A 62-year-old woman presents with progressive jaundice, weight loss, and clay-colored stools. Transabdominal ultrasound shows a heterogeneous ill-defined mass in the gallbladder fossa replacing most of the gallbladder lumen, with multiple gallstones embedded in the mass and direct infiltration of segment V of the liver. The MOST likely diagnosis is:

• A Xanthogranulomatous cholecystitis
• B Hepatocellular carcinoma invading the gallbladder
• C Gallbladder carcinoma ✓
• D Metastatic melanoma to the gallbladder

Explanation

Gallbladder carcinoma most commonly presents as an infiltrative mass replacing the gallbladder with associated gallstones (present in over 90% of cases) and direct hepatic invasion. Xanthogranulomatous cholecystitis can mimic malignancy but typically shows intramural hypoechoic nodules without frank liver invasion. HCC invading the gallbladder is uncommon and usually shows arterial enhancement rather than the hypoechoic infiltrative pattern described.

Reference: Hepatobiliary Imaging, Gillian (Abdominal Imaging series) ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.