Clin Endosc > Volume 56(1); 2023 > Article
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Kim and Lee: A rapidly growing round mass in the gallbladder


A 72-year-old man was admitted for an abnormal gallbladder lesion on follow-up abdominal computed tomography (CT). He had a surgical history of hemicolectomy for sigmoid colon cancer two years ago. A physical examination of the abdomen showed a flat and non-tender abdomen. Blood chemistry and tumor marker tests, including CA19-9 results, were all within normal ranges.
Abdominal CT during the follow-up period after surgery showed minimal ovoid-shaped gallbladder wall thickening in the fundus lesion, suggesting fundal adenomyomatosis (Fig. 1A). Therefore, a follow-up CT was performed six months later for gallbladder lesions, which revealed an increased cystic mass lesion on the fundus of the gallbladder (Fig. 1B). Endoscopic ultrasonography (EUS) later revealed an approximately 2×1 cm elliptical wall thickening on the fundus (Fig. 2). The mucosal and serosal layers were well-preserved, and multiple internal hyperechogenic spots and hypoechoic lesions were mixed within a round, mass-like lesion. Moreover, no bile duct dilatation or lymph node enlargement was observed around the bile duct. What is the most likely diagnosis?


Conflicts of Interest
Tae Hoon Lee is currently serving as a section editor of Clinical Endoscopy; however, he had not involved in the peer reviewer selection, evaluation, or decision process of this article. The authors have no potential conflicts of interest.
Author Contributions
Conceptualization: THL, HJK; Data curation and Investigation: HJK; Writing–original draft: THL; Writing–review & editing: HJK, THL.

Fig. 1.
Abdomen computed tomography (CT) findings. (A) Enhanced CT showed focal enhancement and wall thickening on the fundus (yellow arrow) of the gallbladder without disruption of the wall layer. (B) A follow-up CT showed similar findings, but with enlarged enhancing wall thickening and a hypodense lesion on the gallbladder fundus (yellow arrow). Direct liver invasion or wall disruption of the gallbladder was not definitive.
Fig. 2.
Endoscopic ultrasound image shows about 2×1 cm sized elliptical wall thickening without disruption of the wall layer. Internal echogenicity was mixed with diffuse hyperechoic spots and hypoechoic lesions.
Fig. 3.
Pathologic features of the resected specimen. (A) A Low-power field (hematoxylin and eosin stain, ×10) showed Rokitansky-Aschoff sinuses resulting from hyperplasia and herniation of epithelial cells through the fibromuscular layer of the gallbladder wall. (B) A high-power field (hematoxylin and eosin stain, ×100) revealed abundant infiltration of foamy histiocytes, lymphocytes, and multinucleated giant cells.


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