Systematic Selective Sampling of Cholecystectomy Specimens Is Adequate to Detect Incidental Gallbladder Adenocarcinoma

Many gallbladder adenocarcinomas (ACs) are detected incidentally in routine cholecystectomy specimens, yet sampling practices vary when intestinal metaplasia (IM) or dysplasia are found via routine sampling. Our practice has been to submit 5 additional sections when IM is found, but cases with dysplasia are entirely submitted. We sought to determine an appropriate sampling protocol when encountering these findings. We retrospectively identified cholecystectomy specimens with these features over a 26-month period, yielding 48 of 4059 (1%) cases. Four pathologists independently classified the (2 longitudinal and 1 cystic duct margin) original sections into 1 of 3 categories (IM, low-grade dysplasia [LGD] or high-grade dysplasia [HGD]); initial findings were correlated with final diagnoses. Sixteen (33%) cases had additional findings upon further sampling, including LGD (n=10) or HGD (n=4) and AC (n=2). HGD always accompanied malignancy. We prospectively analyzed 39 of 3133 (1%) additional cholecystectomy specimens, initially submitting the same routine sections. We submitted 5 random sections from cases with IM. Cases with LGD were first examined with 1 additional section per centimeter. All remaining tissue was submitted in all of these cases and separately reviewed. Cases with HGD were entirely submitted as both test cases with HGD in initial sections ultimately showed carcinoma. This protocol detected all cases of HGD and AC. Patients with clear cystic duct margins did not e...
Source: The American Journal of Surgical Pathology - Category: Pathology Tags: Original Articles Source Type: research

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ConclusionIncidence of incidental carcinoma gallbladder is 0.51%, most commonly affecting middle-aged females. Risk factors associated with incidental carcinoma gallbladder were found to be multiple gallbladder calculi, single large stone, and gallbladder polyps. Survival is better in males, young patients with uneventful primary surgery and better-differentiated pathology.
Source: Journal of Gastrointestinal Cancer - Category: Cancer & Oncology Source Type: research
Authors: Matsubayashi H, Matsui T, Sugiura T, Makuuchi R, Kaneko J, Satoh J, Satoh T, Fujie S, Ishiwatari H, Sasaki K, Ono H Abstract Pancreatobiliary maljunction (PBM) is a rare congenital malformation, often associated with adenocarcinoma. However, PBM accompanying gallbladder carcinosarcoma has rarely been reported. A 72-year-old woman was referred to our hospital, complaining of abdominal pain. Computed tomography showed a polypoid mass in the gallbladder. Endoscopic retrograde cholangiopancreatography showed PBM, and aspirated bile demonstrated elevated levels of pancreatic-type amylase (26,780 U/L) and cancer...
Source: Internal Medicine - Category: Internal Medicine Tags: Intern Med Source Type: research
ConclusionGallbladder is an unusual site of RCC metastasis. In patients with history of this disease, all vesicular lesions should be given attention, even where the primary tumor has been treated many years before.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
ConclusionsGallbladder cancer is a rare type of cancer in Saudi Arabia, and most patients are treated surgically, despite being mostly diagnosed at the advanced stage of the disease.
Source: Annals of Medicine and Surgery - Category: General Medicine Source Type: research
ConclusionIncidentally detected gallbladder dysplasia in a cholecystectomy specimen, without any gross abnormality, has almost no risk of a hidden invasive carcinoma. Although cholecystectomy is sufficient treatment for gallbladder dysplasia, in our study cohort, 18.9% of cases with incidental dysplasia in gallbladder had an associated pancreatobiliary carcinoma, which supports the hypothesis of multifocal neoplastic potential in the pancreatobiliary tree (also known as field effect). Although follow-up on 16 cases shows no subsequent development of any other pancreatobiliary neoplasm, this number is probably not enough to...
Source: Journal of Gastrointestinal Surgery - Category: Surgery Source Type: research
We presented a case report with gallbladder adenocarcinoma with sarcomatoid carcinoma accompanied by intrahepatic metastasis, focusing on the ultrasound imaging features of this tumor, especially its enhancement pattern on CEUS. CEUS provided helpful information for diagnosis. Herein, we report the case; and the associated literature is further reviewed.
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
Conclusion Though standards of treatment for MANECs have not been established,multidisciplinary theraphy is necessary to improve outcome.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
We present a treated case of carcinoma of the ampulla of Vater after a diversion operation for PBM. A 65-year-old woman presented with abdominal pain. She had undergone extrahepatic bile duct resection and cholecystectomy 2 years 9 months previously for the treatment of type Ic PBM according to the Todani classification. At the current admission for evaluation of the abdominal pain, computed tomography and magnetic resonance imaging showed only dilation of the main pancreatic duct. However, gastrointestinal endoscopy showed a tumor at the papilla of Vater, and biopsy revealed adenocarcinoma of the papilla of Vater. We perf...
Source: Case Reports in Gastroenterology - Category: Gastroenterology Source Type: research
BY LOUISE VESANEN, MSC, &AHMED RAZZIUDIN, MD​​A 53-year-old woman was brought to the ED from a nursing home for hypotension and hypoxia. She appeared septic. Her blood pressure was 80/60 mm Hg, and she was pale, cyanotic, and jaundiced. The patient was nonverbal at baseline due to underlying cerebral palsy, so information about her present illness was provided by her nursing home. Recent records listed elevated alkaline phosphatase and gallstone finding on ultrasound. Physical exam demonstrated abdominal distension and tenderness on palpation of her right upper quadrant.​Initial workup included CBC, CMP, blood gl...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
We describe a case of implantation of dysplastic cells with subsequent malignant transformation at the incision site 3 years post-cholecystectomy for an inflamed gallbladder. Histopathological examination of this tumour confirmed adenocarcinoma of pancreatobiliary origin, possibly secondary to gallbladder cells implantation and subsequent carcinomatous change. Unlike previously reported cases, the present case has two unique features: Firstly, the histology of the resected gallbladder at the initial operation was that of a low-grade dysplasia and not carcinoma; and secondly, there was a long interval between initial surger...
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
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