Incidental finding of gallbladder adenocarcinoma in the 2nd trimester of an otherwise healthy pregnant woman.




Cushen, Spencer
Logarajah, Shankar
Kabbani, Wareef
Osman, Houssam
Jeyarajah, Rohan


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Background Pregnancy causes an increased production of steroid sex-hormones resulting in more cholesterol laden bile and decreased gallbladder emptying. This results in greater incidence of gallbladder disease in pregnant women with 10% of pregnant women developing gallstones or sludge and a further 1% of these developing symptomatic disease. In addition to simple gallstone disease, multiple pregnancies increase the risk of gallbladder in cancer. In this Case Report, we present what is, to our knowledge, the first report of incidental gallbladder adenocarcinoma in an otherwise healthy pregnant woman. Case Presentation A 36-year-old woman presented to the emergency department with right upper quadrant abdominal pain at 16 weeks of gestation. A clinical picture of acute cholecystitis was developed and confirmed by ultrasound demonstrating sonographic Murphy's sign, gallbladder containing gallstones, 2 mm thick gallbladder wall, and pericholecystic fluid. This patient then underwent laparoscopic cholecystectomy. Routine pathologic assessment of the gallbladder demonstrated a 3.9 cm calculus, 2.5 cm wide high-grade dysplasia, and a 1.0 cm invasive, moderately differentiated adenocarcinoma. This malignant lesion extended through the wall of the gallbladder, giving it a tumor classification of pT2a. The patient was then referred to the hepatopancreaticobiliary (HPB) surgery service for completion of an extended cholecystectomy as indicated to stage the cancer and remove additional disease. After this surgery no lymph nodes, cystic duct margins, or liver sections collected for pathology demonstrated malignancy, giving the final TNM classification of pT2aN0M0R0, Stage IIA. On 6 month follow up patient had received chemotherapy and was free of evidence of malignancy on MRI. Conclusions To our knowledge this is only the second case report demonstrating a pregnant woman being diagnosed with gallbladder cancer. In the other report, the woman had Crohn's disease and gallbladder changes consistent with Crohn's disease. Therefore, this is the first presentation of an otherwise healthy pregnant woman being incidentally diagnosed with gallbladder cancer after acute gallstone disease. This report adds to the current understanding of pregnancy induced gallstone disease by providing a rare end point to such disease processes.