Benign tumors and tumor-like lesions of the gallbladder and extrahepatic biliary tract (original) (raw)
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Malignant tumours of gallbladder and extrahepatic bile ducts
Diagnostic Histopathology, 2010
Biliary tract neoplasms are divided into cancers of the gallbladder (GB) and intrahepatic and extrahepatic bile ducts (EBD). GB and EBD tumours are closely related, although they show marked differences in epidemiology, aetiology and clinical presentation. GB neoplasms are uncommon in North America but endemic in South America and Asia, whereas EBD tumours show no geographic predilection. Both gallbladder cancer (GBC) and extrahepatic bile duct cancer (EBDC) present at an advanced stage, and are associated with an aggressive course and poor prognosis. These tumours occur primarily in older patients and are strongly associated with chronic inflammation of the biliary epithelium. GBC is more common in women while EBDC is slightly more common in men. Over 90% are carcinomas, usually of the pancreaticobiliary type. Histologic grade, histologic type and stage of disease are useful prognostic indicators. Compared with other histologic variants, papillary carcinomas at both sites have a more favourable prognosis. Despite the common embryologic and histologic features of the bile duct and gallbladder, the natural history and management of cancer arising from these structures have both similarities and major differences.
Clinicopathological Study of Gallbladder Lesions
Annals of Pathology and Laboratory Medicine, 2018
Background: Gallbladder is one of the most frequently surgically resected organs which stores and concentrates the bile and is involved by both non neoplastic as well as neoplastic diseases. Chronic calculous cholecystitis is the most common benign lesion of gallbladder and pain abdomen is the commonest clinical presentation. Both non neoplastic and neoplastic lesions have similar clinical presentation and overlapping radiological findings. Methods: Total 550 cholecystectomy specimens were received in pathology department. Grossly, formalin fixed specimens were examined carefully and section were given from neck, fundus and body of gallbladder. Whenever it was necessary, additional sections were given. After processing, the H&E stained sections were studied thoroughly. All the clinical details were taken from case papers. Result: The commonly seen non neoplastic lesions were chronic calculous cholecystitis (405 cases), chronic cholecystitis (85 cases), Acute on chronic cholecystitis with or without stones (18 and 3 cases), acute necrotizing cholecystitis (2 cases), eosinophilic cholecystitis (3 cases), follicular cholecystitis (3cases), lymphoplasmacytic cholecystitis (1case), xathogranulomatous cholecystitis (9 cases), cholesterosis (4 cases), mucocele of gall bladder (2 cases), adenomyomatosis (3 cases) and gallbladder cholesterol polyp with cholecystitis (2 cases). Among neoplastic lesions 1 case was adenoma with severe dysplasia and 9 cases were adenocarcinoma. Conclusion: Chronic calculous cholecystitis was the most common lesion and out of 9 cases of carcinoma, 7 cases were diagnosed incidentally. Therefore, histopathological evaluation plays a critical role in identifying incidental gallbladder carcinoma for proper management of patients.
Neoplastic diseases of the gallbladder-a 5 year study
IP Innovative Publication Pvt. Ltd., 2017
Introduction: Gallbladder diseases are the major causes of morbidity and mortality throughout the world. Majority of the diseases are related to gallstones. Gallstone disease is a risk factor for the development of gallbladder carcinoma. Aims and Objectives: The objective is to study the morphological spectrum of neoplastic diseases in gallbladder, and to note the frequency of malignant neoplasms. Materials and Method: The study was conducted on cholecystectomy specimens received in centrallaboratory, Department of Pathology, KIMS, Bengaluru from July 2009 to June 2014. The cholecystectomy specimens received in 10% formalin were examined in detail for gross and microscopic changes. Neoplasms were studied and categorized. Results: There were 700 cholecystectomy specimens received for histopathological study. There were 17 cases of neoplasms of which 6 were adenomas and 11 were carcinomas. Of the 11 carcinomas 3 were detected only on histopathological examination. Conclusion: Histopathological examination of all the cholecystectomy specimens is a must to rule out incidental carcinoma.
