Korean J Radiol.  2012 Oct;13(5):637-642. 10.3348/kjr.2012.13.5.637.

Mucin-Producing Carcinoma of the Gallbladder: Evaluation by Magnetic Resonance Cholangiopancreatography in Three Cases

• Ishiguro S
• Onaya H
• Esaki M
• Kosuge T
• Hiraoka N
• Mizuguchi
• Arai Y

• KMID: 1392944
• DOI: http://doi.org/10.3348/kjr.2012.13.5.637

Abstract

We report three cases of mucin-producing carcinoma of the gallbladder, along with the magnetic resonance (MR) findings, especially the findings on a MR cholangiopancreatography. In our cases, linear or curvilinear streaks were detected running along the long axis of an enlarged gallbladder (mucus thread sign). When such findings were seen, a mucin-producing carcinoma of the gallbladder should be included as a differential diagnosis. Thus, gadolinium-enhanced MR imaging is mandatory for the precise diagnosis of the mucin-producing carcinoma of the gallbladder.

Keyword

Gallbladder, neoplasms; Bile ducts, neoplasms; Magnetic resonance; Cholangiopancreatography; Gadolinium; Ultrasound

MeSH Terms

Adenocarcinoma, Mucinous/*diagnosis/pathology/surgery
*Cholangiopancreatography, Magnetic Resonance
Cholecystectomy
Contrast Media/diagnostic use
Diagnosis, Differential
Fatal Outcome
Female
Gadolinium DTPA/diagnostic use
Gallbladder Neoplasms/*diagnosis/pathology/surgery
Humans
Male
Middle Aged

Figure

• 

  Fig. 1 Intracystic papillary adenocarcinoma in 59-year-old man. A. Right intercostal Ultrasonography performed with 5.0 MHz probe demonstrates that tumors in fundus (arrow) and several striations of variable width (arrowheads) are almost same echogenicity. B. Thick-slab magnetic resonance cholangiopancreatography (repetition time msec/echo time msec, infinite/1023 [effective]; 60-mm-thick slab) depicts some fine hypointense striations (arrowheads) in moderately enlarged gallbladder showing marked hyperintensity. C. Axial T1-weighted fat-saturated gradient-recalled echo (175/2.1; flip angle, 70°) obtained 3 min after Gd-DTPA injection reveals well-enhanced papillary projections (arrows) in fundus that could be clearly differentiated from mucus striations. D. Microscopically, significant mucin (asterisk) sticks to surface of papillary carcinoma, and floating in mucin are clumps or strands of epithelium, some of which contain malignant cells (Hematoxylin & Eosin staining; original magnification × 200).

• 

  Fig. 2 Papillary adenocarcinoma invading subserosal layer with lymph node metastasis in 53-year-old woman. A. Coronal thin-section magnetic resonance cholangiopancreatography (MRCP) (infinite/99.6 [effective], 4-mm-thick sections) clearly shows some striations running along long axis (arrowheads) of gallbladder. B. Coronal gadolinium-enhanced T1-weighted image (150/1.8; flip angle, 70°) anterior to (A) demonstrates protruding lesion (arrow) in body of enlarged gallbladder. C. Subcostal ultrasonography performed with 9.0 MHz probe reveals hyperechoic polypoid lesion with papillary surface (arrows) that seems to produce threading striations (arrowheads) similar to those visualized on MRCP images.

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  Fig. 3 Mucinous carcinoma with peritoneal dissemination in 48-year-old woman. A. Thick-slab magnetic resonance cholangiopancreatography (infinite/1023 [effective], 60-mm-thick slab) shows two separate compartments of gallbladder. Markedly hyperintense portion near cystic duct (asterisk) corresponds to native lumen of gallbladder, while weakly hyperintense fundic part (arrows) filled with mucus materials shows hypointense streaks of mucinous carcinoma extending to highly thickened wall. Separation between two parts is seen as localized wall thickening with papillary surface observed as luminal lesion in fundus (black arrowheads). Poorly formed area of hyperintensity surrounds gallbladder (white arrowheads), which is indicative of pooled mucin due to perforation. B. Coronal gadolinium-enhanced T1-weighted image (150/1.8; flip angle, 70°) shows several papillary enhancements with irregularly thickening wall (arrows). C. Macroscopically, fundus of enlarged gallbladder was covered thickly with overflowing gelatinous mucin (arrowheads).

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