case_images: PMC10766800_01
case_images: Plain scan CT examination before LC and pathology after LC. (A,B): CT examination before LC; (C): Gross specimen of the gallbladder; (D-F): Results of HE staining of the gallbladder.
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case_images: F1
case_images: A computerized tomography (CT) scan showed a gallbladder wall thickness of 4 mm, and no positive stones (Figures 1A, B). Histopathology suggested chronic cholecystitis, and no pathological manifestations of accidental gallbladder cancer or dysplasia were reported (Figures 1C-F). Preoperative abdominal wall ultrasound showed uneven hypoechoic nodules under the skin of the navel, approximately 17 x 11 mm in size (Supplementary Figures S1A, B). Abdominal plain CT scan showed subcutaneous nodules in the umbilical region with uniform density, approximately 2.2 cm x 3.1 cm in size (Supplementary Figures S1C, D). However, a white hard mass in the umbilical cord was visible (Supplementary Figures S1E, F), and umbilical nodule resection was performed during the operation.
case_images: Results of gross specimen, HE staining after the first umbilical nodule resection. (A): Gross specimen after the first umbilical nodule resection; (B-D): HE staining after the first umbilical nodule resection.
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case_images: F2
case_images: WT-1(-), KI-67 hotspot about 30% (+) (Figures 2A-D). We first considered the source to be the digestive system because of the IHC results and the patient's medical history, but did not exclude the possibility of cholangiocyte origin. To clarify the possible primary lesion of the mass, the patient underwent upper abdominal enhanced CT and systemic positron emission tomography (PET)-CT examination; however, no systemic lesion imaging findings were found in the rest of the body, including intra-abdominal tumors, except for the umbilical lesions (Supplementary Figures S2A, B and Figures 3A-D). Moreover, there were no positive findings on gastroscopy or colonoscopy (Supplementary Figures S2C, D).
case_images: PET-CT examination after the first umbilical nodule resection. (A): PET-CT results at the gallbladder fossa level; (B): PET-CT results at the bladder level; (C,D): PET-CT results at the umbilical nodule level.
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case_images: F3
case_images: To clarify the possible primary lesion of the mass, the patient underwent upper abdominal enhanced CT and systemic positron emission tomography (PET)-CT examination; however, no systemic lesion imaging findings were found in the rest of the body, including intra-abdominal tumors, except for the umbilical lesions (Supplementary Figures S2A, B and Figures 3A-D).
case_images: Results of gross specimen, HE staining and immunohistochemistry after the second umbilical nodule resection. (A): Gross specimen after the second umbilical nodule resection; (B-D): HE staining after the second umbilical nodule resection; (E): CDX-2 staining after the second umbilical nodule resection; (F): CK7 staining after the second umbilical nodule resection; (G): CD20 staining after the second umbilical nodule resection; (H): KI67 staining after the second umbilical nodule resection; (I): MUC5AC staining after the second umbilical nodule resection.
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case_images: F4
case_images: In addition, cancerous tissue was not detected in the 3-6-9-12 points of the specimen's margins (Figures 4A-I).