Hepatoid adenocarcinoma of the gallbladder
Hiroshi NakashimaKazumitsu NagafuchiHiroshi SatohKazuhisa TakedaToru YamasakiHirotoshi YonemasuHideki Kishikawa
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Gallbladder Cancer
Background - The gallbladder cancer is a rare cancer with poor prognosis. The association with gallstone disease is the main risk factor of this cancer. Aim - Describe the demographics, clinic-pathologic and therapeutic management of incidentally gallbladder cancer diagnosed on cholecystectomy specimens. Methods - retrospective study including 30 cases of gallbladder cancer incidentally detected on cholecystectomy specimens. Results - The incidence of gallbladder cancer incidentally discovered was 0.83%. The sex ratio M/F was 0.5 and the average age was 68 years. The main risk factor was cholelithiasis (38%). Adenocarcinoma was the most frequent histological type found in 86.6% of cases and it was biliary-type in 56.6% of cases. 76,7% of the tumors were classified in early stages (stages 0, I and II) and 23,3% were in advanced stages (III and IV). A simple cholecystectomy was curative in 66.7% of cases. Overall survival rate was 56.7% at one year. The best survival rate was for the early stages: 100% stages 0-I and 45.4% stage II. Conclusions - The gallbladder cancer has poor prognosis because of its late diagnosis. Thorough sampling and careful attention on histological examination of all parts of cholecystectomy specimens allows detection of early cancer with better prognosis.
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The optimal surgical extent for T1 gallbladder cancer (GBC) remains controversial. Simple cholecystectomy is routinely performed for T1 GBC while several guidelines recommend extended cholecystectomy for T1b GBC. However, evidence regarding the optimal surgical extent for T1 GBC is lacking. This study aims to systematically evaluate the optimal surgical extent for early GBC with regard to long-term survival.A comprehensive literature search in MEDLINE was performed to identify studies with histologically proven GBC and survival data. A total of 22 articles with a total of 2,578 patients were included in the final analysis. Dichotomous data regarding cancer-related death in all T1, T1a, and T1b GBC cases were extracted. Risk ratios, risk differences, and 95% confidence intervals (CIs) were pooled.The risk ratio between simple and extended cholecystectomy in T1 GBC patients was 1.06 (95% CI 0.97-1.16); T1a, 0.82 (95% CI 0.70-0.96); and T1b, 1.06 (95% CI 0.93-1.22). No significant difference was found according to the extent of surgery in all T1 or T1b GBC cases (P = 0.17 and P = 0.36, respectively). Simple cholecystectomy had significantly lower cancer-related death in T1a GBC patients (P = 0.01).Simple and extended cholecystectomy showed comparable survival outcomes in T1 GBC patients.
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Adenomyomatosis (ADM) of the gallbladder is a condition characterized by the proliferation of Rokitansky-Aschoff sinus (RAS), in which the epithelium of the gallbladder extends into the muscular layer, causing a thickening of the gallbladder wall. Although ADM is generally considered not to be a precancerous lesion of gallbladder cancer, there are some reports of cases of gallbladder cancer from ADM. Therefore, the relationship between ADM and gallbladder cancer remains controversial. We herein report a case of early-stage gallbladder cancer, BilIN3 (high grade), arising from ADM that was positive for ALDH1A1, an important marker of stem cells and cancer stem cells.
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Objective To investigate the clinical value of contrast-enhanced ultrasound(CEUS) in the diagnosis of gallbladder cancer.Methods Twenty patients with gallbladder cancer and thirty-seven patients with benign gallbladder disease underwent conventional ultrasound and real-time CEUS.The enhancement patterns including types of time-intensity curve,centripetal fill-in,homogeneity and intensity of enhancement were analyzed.Results The focus and gallbladder wall in gallbladder cancers were enhanced at the same time,hepatic artery phase was mainly highly enhanced,hepatic portal vein phase was mairdy lowly enhanced.The percentages of those lesions that exhibited hyper-enhancement or iso-enhancement in the early phase and turned to hypo-enhancement within 35 s after contrast agent administration were 95.0%(19 /20) in gallbladder cancers and 16.2%(6 /37) in benign lesions(P = 0.000).Inhomogeneous enhancement was found 80.0%(16 /20) in gallbladder cancers and 23.3%(7 /30) in benign lesions (P =0.000).Destruction of the integrality of gallbladder wall was found 85.0%(17/20) in gallbladder cancers and none(0.0%,0 /37) in benign lesions(P = 0.000).The diagnose accordance rate、sensitivity and specificity of benign and malignant gallbladder diseases by CEUS was were 92.98% 、95.00% and91.83%,respectively.Conclusion CEUS can improve the diagnosis rates of gallbladder cancer and the ability of differentiating diagnosis between benign and malignant gallbladder diseases compared with conventional ultrasound.
