# Adenocarcinoma of the gallbladder: an incidental histopathological finding post-operative laparoscopic cholecystectomy in Saudi Arabia

## TL;DR

A case of gallbladder cancer was discovered after a routine surgery for gallstones in a 68-year-old Saudi woman, highlighting the importance of checking all removed gallbladders for cancer.

## Contribution

This case emphasizes the need for routine histopathological examination of cholecystectomy specimens to detect silent gallbladder cancer.

## Key findings

- Gallbladder adenocarcinoma was detected incidentally in a patient with no visible mass or symptoms.
- Histopathology revealed moderately differentiated cancer reaching the gallbladder's hepatic surface.
- No metastasis was found, and the patient was advised regular follow-up with specialists.

## Abstract

Gallbladder adenocarcinoma (GBC) is a rare and challenging diagnosis, often associated with chronic gallstones and discovered incidentally during histopathological examination. It may present in early or late stages without overt clinical or radiological signs. Laparoscopic cholecystectomy is commonly performed for gallstones, and in such cases, gallbladder cancer may be detected even in the absence of a visible mass or atypical clinical presentation. A 68-year-old female with no significant medical history presented with a gallstone, confirmed via abdominal ultrasound, showing multiple stones and sludge. The patient underwent an elective laparoscopic cholecystectomy without intraoperative complications, such as bile spillage, significant bleeding, or organ injury. Postoperative recovery was uneventful, with no additional symptoms. Histopathological analysis revealed grade 2 (moderately differentiated) adenocarcinoma extending to the hepatic surface of the gallbladder. Gallbladder adenocarcinoma can present silently in its early stages, underscoring the importance of histopathological examination of all cholecystectomy specimens, especially in older patients with gallstones. Avoidance of bile spillage during surgery is crucial for improving prognosis. Further metastatic evaluation through chest, abdominal, and pelvic CT shows no abnormalities in this case. Regular follow-up with hepatobiliary and oncology teams was recommended.