Incidental Detection of Precancerous and Malignant Gall Bladder Lesions in Routine Cholecystectomy Specimens
A Retrospective Study of 3 Years
Keywords:
Cholecystectomy, gall bladder, incidental, lesio
Abstract
Background & Objectives: Gallbladder dysplasia (GBD) and adenoma are premalignant lesions, which may progress to carcinoma through different pathways. Gall bladder (GB) neoplasms are relatively uncommon and are usually asymptomatic during early stages. We analyzed the clinico-pathological features of precancerous and malignant gallbladder lesions in routine cholecystectomy specimens and studied the association of mucosal metaplasia and gall stones with GB adenoma, dysplasia and carcinoma. Materials & Methods: This is a 3 year retrospective study where histopathology proven cases of GBD, adenomas and carcinomas were retrieved from Pathology database from January 2012 to December 2014. The clinical details and histopathological features of these cases were studied and analyzed. Results: Out of total 2200 cholecystectomy specimen studied, 7 cases of GBD, 5 cases of adenoma and 10 gallbladder carcinomas (GBC) were identified. Out of total 22 patients, 11 were females. Predominant clinical feature was pain in 86% cases. On ultrasonography (USG), majority showed cholelithiasis. Cholecystectomy was performed in all predominantly due to cholecystitis and lithiasis. On microscopy, 43% cases of dysplasia showed high grade features, 60% cases of adenoma showed tubular type with pyloric metaplasia and 50% of GBC were moderately differentiated. Associated dysplasia in GBC was noted in 50% and associated metaplasia in 60% cases. Follow up ranged from 2-4.5 years. 40% GBC showed lymph node involvement and 20% showed distant metastasis. Conclusion: All cholecystectomy specimens should definitely be sent for histopathologic evaluation to detect unapparent GB lesions. Early detection of these lesions may lead to good prognosis and prolonged survival.References
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2. Singh G, Mathur SK, Parmar P, Kataria SP, Singh S, Malik S, Bhatia Y. Premalignant epithelial lesion of gallbladder: A Histopathological study. IJHSR. 2016;6(4):141-145
3. Kalita D, Pant L, Singh S, Jain G, Kudesia M, Gupta K, Kaur C. Impact of Routine Histopathological Examination of Gall Bladder Specimens on Early Detection of Malignancy - A Study of 4,115 Cholecystectomy Specimens. Asian Pacific J Cancer Prev. 2013;14(5):3315-3318
4. Cavallaro A, Piccolo G, Panebianco V, Lo Menzo E, Berretta M, Zanghi A et al. Incidental gallbladder cancer during laproscopic cholecystectomy: managing an unexpected finding. World J Gastroenterol 2012;18:4019
5. Ghnnam WM, Elbeshry TMAS, Malek JR, Emarra ES, Alzaharany ME, Alqarny AA. Incidental Gall bladder carcinoma in Laproscopic Cholecystectomy: Five years local experience. El medicine Journal. 2014;2: 47-51
6. Jain BB, Biswas RR, Sarkar S, Basu AK. Histopathological Spectrum of Metaplasia, Dysplasia and Malignancy in Gall Bladder and Association with Gall Stones. JIMSA. 2010;23(2):81-8
7. Gupta SC, Misra V, Singh PA, Misra SP, Srivastava M, Agrawal R. Mucin histochemistry--a simple and effective method for diagnosing premalignant and early malignant lesions of lower gastrointestinal tract. Indian J Pathol Microbiol. 1997 Jul;40(3):327-33.
8. Kamble MA, Thawait AP, Kamble AT. Incidental Gall Bladder Carcinoma in Patients Undergoing Laparoscopic Cholecystectomy. J of Evolution of Med and Dent Sci. 2014;28(3):7840-7852
9. Iva´N Roa, Xabier de, Aretaxabala, Juan C. Araya and Juan Roa. Preneoplastic Lesions in Gallbladder. Cancer. 2006;93:615-623.
10. Levy AD, Murakata LA, Rohrmann CA Jr. Gallbladder carcinoma: radiologic-pathologic correlation. Radiographics. 2001;21:295-314.
11. Saavedra J, Montero F, Albores D, Schwartz A, Klimstra D, and Henson D. Early Gallbladder Carcinoma: A Clinicopathological study of 13 cases of intramucosal carcinoma. Am J Clin Pathol. 2011;135:637-642.
12. Dowling GP, Kelly JK, The histogenesis of adenocarcinoma of the gall bladder. Cancer. 1986;58 :1702-1708.
13. Kwon SY, Chang HJ. A clinicopathological study of unsuspected carcinoma of the gallbladder. J Korean Med Sci. 1997 Dec;12(6):519-22.
14. Yi X, Long X, Zai H, Xiao D, Li W, Li Y. Unsuspected gallbladder carcinoma discovered during or after cholecystectomy: focus on appropriate radical re-resection according to the T-stage. Clin Transl Oncol. 2013 Aug;15(8):652-8.
15. Mazer LM, Losada HF, Chaudhry RM, Velazquez-Ramirez GA, Donohue JH, Kooby DA etal. Tumor characteristics and survival analysis of incidental versus suspected gallbladder carcinoma. J Gastrointest Surg. 2012;16(7):1311-7.
Published
2019-05-30
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