A 60-year-old woman presents with persistent jaundice, pruritus, and dark urine for two weeks, in a background of nausea, vomiting, and intermittent upper abdominal pain for four weeks, and a 15kg weight loss over three months. Her medical, surgical, allergic, and family histories are unremarkable. She only drinks socially, does not smoke, and has never used recreational drugs. There is no history of recent foreign travel. A complete blood count is found to be within normal parameters.
AST: 292 U/L (8-48) ALT: 390 U/L (7-55) ALP: 650 U/L (45-115) GGT: 85 U/L (8-38) Tot. bilirubin: 6 mg/dL (0.1-2) Dir. bilirubin: 4 mg/dL (0.1-0.4)
There is a 7 cm × 4 cm mass in the right upper quadrant, in the usual location of the gallbladder. Peripancreatic and perihilar lymphadenopathy is present. Diffuse intrahepatic and common bile duct dilation is seen.
There is a 7.3 cm × 4.2 cm mass arising from the gallbladder and infiltrating the liver. A total of three peripancreatic and perihilar lymph nodes are enlarged. The intrahepatic bile ducts and common bile duct are markedly dilated.
ERCP reveals a wide common bile duct and dilatation of the intrahepatic duct. Biopsies reveal the presence of adenocarcinoma of the gallbladder.