A 40-year-old woman presents with a long history of vague upper abdominal pain and frequent indigestion. Physical examination reveals an obese woman with jaundice and abdominal tenderness. Serum bilirubin is elevated (4.2 mg/dL). There is a mild increase in serum AST and ALT (62 and 57 U/L, respectively) and a moderate increase in alkaline phosphatase (325 U/L). Markers for viral hepatitis are negative. Abdominal ultrasound examination shows echogenic stone-like material within the gallbladder and thickening of the gallbladder wall. An intrahepatic mass is also visualized adjacent to the gallbladder. A cholecystectomy is performed. Histologic examination shows dense fibrosis and glandular structures in the wall of the gallbladder. What is the most likely diagnosis?
High-Yield Explanation
Adenocarcinoma of the gallbladder is an incidental finding in 2% of patients who undergo gallbladder surgery due to chronic cholelithiasis. The tumor arises from the mucosal surface epithelium and may cause obstructive jaundice (as in this case) by involvement of the extrahepatic biliary tree. The other choices are not associated with a history of chronic cholecystitis and cholelithiasis and infrequently cause obstructive jaundice.Diagnosis: Carcinoma of the gallbladder