Unusual histological variant of giant cell gall bladder carcinoma.

60 years old female patient presented with pain in the right hypochondriac region, which was colicky and nonradiating and associated with nausea, vomiting and generalised itching for 6 months off and on. There was no significant past history of any major illness. The patient was afebrile, and icterus was present. An ill-defined mass was found in the right hypochondriac region, which was firm, tender and immobile and measured 5 x 4 cm. Routine haematological parameters were within the normal limits. Liver function tests showed bilirubin 8 mg% (direct 6.4 mg%), SGOT was 68 I/U and SGPT 80 I/U. Alkaline phosphatase was 3 times the upper limit of normal. Ultrasonography of abdomen revealed an isoechoic mass in the supraduodenal region. The gall bladder was distended and filled with sludge and microlithiasis and the common bile duct was dilated. Peripancreatic and periportal lymphnodes were enlarged. Computerised tomographic scan of the abdomen showed hepatomegaly with dilated intrahepatic biliary radicles, irregularity and thickening of gall bladder wall. A mass was seen at the neck of gall bladder reaching up to segment IV of liver and compressing the common bile duct. Patient subsequently underwent endoscopic retrograde cholangio-pancreatography which showed filling defect in gall bladder with dilated biliary radicles. A papillotomy was performed and stent was inserted for the biliary drainage. When the patient’s general condition was stabilized an exploratory laparotomy was performed which revealed a mass in the neck of gall bladder measuring 6 cm x 5.5 cm, adherent to common bile duct