INCIDENTAL HIGH-GRADE BILIARY INTRAEPITHELIAL NEOPLASIA (BILIN-3) IN A PATIENT WITH RIGHT UPPER QUADRANT PAIN SECONDARY TO PIOCOLECYSTIS: A CASE REPORT alexrossano@yahoo.com

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INCIDENTAL HIGH-GRADE BILIARY INTRAEPITHELIAL NEOPLASIA (BILIN-3) IN A PATIENT WITH RIGHT UPPER QUADRANT PAIN SECONDARY TO PIOCOLECYSTIS: A CASE REPORT

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Mexico

Poster Exhibition only

Abdominal pain in elderly patients with multiple comorbidities poses a diagnostic challenge. In individuals with advanced chronic kidney disease (CKD), gastrointestinal symptoms such as nausea or diarrhea may be nonspecific, delaying identification of biliary pathology. Right upper quadrant pain can indicate complications like cholecystitis or, more rarely, pyocholecystitis, requiring prompt surgical intervention. Biliary intraepithelial neoplasia (BilIN) is a rare, premalignant microscopic lesion of the bile ducts, typically undetected preoperatively due to lack of imaging findings or clinical suspicion. High-grade BilIN (BilIN-3) is considered a direct precursor to cholangiocarcinoma and is often diagnosed incidentally after cholecystectomy for enign conditions.

We report a 76-year-old male with stage 4 CKD who presented with persistent right subcostal abdominal pain, aggravated by cholecystokinetic foods, accompanied by nausea and diarrhea. Abdominal Ultrasound revealed a distended, pear-shaped gallbladder (12.3 × 5.4 × 5.7 cm; volume: 203.4 cc), with anechoic content and a thickened wall (0.46 cm), consistent with pyocholecystitis. Laparoscopic cholecystectomy was performed without complications.

Histopathological analysis showed high-grade BilIN (BilIN-3) associated with ulcerated chronic and acute cholecystitis. Resection margins were free of neoplastic involvement.

Although pyocholecystitis was the initial diagnosis, the incidental finding of BilIN-3 underscores the importance of histopathological evaluation, even in routine gallbladder resections. While no direct link exists between pyocholecystitis and BilIN, this case suggests that acute inflammation may coexist with silent premalignant lesions, warranting further surveillance and potentially impacting long-term management.