Rare Case of Metastatic CLL Presenting as Focal Mass in the Gallbladder
Posted: Monday, May 24, 2021
A rare case of metastatic chronic lymphocytic leukemia (CLL) presenting as a focal mass in the gallbladder, described in Radiology Case Reports, was diagnosed after extensive surgical resection. According to Andrij R.Wojtowycz, MD, of SUNY Upstate Medical University, Syracuse, and colleagues, early diagnosis of this disease may allow for proper treatment with chemotherapeutic agents and potentially avoid unnecessary surgery.
A 67-year-old woman with a history of hyperlipidemia, mild jaundice, and untreated and indolent CLL presented with elevated levels of total bilirubin. Ultrasonography revealed a slightly echogenic liver without intrahepatic ductal or common bile duct dilation. Multiple echogenic foci were found in the distended gallbladder, with accompanying pericholecystic fluid and edema; this led to the presumptive diagnosis of cholelithiasis with possible acute cholecystitis.
A CT scan revealed common bile duct dilatation with portacaval and porta hepatis lymphadenopathy; the gallbladder wall was reported to be indistinct, and cholelithiasis was present. Further MRI evaluation showed cholelithiasis in the gallbladder neck, a thickened gallbladder wall, and common bile duct dilatation; the findings were consistent with possible acute cholecystitis.
The patient underwent endoscopic retrograde cholangiopancreatography after experiencing an increase in bilirubin levels; a biliary tract obstruction was identified. Fine-needle aspiration of the largest porta hepatis node demonstrated findings consistent with CLL. After undergoing these procedures, her bilirubin levels decreased. One month later, cytopathologic analyses of biliary duct brushings revealed biliary adenocarcinoma with local extension. After receiving a chemotherapeutic regimen, she underwent an extended hepatectomy with extrahepatic bile duct resection and cholecystectomy. The surgical pathology revealed small lymphocytic lymphoma without evidence of primary hepatic or biliary carcinoma. After 2 years of follow-up, there did not seem to be evidence of disease recurrence.
“Radiologists must remember that gallbladder lymphoma can present as an infiltrative process or as a distinct mass arising from the gallbladder wall,” the investigators concluded.
Disclosure: The study authors reported no conflicts of interest.