An 83-year-old man with hypertension presented with a 3-month history of a painful, progressively enlarging mass in the right subcostal region. He reported no associated constitutional symptoms and no history of abdominal surgery. Local examination revealed a tender, erythematous, fluctuant mass, 3 cm by 2 cm, with clinically significant surrounding induration and an underlying fixed mass (Panel A).
Computed tomography revealed that the mass was communicating with a large gall bladder mass (Panel B, arrow). Ultrasonography-guided needle biopsy, along with histologic and immunocytochemical examinations, confirmed that the mass was an adenocarcinoma of the gall bladder. The patient did not agree to any further evaluation or treatment. He was discharged with plans for palliative care and died 5 weeks later.