A case of gallbladder carcinoma with infiltration into the muscular layer that resulted in relapse and death from metastasis to the liver and lymph nodes.

An eighty-six-year old woman was submitted to simple cholecystectomy and choledocholithotomy for acute obstructive cholangitis due to cholecysto-choledocholithiasis. At the operation, neither lymphogenic nor hematogenic metastasis was observed. Grossly, a protuberant lesion with an uneven surface and obscure borders was seen spread over the fundus and the body of the resected gallbladder. Histologically, it was a well-differentiated adenocarcinoma with slight invasion to the muscular layer. The patient died of recurrent carcinoma three years and eight months after the operation. At autopsy, multiple metastatic tumors were found in both lobes of the liver, and many lymph node metastases around the hilus of the liver, hepatoduodenal ligament and pancreas were also observed. It is strongly believed that gallbladder carcinomas that infiltrate the muscular layer should be classified as early-stage carcinomas with a fair prognosis, together with mucosal carcinomas. However, on the basis of the present case of relapse following simple cholecystectomy as described above, radical cholecystectomy including a wedge resection of the liver and dissection of the regional lymph nodes would seem necessary even for gallbladder carcinoma with infiltration into the muscular layer.