Signet-ring cell carcinoma of the gallbladder complicated by pulmonary tumor thrombotic microangiopathy.

[carcinoma of the gallbladder]

Biliary drainage was performed in a 71 -year -old man with obstructive jaundice of unknown origin ; however , he died due to acute pulmonary failure . At autopsy , proliferation of adenocarcinoma cells was observed in the gallbladder mucosa transitioning from isolated signet-ring cell carcinoma (SRCC ) to the subserosa and bile ducts without growth toward the gallbladder lumen . Furthermore , fibrocellular intimal proliferation , tumor emboli and organized thrombi were observed in the small pulmonary arteries . The final diagnosis was gallbladder carcinoma complicated by SRCC associated pulmonary tumor thrombotic microangiopathy (PTTM ). PTTM may present as rapidly progressive dyspnea , and a high level of clinical suspicion is required to make the differential diagnosis .