Malignant Portal Vein Thrombosis in Adenosquamous Carcinoma of the Gall Bladder

We report a rare case of adenosquamous carcinoma of the gall bladder (GB) causing portal vein tumor thrombus. A 40-year-old gentleman presented with acute-onset right upper abdominal pain. Ultrasonography revealed multiple calculi in the GB with wall thickening, suggesting acute cholecystitis. Intraoperatively, irregular wall thickening of GB with infiltration into the duodenum and stomach was found. Partial cholecystectomy was performed, and a histopathological examination of the resected specimen revealed adenosquamous carcinoma. PET-CT revealed a fluorodeoxyglucose (FDG)-avid lesion in the GB and the main portal vein, suggesting a tumor thrombus. Two weeks later, he developed jaundice, and contrast-enhanced CT (CECT) showed a heterogeneously enhancing mass in the GB fossa, encasing the main portal vein, with an enhancing filling defect within its lumen, suggestive of tumor thrombus. Multiple periportal and peripancreatic lymph nodes were seen, encasing the common bile duct and causing intrahepatic biliary radical dilation. Percutaneous transhepatic biliary drainage was performed, and palliative chemotherapy was started.