A 40-year-old woman presents with a long history of vague upper abdominal pain and frequent indigestion with abdominal tenderness. Serum bilirubin is elevated (4.2 mg/dL). There is a mild increase in serum AST and ALT (62 and 57 U/L, respectively) and a moderate increase in alkaline phosphatase (325 U/L). Markers for viral hepatitis are negative. Abdominal ultrasound examination shows echogenic stone-like material within the gallbladder and thickening of the gallbladder wall. An intrahepatic mass is also visualized adjacent to the gallbladder. A cholecystectomy is performed. Histologic examination shows dense fibrosis and glandular structures in the wall of the gallbladder. What is the most likely diagnosis?: (A) Carcinoma of the gallbladder, (B) Hemangiosarcoma, (C) Hepatic adenoma, (D) Hepatocellular carcinoma
Answer is A. Adenocarcinoma of the gallbladder Arises from the mucosal surface epithelium - Obstructive jaundice (as in this case) by involvement of the extrahepatic biliary tree. The other choices are not associated with a history of chronic cholecystitis and cholelithiasis and infrequently cause obstructive jaundice.