[Precancerous lesions of the gallbladder]
To elucidate the morphological characteristics and the incidence of precancerous lesions of the gallbladder, 200 gallbladders removed for presumed benign diseases were examined histopathologically. Dysplastic epithelia with distinct cellular and structural atypic were graded into either mild or moderate to severe degree. Twenty-nine (14.5%) of 200 cases showed dysplasia ; 5 (2.5%) was to moderate to severe degree and 24 (12%) to mild degree. Carcinoma in situ was found in 4 cases (2%) and occult invasive carcinoma in 2 cases (1%). Simple hyperplasia was seen in 54 cases (27%). Abnormal epithelia showed a male preponderace in consistent with the previous report on cancer epidemiology in Japan. Dysplasia and hyperplasia were found to have close association with chronic cholecystitis, but not with gallstones per se. It was postulated that the progression of dysplasia or carcinoma in situ into invasive carcinoma may occur in the sixties to seventies. cancer ; cholecystitis ; dysplasia ; gallbladder ; gallstone In recent years much attention has been paid to the precancerous lesions in the gastrointestinal tract ; the organ with a tendency to develop cancers (Satoh et al. 1979). However, in the pancreas (Mukada and Yamada 1982) or the gallbladder (Albores-Saavedra et al. 1980), the identity of precancerous conditions seems to be less well established either clinically or pathologically in spite of their increasing interest in the diagnostic practice. Since carcinoma of the gallbladder is fairly common among Japanese, particluarly in males (Segi 1977), it is expected that precancerous lesions are frequently encountered in the unselected non-cancerous subjects. The purpose of the present study is to elucidate the morphological characteristics of the gallbladder dysplasia and related lesions through histopathological
Cytologic diagnosis of gallbladder lesions - A study of 150 cases
The Indian journal of surgery, 2010
Gallbladder (GB) carcinoma is among the five most common forms of gastrointestinal cancers and the diagnosis is usually made when the carcinoma is already in an advanced stage. The aim of this study was to assess the application of ultrasound (US) guided fine needle aspiration (FNA) in diagnosing GB carcinoma. The present study was carried out on 150 patients suspected to have GB carcinoma on ultrasonography. US-guided FNA from GB was done in these patients and FNA of the other organs was simultaneously done in 20 patients. Histopathology of the GB was available in 14 cases. Ultrasonography in these patients revealed mass/thickening of the wall of GB in 140 (93.3%) cases and nonspecific US findings in 10 (6.7%). Out of the 140 cases malignancy was cytologically diagnosed in 105 (75%) cases while 12 (8.5%) cases were inflammatory and 23 (16.5%) were inconclusive. Adenocarcinoma was the most common morphologic type. Metastatic tumor deposits were noted in FNA from space occupying lesi...
