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Gallbladder Carcinoma

Gall Bladder Carcinoma

Gallbladder carcinoma is a rare but highly malignant disease that is predominantly identified at a very late stage. The clinical presentation, comprised of nonspecific signs such as abdominal pain in the right upper quadrant, weight loss, jaundice, and fever, is often insidious. Imaging studies and biopsy are needed to make the diagnosis and determine the stage.


Presentation

With estimated incidence rates of 3 per 100,000 individuals in the United States, gallbladder carcinoma is rarely encountered in clinical practice [1]. Still, it encompasses up to 90% of all neoplastic processes arising from the biliary tree [1] [2]. Risk factors are increasing age, female gender, certain ethnic (native American ancestry) and geographic predispositions (southeast Asia has a significantly higher incidence rate compared to the rest of the world), the presence of gallstones and chronic inflammation, as well as parasitic infections, congenital abnormalities of the biliary tract, and genetics [1] [2] [3] [4] [5]. The 5-year survival rate of patients suffering from gallbladder carcinoma from the time of diagnosis is less than 5% [3], and the poor overall prognosis occurs due to two reasons. Firstly, the gallbladder lacks a serosal layer at the site where it is in contact with the liver, thus allowing rapid dissemination and metastatic spread of the tumor [3]. And secondly, the clinical presentation is often nonspecific and mimics other more common pathologies of the biliary tree (cholelithiasis, cholecystitis, other abdominal tumors, etc.) [1] [2] [4] [5] [6] [7]. Right upper quadrant abdominal pain, fever, jaundice, nausea, vomiting, pruritus, anorexia, and weight loss are the most important complaints in the literature when it comes to gallbladder carcinoma [1] [2] [4] [6] [8].

Weight Loss
  • Right upper quadrant abdominal pain, fever, jaundice, nausea, vomiting, pruritus, anorexia, and weight loss are the most important complaints in the literature when it comes to gallbladder carcinoma.[symptoma.com]
  • A 45-year-old woman came to us with complaints of flatulent dyspepsia associated with weight loss and anorexia.[ncbi.nlm.nih.gov]
  • […] a malignant neoplasm of the bile reservoir, characterized by anorexia, nausea, vomiting, weight loss, progressively worsening right upper quadrant pain, and eventually jaundice. Tumors of the gallbladder are predominantly adenocarcinomas.[medical-dictionary.thefreedictionary.com]
  • Most patients are asymptomatic until the disease is advanced but presenting symptoms include abdominal pain (usually in the upper right quadrant), nausea, vomiting, jaundice, anorexia and weight loss.[orpha.net]
Painless Jaundice
  • Of note, Courvoisier's law states that in the presence of a palpably enlarged gallbladder which is nontender and accompanied with mild painless jaundice, the cause is unlikely to be gallstones.[en.wikipedia.org]
Soft Tissue Mass
  • Skull x-ray revealed a well circumscribed soft tissue mass over a lytic bone defect in the frontal region.[ncbi.nlm.nih.gov]
Collapse
  • The co-existence of gallstones, non-focal thickening, and collapsed lumen on HRUS was independently associated with XGC.[ncbi.nlm.nih.gov]
Abdominal Pain
  • Right upper quadrant abdominal pain, fever, jaundice, nausea, vomiting, pruritus, anorexia, and weight loss are the most important complaints in the literature when it comes to gallbladder carcinoma.[symptoma.com]
  • A 72-year-old woman presented with postprandial abdominal pain and was found to have a mass in the body of the gallbladder with direct liver invasion. Histological examination showed an adenosquamous carcinoma with an infiltrate of benign OGCs.[ncbi.nlm.nih.gov]
  • Most patients are asymptomatic until the disease is advanced but presenting symptoms include abdominal pain (usually in the upper right quadrant), nausea, vomiting, jaundice, anorexia and weight loss.[orpha.net]
Abdominal Mass
  • An abdominal mass: An enlarged gallbladder may indicate gallbladder cancer. An enlarged gallbladder is caused by a blockage of the bile ducts.[verywell.com]
Jaundice
  • A 52-year-old woman presented with right upper quadrant pain and obstructive jaundice.[ncbi.nlm.nih.gov]
  • Right upper quadrant abdominal pain, fever, jaundice, nausea, vomiting, pruritus, anorexia, and weight loss are the most important complaints in the literature when it comes to gallbladder carcinoma.[symptoma.com]
Biliary Colic
  • Cancer of the gallbladder is a rare gastrointestinal (GI) tract pathology that must be diagnosed by clinical tests as its symptoms overlap with those of other GI tract conditions, such as biliary colic and gallstones.[news-medical.net]
  • […] they are diagnosed and treated at an advanced stage. 1,2 The neoplasm most frequently affects the fundus and body of the gallbladder and along with its non-specific, late clinical presentation which is comparable to other more common disorders–such as biliary[elsevier.es]
  • The symptoms of gallbladder cancer overlap with the symptoms of gallstones and biliary colic. Abdominal pain may be of a more diffuse and persistent nature than the classic right upper quadrant pain of gallstone disease.[clinicaladvisor.com]
Gallbladder Enlargement
  • Gallbladder cancer symptoms include: • Nausea and vomiting • Abdominal pain • Jaundice • Gallbladder enlargement • Abdominal swelling • Weight loss • Loss of appetite Who Gets Gallbladder Cancer The American Cancer Society’s estimates for gallbladder[cancertutor.com]
Hepatic Mass
  • Spiral CT at admission showed only a hepatic mass in the 4th segment, compatible with hepatocellular carcinoma and gallbladder lithiasis. Cholecystectomy was performed followed by a wedge resection of the 4th segment of the liver.[ncbi.nlm.nih.gov]
Hepatomegaly
  • Ultrasound of the abdomen revealed hepatomegaly with thick-walled gallbladder with multiple stones and a mass at the fundus, but normal uterus and ovary.[ncbi.nlm.nih.gov]
Diplopia
  • One month later she came to our observation after having developed diplopia and ophthalmic pain due to an orbital metastasis. We decided not to perform a surgical second look because of the already rapid dissemination of the malignant tumor.[ncbi.nlm.nih.gov]
Eruptions
  • The eruptions with pruritus resolved within 1 wk after the operation. This is the first report, to our knowledge, of coincident biliary malignancy and erythroderma.[ncbi.nlm.nih.gov]
Dermatitis
  • Although exfoliative dermatitis (erythroderma) secondary to malignancy is commonly associated with lymphomas or leukemias, coincident gastrointestinal (GI) malignancy and erythroderma is rare.[ncbi.nlm.nih.gov]
Subcutaneous Nodule
  • A 42-year-old woman presented with multiple subcutaneous nodules over the abdominal wall, anterior chest wall, back and in bilateral breasts. Fine needle aspiration cytology (FNAC) of these nodules revealed metastatic adenocarcinoma.[ncbi.nlm.nih.gov]
Meningism
  • A variety of neurological signs and symptoms can be seen depending on the extent and location of the meningeal metastasis.[ncbi.nlm.nih.gov]
Dark Urine
  • If you have gallbaldder cancer, you may have some of the following symptoms: feeling sick vomiting pain in the upper right side of the abdomen (tummy) which can come and go your skin and the white of your eyes are yellowed (jaundice) dark urine pale coloured[global.ihi.com]

