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Gall Bladder Pathology Online
Carcinoma of the gall bladder is the
fifth most
common tumour in the gastrointestinal tract.
Gallbladder
carcinomas are epithelial in origin and account for 98% of
all gallbladder malignancies.
The remainder are
sarcomas, lymphomas, carcinoid, metastases, and other
unusual malignancies.
Sarcomatoid Carcinoma/Carcinosarcoma of Gall
Bladder
;
Lymphoma of Gall Bladder
;
Metastatic Tumours of Gall Bladder
Epidemiologic
studies have shown that female sex, age, postmenopausal
status, and cigarette smoking are risk factors.
Chronic
Salmonella typhi infection is associated with bile
carcinogens and contributes to an increased risk of
hepatobiliary carcinoma and gallbladder carcinoma.
Exposure to
chemicals used in the rubber, automobile, wood finishing,
and metal fabricating industries has been associated with
an increased risk of gallbladder carcinoma.
Cholelithiasis is
a well-established risk factor for the development of
gallbladder carcinoma, and gallstones are present in
74%–92% of affected patients. Gallstones cause chronic
irritation and inflammation of the gallbladder, which leads
to mucosal dysplasia and subsequent carcinoma.
The calcified gallbladder
(Porcelain Gall Bladder),
which represents an extreme variant of chronic cholecystitis, is
particularly prone to the development of gallbladder cancer.
The average age
of the patients affected by the tumour is between 60-65 years. Most
patients are females.
Symptoms are
typically indolent. Chronic abdominal pain, anorexia, or
weight loss are common initial complaints. Physical
examination may demonstrate a palpable mass, hepatomegaly,
and jaundice. Jaundice occurs more frequently as a result
of malignant obstruction of the biliary tree rather
than hepatic metastasis or coexistent choledocholithiasis. Elevated
serum levels of alpha-fetoprotein and carcinoembryonic
antigen have been reported in association with gallbladder carcinoma.
A correct
pre-operative diagnosis is made in less than 10% of patients.
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The majority of
gallbladder carcinomas are diffusely infiltrating lesions,
and the remainder exhibit intraluminal polypoid growth.
Approximately 60%
of tumours originate in the gallbladder fundus, 30% in the
body, and 10% in the neck.
Submucosal
spread of infiltrating carcinomas appears grossly as focal or
diffuse areas of wall thickening, nodularity, or induration
in the gallbladder wall.
In some cases of
direct invasion, a thick neoplastic wall encases the
gallbladder when direct extension to the liver has
occurred.
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Adenocarcinomas may be papillary or mucinous, giant cell and
intestinal type and occasionally with choriocarcinoma like areas.
It is usually
desmoplastic,
and thus the wall of the gallbladder becomes thickened
and leathery.
Squamous
metaplasia
may be so conspicuous that the tumour is thought to be
a squamous carcinoma.
Occasionally, the tumour grows into the lumen of the
gallbladder and assume a
papillary
configuration.
Squamous cell carcinoma only occur in about 4% of cases.
Undifferentiated carcinoma, comprising 5% of gall bladder tumours, are
undifferentiated anaplastic carcinomas, which are bulky and replace
most of the gall bladder.
Anaplastic, giant cell, and spindle cell forms of
gallbladder carcinoma have been reported.
Anaplastic small cell carcinoma is
exceptionally rare.
The complications of tumour include fistula
formation, perforation, cholecystitis and empyema.
The rich lymphatic plexus of the gallbladder provide
the most common route of metastasis.
The tumour spreads by lymphovascular invasion, peritoneal spread, intraductal, and lymph
node invasion. Lymph nodes are involved in 35% of cases. 5 year survival is
approximately 5%.
Direct
spread into the liver and contiguous structures occurs.
Survival is usually limited to those with papillary tumours or with localized disease where the tumours are an incidental
finding by the pathologist on examination of a cholecystectomy
specimen.
Papillary Adenocarcinoma of the Gall Bladder
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