Incidental Gallbladder Carcinoma in North Indian Population: Importance of Routine Histopathological Examination of All Benign Gallbladder Specimens

Abstract

Aim: To evaluate the incidence of incidental gallbladder carcinoma in specimens of cholecystectomy performed for benign gallbladder diseases and to establish the utility of routine histopathological examination of all gallbladder specimens obtained following cholecystectomy done for benign diseases.Material and Methods: This was a hospital-based three years prospective and retrospective study done at a tertiary care centre in North India. Gallbladder specimens from laparoscopic and open cholecystectomies done for benign gallbladder diseases without any clinico-radiological evidence of malignancy were included in the study. Routine histopathological evaluation of 1,268 such gallbladder specimens was carried out to get the incidence of incidental gallbladder carcinoma and pathological staging of carcinoma was done according to American Joint Committee recommendations for cancer staging (AJCC). All the diagnosed cases of Incidental gallbladder carcinoma (IGBC) were analysed in terms of demographics, radiology findings, and gross and microscopic pathology findings.Results: Out of 1,268 gallbladder specimens of clinically benign diseases, 16 cases (1.26%) were diagnosed as cases of IGBC with female predominance with a male to female ratio of 1:7. Mean gallbladder thickness in these cases was 0.77±0.20 cm, and 98.30% cases of IGBC were associated with gall stone disease. However, no correlation was observed between the age, gallbladder thickness and pathological stages of these IGBC. Conclusion:IGBC is an occult disastrous malignancy of the gallbladder, which can be missed in the pre and intraoperative periods despite careful clinical and radiological evaluation and comes as a surprise for pathologists the first time. We recommend that all specimens of gallbladder obtained from its surgical resection for benign diseases should be subjected to histopathological examination.

Practices in the Management of Incidental Gallbladder Cancer

“…Several reports from high GBC incidence areas such as India, Nepal, and Pakistan [14][15][16][17][18] recommend and advocate routine histopathological examination for all GB specimens as a must so as not to miss an iGBC. It is not uncommon to see a patient, who underwent a simple cholecystectomy, but the GB was not sent for/subjected to histopathological examination and the patient comes back a few months later with recurrent/metastatic GBC-this is a missed GBC.…”