Rare case of gallbladder carcinoma misdiagnosed as pancreatic adenocarcinoma in a 5 week pregnant female patient

Abstract

Background: Gallbladder carcinoma is the fifth most common gastrointestinal malignant neoplasm and the most frequent malignant tumor of the biliary tract. It has a poor prognosis, with a 50% 1-year survival rate for patients with stage 1 disease. Unfortunately, this rare disease usually presents at a more advanced stage, with a 5-year survival rate of only 5%.

Case Presentation: The present study describes a case of gallbladder adenocarcinoma presenting in a 34 years old female patient of 5 weeks gestational age in the form of a right upper quadrant pain radiating to the back. The patient had no known history of gallstones, cholecystitis, chronic H. pylori infection or other risk factors. Being 5 weeks pregnant, imaging was first restricted to an abdominopelvic ultrasound and MRI without contrast, which revealed a peri-duodenal-pancreatic mass. There was a high suspicion of pancreatic tumor after an endoscopic ultrasound FNA had revealed an adenocarcinoma, on pathology. It was only after opting for a Whipple procedure that pathology revealed that the primary tumor was a gallbladder adenocarcinoma with an 8 cm peri-pancreatic mass, represented by a poorly-differentiated adenocarcinoma, that probably developed within a lymph node. Fortunately, the patient presented early and resection was successfully performed. She is following-up with oncology for chemotherapy.

Conclusions: The purpose of this report is to highlight a rare disease occurring in a young pregnant patient, and how it was misdiagnosed as a pancreatic adenocarcinoma due to the involvement of the peri-pancreatic lymph node, the results of the EUS guided FNA, and of the preoperative imaging studies.