Workup

Because of the very low survival rate of patients with gallbladder carcinoma, physicians must raise clinical suspicion toward a malignant disorder in the presence of nonspecific abdominal complaints. A detailed patient history and a complete physical examination, which will assess the course and progression of symptoms, but also their potential origin (through abdominal inspection and palpation), are vital steps in the workup. Laboratory tests are of limited benefit in the raising suspicion toward gallbladder carcinoma [4] [8]. Serum tumor markers, however, mainly carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA 19-9), are frequently elevated in this patient group, suggesting their important role in the workup [9] [10]. Imaging studies are the cornerstone in making the diagnosis. Various techniques are recommended, including computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography (particularly high-resolution), positron emission tomography (fludeoxyglucose (FDG)-PET and PET-CT), endoscopic ultrasonography (EUS), and magnetic resonance cholangiopancreatography (MRCP) [1] [2] [6] [7]. A large space-occupying mass in the gallbladder that is frequently infiltrating the liver is a typical finding, while asymmetric and extensive gallbladder wall thickening is also an important sign used to discriminate this tumor from other etiologies [1] [2]. Once the initial diagnosis is made, often through high-resolution US, CT, or MRI (all used to assess nodal or metastatic spread as well), EUS is vital in determining the exact stage of the tumor, as it provides the ability to perform a biopsy (through fine-needle aspiration) and subsequent histopathological examination [3] [11].

Ovarian Mass
  • The interest of this case lies in the long progression-free survival, the venous thromboembolism syndrome that preceded by a few months the diagnosis of the ovarian mass and the discrepancy between the radiologic and the laparoscopic stage assessment.[ncbi.nlm.nih.gov]

Treatment

  • Surgical resection has been thought to be the treatment of choice, while the role of radiotherapy as adjuvant or palliative treatment has not been fully clarified in the literature.[ncbi.nlm.nih.gov]

Prognosis

  • CONCLUSION: Preoperative NLR and PLR were closely related to prognosis of patients with GBC and might be useful for the evaluation of prognosis of patients with GBC.[ncbi.nlm.nih.gov]

Etiology

  • The etiology was tumor emboli and PTTM from gallbladder carcinoma, which remained elusive prior to her death despite appropriate clinical investigations and was established on autopsy.[ncbi.nlm.nih.gov]
  • Etiology The exact etiology is unknown. Genetic susceptibility elicited by chronic inflammation of the gallbladder leading to dysplasia and malignant change is one possibility.[orpha.net]
  • A large space-occupying mass in the gallbladder that is frequently infiltrating the liver is a typical finding, while asymmetric and extensive gallbladder wall thickening is also an important sign used to discriminate this tumor from other etiologies.[symptoma.com]
  • In this new 8th edition an outstanding editorial team from world-renowned medical centers continues to hone the leading edge forged in previous editions, with timely information on biology, immunology, etiology, epidemiology, prevention, screening, pathology[books.google.com]

