Intermittent high fever accompanied with adenosquamous carcinoma of the gallbladder successfully managed by complete radical resection : a case report

We report a case of adenosquamous carcinoma of the gallbladder with intermittent high fever and positive findings of a primary lesion and regional lymph nodes on positron emission tomography (PET-CT). The patient was a 62-year-old man who visited a local clinic with a high fever. His white blood cell count (WBC) and serum level of C-reactive protein (CRP) were elevated. However, the origin of the fever was not identified. He was diagnosed with an unidentified fever and admitted to our hospital. Abdominal enhanced CT revealed a gallbladder tumor invading the liver and enlarged regional lymph nodes. PET-CT showed positive findings of a local lesion and regional lymph nodes. He was diagnosed with gallbladder cancer with lymph node metastases. The patient underwent hepatic resection of segments 4a+5 with radical lymph node dissection as curative surgery. Preoperative drainage of the gallbladder to improve the high fever was not performed. The post-operative course was uneventful. The severe, intermittent high fever improved immediately, and the levels of WBC and CRP levels decreased to the normal ranges after surgery. The histological findings of the resected specimen revealed that the tumor was an adenosquamous carcinoma invading the liver without any lymph node metastases or inflammatory changes. The radical and aggressive resection contributed to improving the uncontrollable fever as a paraneoplastic syndrome.