Gallbladder carcinoma

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Gallbladder carcinoma
Diagnosis in short

Gallbladder adenocarcinoma. H&E stain.

LM atypical epithelium usually gland forming, may be bland with an infiltrative growth pattern
LM DDx adenomyoma of the gallbladder, metastatic carcinoma (e.g. cholangiocarcinoma)
IHC CK7 +ve, CK20 -ve, CDX2 -ve
Gross lesion - usually fundus of gallbladder
Site gallbladder

Associated Dx chronic cholecystitis, gallstones, primary sclerosing cholangitis
Prevalence uncommon

Gallbladder carcinoma is a malignant epithelial neoplasm arising from the gallbladder. Most gallbladder carcinomas are adenocarcinomas.

General

  • Uncommon.

Treatment:

  • Cholecystectomy +/- lymph nodes +/- partial hepatectomy.[1]

Epidemiology

Notes:

  • Diffuse calcification of gallbladder wall, AKA "porcelain gallbladder" is not associated with carcinoma - based on a series of 10,741 cholecystectomies.[2]
    • Focal mucosal calcification is associated with malignancy.[3]
  • Cholangiocarcinoma is dealt with in the liver neoplasms article.

Gross

  • Classic: mass projecting into the lumen.
  • Marked gallbladder wall thickening.
    • >10 mm should be considered with suspicion.[4]

Image:

Microscopic

Features:

Notes:

  • May be very subtle, i.e. difficult to differentiate from normal glands.
    • "Deep glands" that look bland shouldn't immediately be dismissed as benign.

Subtypes:

DDx:

Images

IHC

Features - conventional:[6]

  • CK7 +ve (7 of 8 cases.
  • CK20 -ve (7 of 8 cases).
  • CDX2 -ve (8 of 8 cases).

See also

References

  1. Biswas, PK. (Jul 2010). "Carcinoma gallbladder.". Mymensingh Med J 19 (3): 477-81. PMID 20639849.
  2. Towfigh S, McFadden DW, Cortina GR, et al (January 2001). "Porcelain gallbladder is not associated with gallbladder carcinoma". Am Surg 67 (1): 7?0. PMID 11206901.
  3. Stephen, AE.; Berger, DL. (Jun 2001). "Carcinoma in the porcelain gallbladder: a relationship revisited.". Surgery 129 (6): 699-703. doi:10.1067/msy.2001.113888. PMID 11391368.
  4. Kim, HJ.; Park, JH.; Park, DI.; Cho, YK.; Sohn, CI.; Jeon, WK.; Kim, BI.; Choi, SH. (Feb 2012). "Clinical usefulness of endoscopic ultrasonography in the differential diagnosis of gallbladder wall thickening.". Dig Dis Sci 57 (2): 508-15. doi:10.1007/s10620-011-1870-0. PMID 21879282.
  5. Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 174. ISBN 978-0470519035.
  6. 6.0 6.1 Dursun, N.; Escalona, OT.; Roa, JC.; Basturk, O.; Bagci, P.; Cakir, A.; Cheng, J.; Sarmiento, J. et al. (Nov 2012). "Mucinous carcinomas of the gallbladder: clinicopathologic analysis of 15 cases identified in 606 carcinomas.". Arch Pathol Lab Med 136 (11): 1347-58. doi:10.5858/arpa.2011-0447-OA. PMID 23106580.