Gallbladder Tuberculosis Mimicking Gallbladder Carcinoma: A Case Report and Literature Review

Metastatic Gallbladder Carcinoma to Pleura with Gallbladder Tuberculosis - Case Report with Literature Review

Gallbladder carcinoma (GBC) is the most common malignant tumor of the biliary system and presents with frequent locoregional lymphadenopathy and distant metastasis. Gallbladder tuberculosis (GT) is rare abdominal tuberculosis (TB). GBC and GT mimic each other. The clinical examinations and radiographic investigations sometimes fail to exhibit the difference between these two which are confirmed only after postoperative histopathological assessment. Herein, we report a patient of GBC with coexistent GT with pleural metastasis and pleural effusion. We emphasize the importance of differential diagnosis of the two conditions, with similar signs and symptoms. The pleura is an extremely rare site of spread of GBC as seen in our patient.

Isolated gallbladder tuberculosis in an 84-year old man: A rare case report

INTRODUCTION

Isolated gallbladder tuberculosis is extremely rare even in endemic regions posing diagnostic challenges as the presentation mimics other gallbladder diseases such as cholecystitis and gallbladder carcinoma. Preoperative suspicion index is negligible with most cases being diagnosed postoperatively from resected specimen.

CASE PRESENTATION

Herein, we report an elderly man who presented with jaundice, and was clinically diagnosed with gallbladder carcinoma.

DISCUSSION

Histopathology of resected gallbladder revealed gallbladder tuberculosis. No features of tuberculous infection were found elsewhere.

CONCLUSION

Healthcare providers should have a high index of suspicion particularly for patients in endemic areas presenting with cholecystitis to obtain a pre-operative diagnosis.

Gallbladder Tuberculosis Presenting as Obstructive Jaundice

Isolated gallbladder tuberculosis is a rare entity, even in endemic zones. Preoperative diagnosis is usually not possible, with most of the cases being diagnosed either as cholecystitis or malignancy. Histopathological examination of the resected specimen clinches the diagnosis. We present a middle-aged man with obstructive jaundice who was diagnosed to have gallbladder malignancy clinically and radiologically and on microscopy, and was diagnosed as gallbladder tuberculosis with the involvement of the common bile duct.

Tuberculosis of the gallbladder-another one of its many faces

Abdominal tuberculosis is not uncommon in developing countries which usually presents as involvement of ileo-caecal junction. Involvement of gall bladder by tuberculosis is rare and thus, imaging diagnosis is unlikely. The diagnosis is confirmed only on histopathology. We present a case of a middle-aged Indian female with tuberculosis of gall bladder who was diagnosed after image guided biopsy and was managed with anti-tubercular treatment.

Histopathological findings in cholecystectomies specimens: A single institution study of 20 584 cases

BACKGROUND

The histopathological examination of cholecystectomy specimens has not been standardized with a debate concerning the routine and the selective approach. The aim of this study was to assess the information obtained from routine histopathological examination of cholecystectomy specimens.

METHODS

All histopathological reports of cholecystectomy specimens between January 2003 and December 2016 were analyzed, including a clinical diagnosis of benign gallstone disease or cholecystitis.

RESULTS

A total of 20,584 reports were examined. The mean age of patients was 54.2 years. Patients aged more than 60 years represent 37.6% of the study population. Of all patients, 15,973 (77.6%) were females. Incidental gallbladder cancers (GBC) were present in 155 cholecystectomies specimens (0.8%). 67.1% of GBC are at T2 and T3 stage. Granulomatous cholecystitis was diagnosed in only 19 cases (0.1%). GBC were more prevalent in older patients (P < 10^-6) and cholesterolosis was more prevalent in young patients (P < 10^-6). There was no gender predilection for GBC (P = 0.739).

CONCLUSIONS

The rate of incidental gallbladder carcinoma in our study is low, yet, we found a higher proportion of T2 and T3 carcinomas stage. Granulomatous cholecystitis may need further investigations and treatments. When a selective approch of histopathological examination of cholecystectomy specimens is used, it is important to take into account that clinical parameters are significantly associated with gallbladder cancer.

Gallbladder tuberculosis camouflaging as gallbladder cancer - case series and review focussing on treatment

INTRODUCTION

Gallbladder tuberculosis, in an endemic region, is a common infectious etiology affecting a rare organ. The high prevalence of carcinoma gallbladder in the endemic regions of tuberculosis, like India, poses diagnostic dilemma.

CASE SERIES

We are reporting three cases of gallbladder tuberculosis mimicking carcinoma gallbladder of which the first two cases were operated with a presumptive diagnosis of malignancy. The third case presented to us after laparoscopic cholecystectomy elsewhere and on evaluation was found to have disseminated tuberculosis.

DISCUSSION

The lack of pathognomonic clinical and radiological characters results in histological surprise of gallbladder tuberculosis following surgery performed for other indications like malignancy. In preoperatively diagnosed patients medical management plays pivotal role in management. Surgery is required in symptomatic patients. On the other hand, histologically proven cases following surgical resection require antitubercular therapy.

CONCLUSION

Previous history of tuberculosis or concomitant tuberculosis at other sites may provide clue to the diagnosis of biliary tuberculosis. Antitubercular treatment after surgery plays an important role in preventing further dissemination.