A 53-year-old African descendant female office assistant was found to have a 2.4 cm gallstone on a gynecological ultrasound over a year ago without any pain or jaundice. Further imaging with ultrasound and MR cholangiopancreatography revealed the gallstone as well as another mass, with the differential diagnosis including potential tumor. The patient underwent a cholecystectomy which found the gallstone as well as remnants of an Ascaris worm, providing the diagnosis.

1. Cholelitiasis X tumor Dr. Carlos Eduardo R Santos CompagnonHepatobiliaire President elect of Brazilian Chapter IHPBA 2011-2012

2. Cholelitiasis X tumor 53y, afro descendent, F, born in Rio de Janeiro, office assistant No family cancer history 1 year fond a cholelitiasis in gynecologic US of 2,4 cm No pain or jaundice history Physical examination Normal Hepatogram Normal www.cirurgiaonline.com.br

3. USG www.cirurgiaonline.com.br

4. USG www.cirurgiaonline.com.br

5. What to Do?

6. Cholangio MR www.cirurgiaonline.com.br

7. Cholangio MR www.cirurgiaonline.com.br

8. What to do?

9. Gallbladder and “Litiasis” www.cirurgiaonline.com.br

10. Mummy of Ascaris www.cirurgiaonline.com.br

11. Thank you very much ! carloseduardo@cirurgiaonline.com.br