case_images: PMC9979752_01
case_images: EUS with an arrow pointing to an ovoid mass that appears to be arising from a choledochocele versus duplicated gallbladder.. EUS, endoscopic ultrasound
case_images: cureus-0015-00000034440-i01.jpg
case_images: PMC9979752_01_cureus-0015-00000034440-i01.jpg
case_images: FIG1
case_images: An endoscopic ultrasound (EUS) was scheduled for the patient showing the presence of an ovoid mass that appeared to be arising from a choledochocele versus duplicated gallbladder, and no regional lymph nodes were observed (Figure 1).
case_images: MRCP with an arrow pointing to the duplicated gallbladder emanating from the proximal right intrahepatic duct takeoff with a filling defect concerning for a mass.. MRCP, magnetic resonance cholangiopancreatography
case_images: cureus-0015-00000034440-i02.jpg
case_images: PMC9979752_01_cureus-0015-00000034440-i02.jpg
case_images: FIG2
case_images: A magnetic resonance cholangiopancreatography (MRCP) showed a duplicated gallbladder emanating from the proximal right intrahepatic duct takeoff with amorphous filling defect concerning for soft tissue mass with otherwise normal biliary tree (Figure 2), and no regional lymph nodes.
case_images: Intraoperative cholangiogram with an arrow pointing to the duplicated gallbladder.
case_images: cureus-0015-00000034440-i03.jpg
case_images: PMC9979752_01_cureus-0015-00000034440-i03.jpg
case_images: FIG3
case_images: The duplicated gallbladder did opacify signifying a direct connection to the biliary tree consistent with the expected duplicated gallbladder with intra cholecystic opacity consistent with the presumed tumor (Figure 3).
case_images: Histological staining with hematoxylin and eosin (H&E) at 40x of the intraoperative frozen section concerning for invasive carcinoma.
case_images: cureus-0015-00000034440-i04.jpg
case_images: PMC9979752_01_cureus-0015-00000034440-i04.jpg
case_images: FIG4
case_images: The gallbladder and duplicated gallbladder were incised showing a pedunculated and friable soft tissue lesion approximately 2 cm within the duplicated gallbladder that appeared consistent with invasive carcinoma microscopically (Figure 4).
case_images: Histological staining with hematoxylin and eosin (H&E) at 200x showing ICPN with high grade intraepithelial neoplasia.. ICPN, intracholecystic papillary neoplasm
case_images: cureus-0015-00000034440-i05.jpg
case_images: PMC9979752_01_cureus-0015-00000034440-i05.jpg
case_images: FIG5
case_images: From a final pathological standpoint, the tumor size was 2 cm by gross measurement and histopathology showed focal adenocarcinoma arising in the intra-cholecystic papillary neoplasm (ICPN) with high grade intraepithelial neoplasia (Figure 5).
case_images: Intraoperative image showing the duplicated gallbladder with black arrow pointing to the tumor in the posterior gallbladder and white arrow to the anterior normal gallbladder.
case_images: cureus-0015-00000034440-i06.jpg
case_images: PMC9979752_01_cureus-0015-00000034440-i06.jpg
case_images: FIG6
case_images: Histologic grade was well-differentiated adenocarcinoma (g1) and the tumor site was the body of the posterior duplicated gallbladder (Figure 6).