Sarcoidosis gallbladder involvement mimicking gallbladder cancer: a case report and review of the literature

Introduction: Gallbladder involvement in sarcoidosis is extremely rare and may closely mimic malignant lesions. Case presentation: A 76-year-old patient presented with biliary colic for 2 months associated with weight loss and asthenia. Thoracoabdominal CT scan revealed an irregular diffuse gallbladder wall thickening with perivesicular, perihilar, and periduodenal lymphadenopathy as well as mediastinal lymphadenopathy. Locally advanced gallbladder cancer was highly suspected and IVb-V hepatectomy with regional lymphadenectomy was performed. However, histological findings were consistent with gallbladder sarcoidosis involvement. Discussion: Extra hepatic biliary involvement may be asymptomatic or present as biliary colic due to intra biliary stricture or compression of enlarged lymph nodes of the porta hepatis. The presence of a gallbladder wall thickening with lymphadenopathy is suggestive of gallbladder cancer, and considering sarcoidosis, in the absence of other systemic signs is challenging. As sarcoidosis and cholangiocarcinoma may coexist, surgical resection remains the most reliable way to rule out malignancy. Specimen pathological examination redresses the definitive diagnosis of sarcoidosis revealing epithelioid granulomas without caseous necrosis. Conclusion: Sarcoidosis should be kept in mind as differential diagnosis in gallbladder wall thickening or mass forming. However, if a malignancy cannot be excluded, surgery remains the clue diagnostic and therapeutic tool in resectable tumors.