Incidental Gallbladder Carcinoma Discovered during Living Liver Donor Evaluation

Gallbladder cancer (GBC) is the most common and aggressive malignancy of the biliary tract, often diagnosed at an advanced stage with a poor prognosis due to its typically insidious onset and nonspecific symptoms. Early-stage GBC is usually asymptomatic and most frequently discovered incidentally following cholecystectomy for presumed benign disease. This case report details the rare incidental discovery of GBC in a potential living liver donor, an individual significantly younger than the typical demographic for this cancer, highlighting the value of comprehensive donor screening protocols.

A 45-year-old asymptomatic Arab female with no significant medical history was evaluated as a potential living liver donor for her brother. Routine preoperative imaging revealed marked gallbladder wall thickening, a solitary gallstone larger than 3 cm, and a suspicious mass extending into the liver. A subsequent PET/CT scan confirmed an FDG-avid lesion localized to the gallbladder and adjacent liver, with no evidence of distant metastasis. The patient underwent an open en bloc resection of the gallbladder with hepatic segments IVb and V. Histopathological examination confirmed a moderately differentiated adenocarcinoma (pT2bN1M0, stage IIIB). The patient recovered well postoperatively and completed six cycles of adjuvant chemotherapy. At a 3-year follow-up, she remains asymptomatic with no evidence of disease recurrence.

This case represents a unique and valuable contribution to the medical literature, documenting a rare incidental finding of gallbladder carcinoma in an asymptomatic living liver donor candidate. The rigorous screening protocols standard for living organ donation proved to be lifesaving by uncovering an occult malignancy at a treatable stage. This report underscores the importance of maintaining a high index of suspicion for any gallbladder abnormalities detected during donor evaluation and serves as a critical reference for transplant, surgical, and oncology teams.