Gallbladder adenocarcinoma and paraneoplastic parathyroid hormone mediated hypercalcemia

Figure 1 Technetium-99 m sestamibi scintigraphy with dual phase.

Figure 2 Subtraction thyroid scan (dual isotope scintigraphy) with technetium pertechnetate.

Figure 3 Gallbladder H and E stain. High power (40 ×) view of the nested tumor shows a relatively monotonous cell population with medium-sized nuclei and a moderate amount of cytoplasm. Central coagulative necrosis is evident on (A) while (B) has frequent mitotic figures.

Figure 4 Gallbladder Immunohistochemical stain is negative for parathyroid hormone (a positive stain would have clear and sharp membranous expression).