Paraganglioma of the Gallbladder: An Extremely Rare Pathology.

Abstract

We report an extremely rare case of gallbladder paraganglioma which was discovered incidentally, during a chest CT scan study of a 79-yr-old male for his underlying emphysema. He was asymptomatic with no abdominal pain, anorexia or jaundice. His abdominal CT scan showed a gallbladder mass which was intensely enhanced in the arterial phase. He underwent a laparoscopic cholecystectomy. His gallbladder histopathology concluded a completely resected non-chromaffin paraganglioma. The source of this gallbladder paraganglioma is likely from the paraganglionic cells along the vagi fibres which innervate the gallbladder. Chronic hypoxia is likely the risk factor for his paraganglioma. Paraganglioma should be considered in the differential diagnosis when investigating a gallbladder mass, particularly in patients with a history of chronic airway disease.

Introduction

We present a 79 year old male who referred to the Upper GI unit of a tertiary hospital with a suspicious gallbladder wall mass, detected incidentally on a CT scan of his chest for his underlying emphysema.

He was asymptomatic with no upper abdominal pain, vomiting or jaundice. Physical examination was unremarkable as was full blood count and liver function tests. Synaptophysin and chromogranin stained cells (o) with round to oval nuclei showing granular chromatin and eosinophilic cytoplasm [b] Cells are arranged in a trabecular and nested pattern (Zellballen) [c] SOX 10 positive sustentacular cells (s) are arranged at the periphery of the poorly formed nest of chromogranin and synaptophysin positive cells.

The patient made an uneventful recovery after being discharged on day one post-operative period. This case was discussed at a surgical oncology multi-disciplinary meeting and no further treatment was required.

Best Regards
Sarah Jhonson
Managing Editor
International Journal of Case Reports
Email: caserep@emedicalsci.org