A case of primary gallbladder choriocarcinoma with a rapidly aggressive course after surgery

A 75-year-old man complaining of right upper quadrant abdominal pain visited another hospital, and the acute cholecystitis was suspected based on ultrasonogram (US) and computer tomography (CT) scans. He was introduced our hospital for further examination and surgical treatment. Enhanced CT scan showed a circumferential wall thickness in the middle third of the gallbladder, and revealed the abcess formation outside the gallbladder wall, too. The clinical diagnosis of suppurative cholecystitis was made, and an urgent cholecystectomy was performed. Histopathological examination incidentally showed a moderately or poorly differentiated adenocarcinoma mixed with multinucleated syncytial trophoblasts. Immunohistochemistry revealed positive staining for HCG in the trophoblastic-cell component. According to the pathological diagnosis, we performed second operation immediately for the necessity of additional hepatectomy and lymph node dissection, but radical excision was immposible because of diffuse peritoneal dissemination and multiple liver metastasis. The patient survived only about four months following the first surgery. Primary gallbladder choriocarcinoma is exceedingly rare, and the prognosis is poorer than typical gallbladder adenocarcinoma in the literature. We report a case of gallbladder choriocarcinoma which demonstrated a rapidly aggressive course after cholecystectomy.