Epidemiology

  • In this review we delve into the epidemiologic, genetic and pathologic characteristics of this enigmatic disease with a special focus on the recent advancements in the field of gallbladder pathology.[ncbi.nlm.nih.gov]
  • Eslick GD (2010) Epidemiology of gallbladder cancer. Gastroenterol Clin North Am 39(2): 307-330. Hundal R, Shaffer EA (2014) Gallbladder cancer: epidemiology and outcome. Clin Epidemiol 6: 99-109.[medcraveonline.com]
  • Epidemiologic aspects of gallbladder cancer: a case - control study of the search program of the International agency for Research on cancer. J Natl Cancer Inst. 1997;891:1132-8. Rustagi T, Dasanu CA.[ijsurgery.com]
Sex distribution
Age distribution

Pathophysiology

  • The exact pathophysiologic mechanism leading to oedema of the gallbladder wall in these diverse conditions is uncertain, but it is likely due to elevated portal venous pressure, elevated systemic venous pressure, decreased intravascular osmotic pressure[radiologyassistant.nl]
  • Pathophysiology Gallbladder cancer arises in the setting of chronic inflammation. In the vast majority of patients ( 75%), the source of this chronic inflammation is cholesterol gallstones .[emedicine.medscape.com]

Prevention

  • Postoperative extra-beam radiation therapy was delivered to the hepatic portal lesion to prevent GBC recurrence. The patient remains disease-free 14 months after the completion of radiation therapy.[ncbi.nlm.nih.gov]
  • […] lymph nodes 5 year survival: Overall 1% ( J Surg Oncol 2008;98:485 ) 85 - 100% for T1, 30 - 40% for T2 Median survival 6 months Diagnosis Adenomyomatosis positive gallbladder cancer is more often diagnosed clinically in the advanced stages; therefore, preventive[pathologyoutlines.com]
  • In this new 8th edition an outstanding editorial team from world-renowned medical centers continues to hone the leading edge forged in previous editions, with timely information on biology, immunology, etiology, epidemiology, prevention, screening, pathology[books.google.com]
  • Gallbladder cancers: associated conditions, histological types, prognosis and prevention. Eur J Gastroenterol Hepatol. 2014;26:562-9. Horgan AM, Amir E, Walter T, Knox JJ.[ijsurgery.com]

References

Article

  1. Furlan A, Ferris JV, Hosseinzadeh K, Borhani AA. Gallbladder carcinoma update: Multimodality imaging evaluation, staging, and treatment options. Am J Roentgenol. 2008;191:1440–1447.
  2. Andrén-Sandberg Å. Diagnosis and Management of Gallbladder Cancer. N Am J Med Sci. 2012;4(7):293-299.
  3. Hundal R, Shaffer EA. Gallbladder cancer: epidemiology and outcome. Clin Epidemiol. 2014;6:99-109.
  4. Graff AE, Lewis SL, Bear JR, Van Echo DC, Dainer HM. Gallbladder Carcinoma, the Difficulty of Early Detection: A Case Report. Cureus. 2016;8(2):e493.
  5. Hsing AW, Gao YT, Han TQ, et al. Gallstones and the risk of biliary tract cancer: a population-based study in China. Br J Cancer. 2007;97:1577–1582.
  6. Rodríguez-Fernádez A, Gómez-Río M, Medina-Benitez A, et al. Application of modern imaging methods in diagnosis of gallbladder cancer. J Surg Oncol 2006; 93:650–664.
  7. Joo I, Lee JY, Kim JH, Kim SJ, Kim MA, Han JK, Choi BI. Differentiation of adenomyomatosis of the gallbladder from early-stage, wall-thickening-type gallbladder cancer using high-resolution ultrasound. Eur Radiol. 2012;23(3):730–738.
  8. Löhe F, Meimarakis G, Schauer C, Angele M, Jauch KW, Schauer RJ. The time of diagnosis impacts surgical management but not the outcome of patients with gallbladder carcinoma. Eur J Med Res. 2009;14:345–351.
  9. Strom BL, Maislin G, West SL, et al. Serum CEA and CA 19-9: potential future diagnostic or screening tests for gallbladder cancer. Int J Cancer. 1990;45:821–824.
  10. Ritts RE Jr, Nagorney DM, Jacobsen DJ, Talbot RW, Zurawski VR Jr. Comparison of preoperative serum CA19-9 levels with results of diagnostic imaging modalities in patients undergoing laparotomy for suspected pancreatic or gallbladder disease. Pancreas. 1994;9:707–716.
  11. Kim HJ, Lee SK, Jang JW, et al. Diagnostic role of endoscopic ultrasonography-guided fine needle aspiration of gallbladder lesions. Hepatogastroenterology. 2012;59(118):1691–1695.

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Last updated: 2019-07-11 21:02