An uncommon case of gall bladder mass: gall bladder tuberculosis

Abstract

Gall bladder tuberculosis (TB) is a rare entity and differentiation of gall bladder TB from gall bladder malignancy is difficult. We hereby present an unusual case of incidental diagnosis of gall bladder TB during the evaluation of a gall bladder with suspicion of gall bladder cancer in a 49-year-old woman. The diagnosis of gall bladder TB was made with fine needle aspiration cytology (FNAC) from the gall bladder mass as the disease was found unresectable after cross-sectional imaging. Even with the advancement of cross-sectional imaging, the differentiation of gall bladder TB from gall bladder malignancy is not possible without tissue diagnosis.

Misdiagnosis of carcinoma gall bladder in endemic regions

“…morphology of thick wall was most common while micronodular type (n = 2) and mass forming type (n = 1) were also noted. Positron emission tomographic (PET) scans show increased metabolic activity, further complicating preoperative diagnosis [ 30 , 31 ]. The presence of other foci of abdominal tuberculosis in these patients can be helpful.…”

Granulomatous inflammation still fooling surgeons

“…2,3 It is characterised by focal to diffuse thickening of the gall bladder wall. 3,6 There is invariably accumulation of foamy macrophages, lymphocytes and plasma cells. Multinucleated giant cells are also seen frequently.…”

“…This is mandatory, both to save patients from unsatisfactory routine cholecystectomy where a radical procedure is indicated, as well as unnecessary radical cholecystectomy and extended hepatectomy, where no malignancy is found, as of course is the case where TB is discovered. 6 This is especially important in India where TB is common but still has a social stigma and patients tend to hide the disease.…”