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Gallbladder cancer (GBC) has a high incidence in certain geographical regions. Morphologically, GBC presents as a mass replacing the gallbladder, a polypoidal lesion, or wall thickening. The incidence of preoperative diagnosis of wall thickening type of GBC is less well studied. The patterns of mural involvement and extramural spread are not well described in the literature. Additionally, wall thickening in the gallbladder does not always indicate malignancy and can be secondary to inflammatory or benign gallbladder diseases and extracholecystic causes and systemic pathologies. Objective reporting of gallbladder wall thickening will help us appreciate GBC's early features. In this review, we illustrate the imaging patterns of wall thickening type of GBC.
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Background: Gallbladder cancer is a rare neoplasm associated with high mortality and poor prognosis.It is usually correlated with cholelithiasis and presents more commonly in elderly and female patients.Diagnosis is seldom made preoperatively because of the indolent progression of the tumor.Methods: The hospitalization and surgical records of our surgical department were examined from January 1992 to December 2001, searching for patients who had undergone cholecystectomy.Additionally, the histopathological diagnoses of the same period were studied searching for patients with the diagnosis of gallbladder cancer established postoperatively and not intraoperatively by frozen section.Results: In the period of 1992-2001, a total of 1,536 cholecystectomies took place and 14 cases of gallbladder cancer were diagnosed postoperatively.The ratio of men to women is 3/ 11 with a mean age of 69.4 years.The clinical symptoms were non-specific and mortality was 57%.Conclusion: In most cases gallbladder cancer is diagnosed after cholecystectomy and even in these cases it can be in an advanced stage and the prognosis of this rare neoplasm is poor. Key words gallbladder -cancer -carcinoma -cholecystectomy SouhrnÚvod: Rakovina žlučníku je vzácný nádor s vysokou mortalitou a špatnou prognózou.Většinou koreluje s cholelitiázou a častěji se prezentuje u starších pacientů a u žen.Tento nádor je málokdy diagnostikován před operací kvůli indolentní progresi nádoru.Metody: Byly prozkoumány hospitalizační a chirurgické záznamy našeho chirurgického oddělení z období od ledna 1992 do prosince 2001.Hledáni byli pacienti, kteří podstoupili cholecystektomii.Dále byly studovány histopatologické nálezy a pomocí zmrzlé tkáně byli identifikováni pacienti s diagnózou rakoviny žlučníku stanovené po operaci, nikoli během operace.Výsledky: V období 1992-2001 proběhlo celkem 1 536 cholecystektomií a nalezeno bylo 14 případů rakoviny žlučníku diagnostikovaných pooperativně.Poměr mužů a žen byl 3/ 11 s průměrným věkem 69,4 let.Klinické příznaky byly nespecifické a mortalita dosahovala 57 %.Závěr: Ve většině případů je vznik rakoviny žlučníku diagnostikován po cholecystektomii a dokonce i v těchto případech může být v pokročilém stadiu.Prognóza tohoto vzácného nádoru je špatná.
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Extrahepatic biliary tract cancer (mainly gallbladder cancer) mortality rates have increased from 7.84 x 100.000 to 9.6 x 100.000 in Chile during the last decade. The most significant risk factor for gallbladder cancer is gallstone disease. However, no apparent changes in the prevalence of gallstone disease has occurred during this period. In contrast, cholecystectomy rates have consistently decreased during the decade. The aim of this study was to correlate extrahepatic biliary tract cancer mortality and cholecystectomy rates of previous years during the last decade in our country. The best correlation coefficient between both variables was obtained when mortality was correlated with cholecystectomy rates two years prior to the mortality rate (r = -0.92). This finding is consistent with the hypothesis that changes in the number of cholecystectomies performed in a specific geographic area would reciprocally change gallbladder cancer mortality rate. It was estimated that increasing cholecystectomies by 12,500 per year would decrease at mortality rate from this cancer by approximately 1.0 x 100.000 two years in Chile.
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Three patients with cholelithiasis were found to possess a duplicate gallbladder. A 48-year-old woman continued to have symptoms one year after cholecystectomy, a 69-year-old woman had symptoms even though her gallbladder had been removed 40 years before, and in a 29-year-old woman a second gallbladder was found during cholecystectomy. In all three patients, the second gallbladder was removed as well, after which they recovered. The differential diagnosis of persistent symptoms following cholecystectomy should also consider the possible presence of an accessory gallbladder.
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