in the gallbladder lumen without any definite etiology. Laparoscopic cholecystectomy was performed. Gross examination of the gallbladder revealed multiple small stones and a large hematoma as well as a 1.6-cm-sized polypoid mass at the gallbladder fundus. Microscopic study of the polypoid mass showed a zellballen appearance. Immunohistochemical analysis revealed that the mass was positive for synaptophysin, CD56, and chromogranin, suggesting GP. GP is difficult to diagnose because of non-specific clinical findings. Almost all GP cases are diagnosed based on histologic findings after cholecystectomy. Simple cholecystectomy was performed as a treatment in all reported cases of GP, including our case. There was no postoperative tumor recurrence or metastasis after surgery.

Keyword

Gallbladder; Paraganglioma; Cholecystitis; Hemorrhage; Cholecystectomy

Figure

  • Fig. 1 Abdominal ultrasonography showing gallbladder distention (A) and an 8.0-cm × 5.0-cm sized heterogenous mass in the gallbladder lumen (arrow in B).

  • Fig. 2 (A, B) Abdominal computed tomography showing an 8.7-cm × 5.3-cm sized uniformly contrasted mass (arrows) and calcification in the gallbladder.

  • Fig. 3 Abdominal magnetic resonance imaging show an 8-cm-sized mass in the gallbladder body and fundus, with uneven high signal intensity on T1-weighted imaging (arrow in A) and uneven low signal intensity on T2-weighted imaging (arrow in B).

  • Fig. 4 Surgical specimen of the gallbladder revealing a large intraluminal hematoma (A) and an approximately 1.6-cm-sized polypoid mass at the fundus (arrow in B).

  • Fig. 5 Microscopic findings of the polypoid mass showing a zellballen pattern (pink boundary; H&E, ×200) (A). In immunohistochemical staining, tumor cells were positive for CD56 (B; ×200), synaptophysin (C; ×200), and chromogranin (D; ×200).


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