A Tumor in Disguise: Gallbladder Tumor Presenting as Hepatic Abscesses

Gallbladder tumors are the most common tumors of the biliary tract. They are rare but clinically aggressive tumors found either as metastatic disease or occasionally detected upon the histopathological assessment of cholecystectomy biopsy. Adenocarcinoma is the most common phenotype of gallbladder cancer, which can be mild to moderately differentiated. Other malignant phenotypes include mucinous adenocarcinoma, signet cell, small cell, papillary adenocarcinoma, intestinal type adenocarcinoma, and undifferentiated carcinoma. The rarity of the disease makes the diagnosis extremely difficult in the initial phases. Liver abscesses are extremely rare and scarcely reported presentation of gallbladder cancer, with only a handful reported cases. It is speculated that the development of hepatic abscesses depicts direct involvement of hepatic parenchyma, development of associated necrosis, and superimposed bacterial infection evolving to an abscess. Gallbladder perforations are rare and potentially life-threatening complications of any gallbladder disease. Increased intraluminal pressure leads to mural necrosis, emphysematous changes in the wall, and vascular compromise which leads to gallbladder wall necrosis leading to perforation. Gallbladder tumors are exceedingly notorious for poor outcomes with very limited survival. Here, we present a case of a 69-year-old male who initially presented with impending perforation of the gallbladder with multiple hepatic masses, which were thought to be metastatic deposits. However, on biopsy, he was found to have multiple hepatic abscesses due to localized necrosis. Further workup revealed that the patient had an advanced metastatic gallbladder tumor that had passed the stage of tumor resection. Gallbladder perforations are classified according to Niemeier's classification. Our patient had a type II perforation which resulted in a hepatic abscess.