VCOM Louisiana Research Day Program Book 2024

Case Studies

Austin Bordelon, OMS-IV; James Bordelon, Jr., MD, FACS; George Collins, DO, FCAP VCOM-Louisiana; Avoyelles Hospital; Delta Pathology 58 RING OF POWER: SIGNET RING CELL CARCINOMA OF THE GALLBLADDER PRESENTING AS ACUTE CHOLECYSTITIS

Background: We describe the case of a 71 year old female patient with a history of hypertension and peptic ulcer disease that presented to the emergency department with recurrent epigastric pain for the last two weeks. Her physical exam revealed mild epigastric tenderness with no rebound or guarding. Her vitals were stable. Her gallbladder ultrasound shows multiple gallstones and sludge with wall thickening and pericholecystic fluid, as well as a positive sonographic Murphy’s sign. Her abdominal and pelvic CT with contrast showed dilatation of the proximal portion of the common bile duct without dilation of the distal common bile duct or choledocholithiasis and some enlarged periportal lymph nodes. General surgery was consulted and a laparoscopic cholecystectomy with intraoperative cholangiography was recommended. Intraoperatively, the gallbladder showed evidence of severe inflammation and gangrene and was non-compressible. The specimen was submitted to pathology for further evaluation. She was admitted to the hospital for 3 days with a non-eventful hospital course. Pathology determined the presence of poorly differentiated signet ring cell carcinoma of at least 7.8 cm with diffuse pattern of gallbladder wall invasion with multifocal perforation of serosa (pT3-pN-pM). She was referred to

medical oncology and surgical oncology for further evaluation. Conclusions: Signet ring cell carcinoma of the gallbladder is an incredibly rare and poorly understood phenomenon, representing less than 3% of all gallbladder cancers. Signet ring cell carcinoma on gross examination presents with a thickened gallbladder wall and has often been compared to “linitis plastica” of the stomach. This finding seems consistent in our case as our tumor measured at a maximal thickness of 0.8 cm throughout the fundus, body, and distal neck of the gallbladder. Additionally, the gallbladder was non-compressible, making retrieval through the trocar site difficult. A diagnosis of signet ring cell carcinoma of the gallbladder could be made erroneously as there are other neoplastic and nonneoplastic conditions that mimic signet ring cell carcinoma. The presence of pigmented stones in this patient may be a reflection of her age and chronic bile stasis as she does not have a history of any hematological disorder. Proper staging of signet ring cell carcinoma of the gallbladder requires further lymph node retrieval and a segment IV or V hepatic resection. This case reinforces the importance of routine histological examination of cholecystectomy specimens.

81 2024 Via Research Recognition Day