Incidental Gallbladder Neoplasms: A Growing Global Burden

Abstract

Background The increasing trend of laparoscopic procedures has made cholecystectomies one of the most common surgical specimens received for histopathological evaluation. This has also led to an increasing trend of finding incidental gallbladder malignancies for a presumed benign disease. The present study describes the histopathological spectrum of neoplastic lesions of the gallbladder along with the historadiological correlation with special emphasis on incidental gallbladder carcinomas (IGBC). Materials and methods All the cholecystectomies received over a span of two and a half years were studied. Demographic details, imaging findings, gross features, and microscopic findings of premalignant and malignant lesions were noted. Special stains were done as and when required. Results Of the 1253 cholecystectomies received during the study period, 50 gallbladders (3.9%) showed neoplastic pathology and were included in the present study. The age range was 40 to 60 years with female predominance. Ultrasonography revealed nonspecific wall thickness in both premalignant and incidental gallbladder carcinomas. Gallstones were seen in 74% of the cases (37/50). Gross and imaging findings in 17 (34%) of the malignant cases were in concordance with microscopic features, whereas the dysplastic lesions (21) and IGBC cases showed evidence of chronic cholecystitis on the same. Microscopic examination revealed focal dysplasia (low and high grade) in 21/50 (42%) cases. Invasive malignancy was seen in 28/50 (56%) of the cases, of which 11 cases (22%) were IGBC. Pancreaticobiliary type of adenocarcinoma was the most common morphology seen in almost all the cases. There was also one case each of intracholecystic papillary neoplasm (ICPN) and carcinosarcoma. Conclusion GBC is an unusual malignancy and its preoperative diagnosis is not so definitive. The incidental form of GBC presents as a radiological disguise and a histopathological surprise. Hence, the present study warrants a complete and scrupulous histopathological examination of all the cholecystectomy specimens for proper and further management of the case.

Identifying the causes of the high incidence of cholelithiasis and a health economics evaluation of two types of cholecystectomies in Qinghai province

“…Cholelithiasis in Western countries is mainly caused by cholesterol. In Northern Europe, the incidence of cholelithiasis is around 20% (12); interestingly, we found a similar incidence in Qinghai province. This region is a multi-ethnic settlement and the diet is not similar to the traditional Chinese diet.…”

Pathologies of Precursor Lesions of Biliary Tract Carcinoma

“…CCA and GBC develop a multistep process involving high-grade BilIN beginning with transformed biliary epithelial cells or stem/progenitor cells [ 23 , 36 ]. BilINs reportedly share histopathologies and phenotypes with pancreatic intraepithelial neoplasms (PanINs) [ 12 , 24 ], suggesting a common developmental process and pathological significance with frequent common molecular expression [ 11 ]. However, genetic comparisons between BilIN and PanIN have not yet been analyzed in detail.…”

“…The WHO 2019 Tumor Classification of Digestive System [ 1 ] proposed several types of precursor lesions of the biliary tract: (i) microscopically identifiable, biliary intraepithelial neoplasm (BilIN); (ii) grossly visible, intraductal papillary neoplasm of bile duct (IPNB); (iii) grossly visible, intracholecytic neoplasm of the gallbladder (ICPN); (iv) pyloric gland adenoma (PGA) of the gallbladder; and (v) hepatobiliary mucinous cystic neoplasm (MCN). These precursors have been rapidly incorporated into management algorithms for biliary tract tumors, which have presented an increasing incidence over the past 40 years [ 7 , 8 , 9 , 10 , 11 ].…”

"Missed Gall Bladder Cancer During Cholecystectomy - What Price Do We Pay?" An Experience of a Tertiary Care Center from India

“…The incidence of gallbladder cancer (IGBC) after cholecystectomy is on a rising trend (7). Completion extended cholecystectomy is the standard treatment of incidentally detected gall bladder cancer.…”