Diagnosis of Gallbladder Tumors

Abstract

Gallbladder cancer is among the organs examined in mass screening for cancer using ultrasonography; the reported prevalence of gallbladder cancer in such screening of a general population was 0.011%, while the prevalence of gallbladder polyps was reported as 4.3 to 6.9%. Endoscopic ultrasonography is useful for the differential diagnosis of gallbladder tumors detected by mass screening, as well as for estimating the depth of tumor invasion and detecting abnormal connections between pancreatobiliary ducts. While a systematic approach leading to diagnosis by endoscopic ultrasonography is useful, recent advances of contrast-enhanced ultrasonography are expected to establish it as a new modality for early detection. At our hospital, 7 of 26 patients with abnormal connections between pancreatobiliary ducts developed gallbladder carcinoma (23.1%), and 7 of 48 patients with gallbladder carcinoma had abnormal connections between pancreatobiliary ducts (12.5%). Serial observation in patients with gallstones and prophylactic surgery in patients with abnormal connections between pancreatobiliary ducts are necessary.

Inflammatory Myofibroblastic Tumor of the Gallblader

“…It is difficult to access small gallbladder masses with percutaneous needle biopsy (16); however, this problem can overcome with endoscopic ultrasonography-guided needle biopsy (19). After biopsy of the gallbladder, abdominal pain (4.5%), bile peritonitis (1-6%) and needle tract seeding complications could be seen (19,20). Smooth muscle actin, CD68 and vimentin are positive on histopathological examination; however, S100, CD100 cytokeratin, CD35 and latent membrane proteins are negative.…”

Laparoscopic Management of Gall Bladder Polyp

“…A galactose-based contrast agent was used in the US for differential diagnosis of polypoid gallbladder lesions. [2] When diffuse and branched types were considered indicative of cancer, accuracy was 85%, sensitivity 100%, and specificity 77%. In gallbladder cancer, staining throughout the tumor was continuous, consistent with diffuse hypervascularity.…”

“…Such images appear promising for distinguishing cholesterol polyps from other polyps, and the overall accuracy for differentiating neoplastic from non-neoplastic masses was reported as 91%. [2,8] Whether EUS alone can be used to determine a treatment strategy for gallbladder polyps is not clear. EUS alone is not sufficient in determining the course of treatment in polyps less than 10 mm, but it may be more accurate than transabdominal ultrasound in determining whether gallbladder polyps are neoplastic.…”

“…[1,10] Advances in multidetector-row CT have increased its accuracy rate for the differential diagnosis of gallbladder polyps, and CT generally shows polypoid gallbladder carcinoma as an enhancing, intraluminal tissue mass denser than surrounding bile and can reliably identify neoplastic lesions. [2] In particular, helical CT may be helpful for evaluating small polypoid lesions of the gallbladder, and can differentiate neoplastic and nonneoplastic small polypoid lesions of the gallbladder and reliably identify the presence of neoplastic lesions that should be resected. [14] The size bigger than 1.5 cm, sessile shape, and perception on unenhanced images are the main factors that differentiate neoplastic from nonneoplastic gallbladder polyps 1 cm or bigger.…”

“…Among polypoid masses, malignant lesions demonstrated early and prolonged enhancements, while benign lesions showed early enhancement with subsequent washout. [2] It has reported that various malignant tumors may show high signal intensity on diffusion-weighted MR imaging (DWI), reflecting their high cellularity and/or their long relaxation time. Therefore, high b-value DWI may be useful for differentiating between benign and malignant polypoid gallbladder lesions.…”