Gallbladder Lesions Identified on Ultrasound. Lessons from the Last 10 Years
Journal of Gastrointestinal Surgery, 2012
Background Possible mass lesions identified on ultrasound (US) of the gallbladder may prompt an aggressive surgical intervention due to the possibility of a malignant neoplasm. Aim This study aims to utilize a large modern series of patients with gallbladder lesions identified on US to evaluate imaging characteristics consistent with malignancy. Methods A retrospective review was conducted of gallbladder ultrasound reports and clinicopathologic data of patients with a mass identified on US. Results Approximately 59,271 abdominal ultrasounds and 9,117 cholecystectomies were performed between February 2000 and February 2010. We identified 213 patients with a questionable gallbladder neoplasm on ultrasonography who underwent surgical exploration. Median age was 52 years (range=11-87 years) and 147 (69%) were females. Final pathology demonstrated no neoplasm in 130 patients (61%), while 32 patients (15%) had a wall adenomyoma, 36 (17%) had a polyp (five of which were malignant), 14 (7%) had an adenocarcinoma not arising from a polyp, and one patient had a cystic papillary neoplasm. The smaller the lesion, the more likely it was to be a pseudo-mass. For lesions measuring <5 mm on US, 83% had no lesion found on final pathology. Significant predictors of malignancy were age >52 years (p<0.001), presence of gallstones on US (p=0.004), size >9 mm (p<0.001), evidence of invasion at the liver interface (p<0.001), and wall thickening >5 mm (p<0.001). Shape (sessile or penduculated), echogenicity (echogenic or isoechoic), or presence of flow on Doppler were not predictors of malignancy. An US size of ≤9 mm had a negative predictive value of 100% for malignancy. Conclusions Despite improvements in imaging, most apparent lesions measuring <5 mm on US are not identified in the surgical specimen. US size >9 mm, age >52 years, US suggestion of invasion at the liver interface, and wall thickening >5 mm, especially in the presence of gallstones, should raise the suspicion of malignancy.
Incidental Carcinoma of the Gallbladder
Biliary Lithiasis, 2008
Incidental gallbladder carcinoma (GBC) is a difficult management issue as there are no established guidelines. Laparoscopic cholecystectomy is associated with increased dissemination of the tumour cells (both in the peritoneal cavity and port sites). Depth of tumour invasion (T stage) and positive surgical margins are the most important prognostic factors, although tumour differentiation, lymphatic, perineural and vascular invasion may also affect the outcome.
Diagnostic Pathology, 2012
Background: Carcinoma of the gallbladder (GBC) clinically mimics benign gallbladder diseases and often escapes detection until advanced stage. Despite the frequency of cholecystectomy, diagnosis of GBC remains problematic in many situations. We sought to identify pathologic features that contribute to the difficulty in recognition of GBC. Methods: We identified 23 patients (ranged from 45 to 86 years, male to female ratio 1:4.5) with carcinoma involving the gallbladder referred to an academic medical center over a period of 10 years for study. This includes 10 cases of primary GBC, 6 cases of metastatic tumor to gallbladder, 6 cases of directly invasive adenocarcinoma arising elsewhere in the biliary tree, and one case of unidentified origin adenocarcinoma. Primary tumors include adenocarcinoma not otherwise specified (NOS) in 6 cases, papillary adenocarcinoma in 2 cases, and single cases of undifferentiated carcinoma and combined adenocarcinoma and neuroendocrine carcinoma (NEC). Metastatic tumors to gallbladder were from a wide range of primary sites, predominantly the gastrointestinal tract. Results: These cases illustrate seven potential pitfalls which can be encountered. These include: 1) mistakenly making a diagnosis of adenocarcinoma of gallbladder when only benign lesions such as deeply penetrating Rokitansky-Aschoff sinuses are present (overdiagnosis), 2) misdiagnosing well-differentiated invasive carcinoma with minimal disease as benign disease (underdiagnosis), 3) differentiating between primary NEC of gallbladder and metastasis, 4) confusing primary mucinous adenocarcinoma of gallbladder with pseudomyxoma peritonei from a low grade appendiceal neoplasm disseminated to gallbladder, 5) confusing gangrenous necrosis related to cholecystitis with geographic tumoral necrosis, 6) undersampling early, grossly occult disease, and 7) misinterpreting extracellular mucin pools. Conclusions: Clinical history and a high index of suspicion are prerequisite to detecting GBC. Detection of GBC at an early stage is difficult because the symptoms mimic benign gallbladder diseases. Misinterpretation of subtle microscopic abnormalities contributes diagnostic failures in early cases. Careful attention to any evidence of mural thickening, thorough sampling, particularly in older patients, and close examination of any deeply situated glandular structures are critical. Correlations with radiographic and clinical findings are important helps to avoid misdiagnosis in this commonly resected organ.