Incidental Detection of Carcinoma Gall Bladder in Laparoscopic Cholecystectomy Specimens: A Thirteen Year Study of 23 Cases and Literature Review

Abstract

Carcinoma of gall bladder is the most common malignancy of the biliary tract worldwide and is usually associated with poor prognosis. In this era of laparoscopic cholecystectomy, there has been increase in detection of early stage incidental gall bladder carcinoma in cholecystectomy specimens. A retrospective study was carried out in tertiary care hospital in central India. A total of 2990 patients underwent laparoscopic cholecystectomy during the year 2001-2013. Hospital records and histopathology reports of these patients were studied in detail. Twenty three cases of gall bladder carcinoma were detected incidentally accounting for an incidence of 0.76 %. It was more common in females with an M: F ratio of 1:1.9. Mean age of presentation was 57.8 years. Gall stones were present in 22 cases and one patient presented with features of acute cholecystitis. Three patients had associated xanthogranulomatous inflammation and 10 had associated intestinal metaplasia. It is not uncommon to encounter incidental malignancies of gall bladder in laparoscopic cholecystectomy specimens sent to histopathology for presumably benign disease. Histopathology reports must include comments on extent of infiltration, perineural invasion, tumor differentiation and nodal involvement for oncologist information and subsequent management of patients.

Safe, selective histopathological examination of gallbladder specimens: a systematic review

“…An additional 18 studies were identified during manual cross‐referencing, resulting in a total of 73 articles, including 232 155 patients, that were eligible for data analysis. These studies were then divided into those performed in countries with a low incidence (39) 6,18–55 and countries with a high incidence (34) 7,56–88 of GBC. Characteristics of all included studies are presented in Table S1 (supporting information).…”

“…54-71) years, and 173 patients (73⋅6 per cent) were women. Nineteen studies 6,7,18,[21][22][23][24]26,36,37,41,43,44,53,59,60,67,69,75 (68 144 patients) including 178 patients with truly incidental GBC reported the clinical consequences of this diagnosis. The consequences for two patients with gallbladder metastases were not described 6,18 .…”

“…In 20 of the 39 studies conducted in countries with a low incidence of GBC, the authors explicitly mentioned the Lohana et al 57 Tantia et al 59 Zhang et al 60 Kim et al 61 Léon et al 62 Mittal et al 63 Sajjad et al 65 Siddiqui et al 67 Sujata et al 69 Deng et al 7 Gulwani et al 75 Munshi et al 77 Tayeb et al 78 Tian et al 79 Khan et al 80 Tanveer et al 84 Abbas et al 85 Singh…”

Risk Management of Incidental Gallbladder Cancer in Cholecystectomy Materials

“…There was no high grade dysplasia. Ultrasonography is preferred and gold-standard technique for diagnosing benign gallbladder diseases, an infiltrative malignancy may not be caught on ultrasonography (9). Although an expert radiologist may be able to recognize early lesions in the case of local wall thickening or small masses, abdominal ultrasound does not always detect any significant lesion in cases of early gallbladder cancer (10).…”

“…Although the incidental malignancies are diagnosed at an early stage, the prognosis of the patient depends on some individual features, including older age, involvement of gallbladder neck, involvement of ductus cysticus surgical margin, maximum tumor diameter greater than 3 cm, poorly histological differentiation, invasion of muscle layer, perineural invasion and lymph node involvement (9). In the study of Roa et al, the degree of differentiation and infiltration level were reported to be the most reliable prognostic factors (16).…”