GALL BLADDER CARCINOMA
GALL BLADDER CARCINOMA
- More common in Females
- Mostly in the 7th decade of life
Risk factors
- Gall stones – most important risk factor (↑size and duration, ↑ risk)
- Porcelain Gall Bladder
- Choledochal cyst
- Chronic typhoid carriers
- Cholecystoses
- Cholesterosis of gall bladder (strawberry GB)
Clinical features
- Nonspecific – indistinguishable from benign gall bladder disease like biliary colic or cholecystitis
- Jaundice(less common), significant weight loss in short duration
- CA 19-9 is elevated in 80%; CEA is also elevated in few cases
- Diagnosis confirmed by multidetector row CT scan
Types
- Adenocarcinoma is the me type (90%)
- The tumor is most commonly nodular and infiltrative, with thickening of the gall bladder wall
Nevin’s staging
|
I |
Intramural |
|
II |
Spread to muscularis |
|
III |
Spread to serosa |
|
IV |
Spread to cystic lymph node of Lund (the sentinel node) |
|
V |
Direct spread to adjacent organs/Distant metastases |
Treatment
- Stage I and II – simple cholecystectomy
- Stage III – cholecystectomy + adjacent hepatic resection (atleast 2cm depth) + regional lymphadenectomy
- Poor prognosis
Exam Important
- Gallstones may be a predisposing factor
- Primary carcinoma of the gallbladder is an uncommon, aggressive malignancy that affects women more frequently than men.
- Older age groups are most often affected, and coexisting gallstones are present in the vast majority of cases.
- The symptoms at presentation are vague and are most often related to adjacent organ invasion. Imaging studies may reveal a mass replacing the normal gallbladder, diffuse or focal thickening of the gallbladder wall, or a polypoid mass within the gallbladder lumen.
- Adjacent organ invasion, most commonly involving the liver, is typically present at diagnosis, as is biliary obstruction. Periportal and peripancreatic lymphadenopathy, hematogenous metastases, and peritoneal metastases may also be seen. The vast majority of gallbladder carcinomas are adenocarcinomas.
- Because most patients present with advanced disease, the prognosis is poor.
- The radiologic differential diagnosis includes the more frequently encountered inflammatory conditions of the gallbladder, xanthogranulomatous cholecystitis, adenomyomatosis, other hepatobiliary malignancies, and metastatic disease.
- The prevalence of lymphatic spread is high in gallbladder carcinoma. Lymphatic metastases progress from the gallbladder fossa through the hepatoduodenal ligament to nodal stations near the head of the pancreas.
- Three pathways of lymphatic drainage have been suggested: the cholecystoretropancreatic pathway, the cholecystoceliac pathway, and the cholecystomesenteric pathway.
- The cystic and pericholedochal lymph nodes are the most commonly involved at surgery and are a critical pathway to involvement of the celiac, superior mesenteric, and para-aortic lymph nodes.
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