Gallbladder cancer associated with cholesterosis

Akiyama, Takayoshi; Sahara, Hiroyuki; Seto, Keitaro; Saitou, Hitoshi; Kiriyama, Masato; Takeuchi, Fujio; Kosaka, Takeo; Kita, I; Takashima, Shigeki; Matsunou, Hisao

doi:10.1007/bf02355043

Cited by 15 publications

(8 citation statements)

References 4 publications

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“…Sugiyama et al [8,19] reported that a tiny echogenic spot and an aggregation of echogenic spots with or without echopenic areas were highly specific (100 %) for cholesterol polyps. Interestingly in our series, EUS detected two polypoid lesions of adenocarcinoma with hyperechoic spotting representing the accumulation of foamy cells underneath cancerous epithelium as in previous reports [24,25]. Therefore, hyperechoic spotting was not always a completely specific variable for non-neoplastic polyps in our series, although it was still very significant statistically.…”

Section: Discussionsupporting

confidence: 71%

A Useful Approach to the Differential Diagnosis of Small Polypoid Lesions of the Gallbladder, Utilizing an Endoscopic Ultrasound Scoring System

Sadamoto¹,

Oda²,

Tanaka³

et al. 2002

Endoscopy

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Section: Discussionsupporting

confidence: 71%

A Useful Approach to the Differential Diagnosis of Small Polypoid Lesions of the Gallbladder, Utilizing an Endoscopic Ultrasound Scoring System

Sadamoto¹,

Oda²,

Tanaka³

et al. 2002

Endoscopy

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“…Although in earlier reports neoplastic polyp associated with cholesterosis was viewed as being very rare, there is some possibility that this condition occurs more frequently than we expected (15,16). Therefore, we should be cautious that an aggregation of hyperechoic spots can also occur in neoplastic polyps when they contain concomitant cholesterosis.…”

Section: Discussionmentioning

confidence: 52%

Can Endoscopic Ultrasonography Differentiate Nonneoplastic from Neoplastic Gallbladder Polyps?

et al. 2006

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The present study aimed to clarify the endoscopic ultrasonography (EUS) features of nonneoplastic (cholesterol polyps and adenomyomatosis) and neoplastic (adenoma and adenocarcinoma) gallbladder polyps and to evaluate the effectiveness and limitation of EUS in the differential diagnosis of these lesions. We retrospectively compared EUS images with histologic findings in 29 surgical cases with gallbladder polyps with a diameter of 10 to 20 mm. Those cases were indicated for surgery based on the findings of a sessile appearance, a solitary lesion, low echogenicity, and/or a lobulated surface. Six of 10 cholesterol polyps were atypically seen as partially or completely hypoechoic due to predominant proliferation of glandular epithelia. Nine of 10 cholesterol polyps demonstrated an aggregation of hyperechoic spots, which represented multiple granules of cholesterosis. All adenomyomatoses (n = 10) showed multiple microcysts, which corresponded to proliferated Rokitansky-Aschoff sinuses. However, three of nine neoplastic lesions (three adenomas and six adenocarcinomas) showed one of these signs due to concomitant cholesterosis (n = 2) or proliferated Rokitansky-Aschoff sinuses (n = 1). In conclusion, 69% (20/29) of gallbladder polyps larger than 10 mm that were preoperatively suspected of malignancy were nonneoplastic. An aggregation of hyperechoic spots and multiple microcysts are considered to be important predictive factors for cholesterol polyps and adenomyomatosis, respectively. However, we should caution that these findings can also occur in neoplastic polyps when they contain a concomitant nonneoplastic component (cholesterosis or proliferated Rokitansky-Aschoff sinuses).

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“…Third, although most of the lesions in the group with benign tumefactive sludge were larger than 1 cm and were confirmed as the absence of polyps at follow-up CT and MR imaging or surgical specimen results, gallbladder polyps could mimic tumefactive sludge in some of patients with benign small tumefactive sludge. Fourth, due to the small number of patients with malignant tumefactive sludge (n = 15) in the final study cohort, the multivariate reported that adenocarcinoma with the accumulation of foamy cells underneath cancerous epithelium may also manifest similarly as hyperechoic spots at US (27). Thus, diagnosis for tumefactive sludge should be based on a combination of clinical results and those of other imaging modalities.…”

Section: Discussionmentioning

confidence: 99%

Tumefactive Gallbladder Sludge at US:Prevalence and Clinical Importance

et al. 2017

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Purpose To evaluate the prevalence of tumefactive sludge of the gallbladder detected at ultrasonography (US) and to assess whether any clinical and imaging differences exist between benign and malignant tumefactive sludge. Materials and Methods The institutional review board approved this retrospective study. The requirement for informed consent was waived. The study included a cohort (n = 6898) of patients with gallbladder sludge drawn from all adults (n = 115 178) who underwent abdominal US between March 2001 and March 2015. Tumefactive sludge was identified according to the following US findings: (a) nonmovable mass-like lesion and (b) absence of posterior acoustic shadowing at B-mode US and vascularity at color Doppler US. Follow-up examinations were arranged to ascertain whether the results showed true sludge or gallbladder cancer. Risk factors for malignant tumefactive sludge based on clinical and US characteristics were identified with multivariate logistic regression analysis. Results The prevalence of gallbladder and tumefactive sludge at abdominal US during the observation period was 6.0% (6898 of 115 178) and 0.1% (135 of 115 178), respectively. Twenty-eight (20.7%) patients were lost to follow-up. Of the 107 with tumefactive sludge, 15 (14%) were confirmed to have malignant tumefactive sludge. The risk factors for malignant tumefactive sludge were old age (odds ratio [OR], 1.06; P = .035), female sex (OR, 5.48; P = .014), and absence of hyperechoic spots within the sludge (OR, 6.78; P = .008). Conclusion Although the prevalence of tumefactive sludge at US was rare, a considerable proportion of patients had a malignancy. Careful follow-up is essential, especially for older patients, women, and those with an absence of hyperechoic spots at US. RSNA, 2016 Online supplemental material is available for this article.

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Gallbladder cancer associated with cholesterosis

Cited by 15 publications

References 4 publications

A Useful Approach to the Differential Diagnosis of Small Polypoid Lesions of the Gallbladder, Utilizing an Endoscopic Ultrasound Scoring System

A Useful Approach to the Differential Diagnosis of Small Polypoid Lesions of the Gallbladder, Utilizing an Endoscopic Ultrasound Scoring System

Can Endoscopic Ultrasonography Differentiate Nonneoplastic from Neoplastic Gallbladder Polyps?

Tumefactive Gallbladder Sludge at US:Prevalence and Clinical Importance

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