Villous adenoma of gallbladder in a patient with systemic lupus erythematosus
A 69-year-old female patient was admitted in Zhejiang Provincial People's Hospital in 2011 for investigation of a gallbladder mass. She had a 15-year history of cholelithiasis (a gallstone measuring 2 cm diameter) detected by screening ultrasonography in a local hospital. No computed tomography (CT) examination had been performed before. She was also a known case of SLE diagnosed 10 years previously. Symptoms of SLE were controlled with methylprednisolone (8 mg/day) and azathioprine (100 mg/week).\nOn admission, her general condition was good with no history of fever, nausea, vomiting, epigastric pain, or weight loss. Tumor markers including AFP, CEA, CA125, CA19-9, CA15-3, and CA72-4 were within normal ranges, and blood chemistry tests revealed alanine aminotransferase (ALT) 22 μ/l (normal range 0-50 μ/l), aspartate aminotransferase (AST) 26 μ/l (normal range 10-52 μ/l), total bilirubin (TBIL) 16.2 μmol/l (normal range 3.4−24 μmol/L). White blood cells were 5.55 × 109/l, and blood sedimentation rate was 17.0 mm/h (normal <20 mm/h).\nAbdominal ultrasonography showed two irregular iso-echoic masses within the lumen of the gallbladder, the bigger one's cross-section size was about 7.6 cm × 4.7 cm. There was no detectable extension through the gallbladder wall or invasion of adjacent structures []. CT showed two broad-based cauliflower-like masses in the gallbladder, from which the bigger mass was about 7.4 cm × 5.1 cm, and the smaller one 4.1 cm × 3.6 cm. The lesions measured 31-36 Hounsfield Unit on non-contrast CT and showed intense enhancement after administration of iodinated contrast material []. There was no evidence of extra-gallbladder extension or metastatic disease.\nMagnetic resonance imaging (MRI) clearly identified the lesions. The mass in the body of the gallbladder was approximately 5.4×7.6×7.9 cm3 while the lesion in the fundus measured about 4.0×4.0×4.5 cm3. On T1-weighted images, the lesions were iso-intense to the liver, whereas on T2-weighted images, they showed high signal intensity []. A gallstone was noted in all imaging studies. The biliary system appeared normal and no associated hepatic lesions were detected.\nOpen cholecystectomy was performed and regional lymph nodes were removed. Histopathology revealed villous adenoma with regular arborization of the villo-tubular adenomatous epithelium. Most of the microscopic fields showed mild−moderate-grade epithelial dysplasia []. No cancerous epithelium was observed in specimens with hematoxylin−eosin staining. The regional lymphoid nodes showed chronic inflammatory reaction. After 17 months of follow-up, the patient reports no complaints.