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Gallbladder Pathology Online

Pathology of  Carcinoma of the Gallbladder

Dr Sampurna Roy  MD  

 

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.

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.

Visit: Salmonellosis

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.

Cholesterol stone ; Pigment stones (calcium bilirubinate) ; "Mixed" stones .

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.

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.

 

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.

Further reading:

Modern perspectives on factors predisposing to the development of gallbladder cancer.

Clinicopathological significance of DNA fragmentation factor 45 and thyroid transcription factor 1 expression in benign and malignant lesions of the gallbladder.

Correlation of S1P1 and ERp29 expression to progression, metastasis, and poor prognosis of gallbladder adenocarcinoma.

Association of BDNF and BMPR1A with clinico pathologic parameters in benign and malignant gallbladder lesions.

Expression of p53 upregulated modulator of apoptosis (PUMA) and C-myb in gallbladder adenocarcinoma and their pathological significance.

Adenocarcinoma of gallbladder: an immunohistochemical profile and comparison with cholangiocarcinoma.

Gallbladder cancer--a comprehensive review

Primary gallbladder cancer: recognition of risk factors and the role of prophylactic cholecystectomy

Carcinoma of the gallbladder and cholecystostomy.

 

 

 

 

 

 

          

 

 

 

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