Clinicopathologic features of advanced gallbladder cancer associated with adenomyomatosis
Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Nabesima 5-1-1, Saga City, Saga 849-8501, Japan.Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin (Impact Factor: 2.65). 12/2011; 459(6):573-80. DOI: 10.1007/s00428-011-1155-1
Adenomyomatosis of the gallbladder has not been considered to have malignant potential, but gross features of adenomyomatosis are sometimes encountered in gallbladders resected under a diagnosis of gallbladder carcinoma. The purpose of this study was to determine the clinicopathologic features and survival rates in cases of gallbladder cancer with gross features of adenomyomatosis. The study subjects were 97 surgically treated gallbladder carcinoma patients. Only gallbladder showing typical gross features of adenomyomatosis was judged as adenomyomatosis-positive gallbladder cancer. In terms of gross findings, 25 cases (25.8%) were classified as adenomyomatosis-positive. The status of adenomyomatosis was significantly associated with the T stage (P=0.0004), lymph node (LN) metastasis (P<0.0001), distant metastasis (P=0.008), and stage (P=0.0005). In the adenomyomatosis-positive group, 16 of the 25 cases (64.0%) were classified as segmental type and 9 cases (36.0%) were classified as fundal type. No diffuse-type cases were present in this series. The status of adenomyomatosis correlated significantly with survival (P=0.0007). However, the multivariate analysis of significant variables identified from the univariate analysis identified only T stage (P=0.0178) and LN metastasis (P=0.0048) as independent prognostic factors. Subset analysis with T stage according to the status of adenomyomatosis showed no significant impact on survival. These results indicate that adenomyomatosis-positive gallbladder cancer is more often diagnosed clinically in the advanced stages. Since preceding adenomyomatosis may prevent the early detection of gallbladder cancer, the usefulness of preventive cholecystectomy in cases of asymptomatic adenomyomatosis should be considered.
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ABSTRACT: To study the clinicopathological features as well as the optimal treatment of gallbladder sarcomatoid carcinoma is of great significance. The clinical data of 3 cases of gallbladder sarcomatoid carcinoma (classified to GSC group) were analyzed retrospectively and compared with that of the other histological type of gallbladder carcinoma cases (classified to GC group, n = 123). Moreover, gallbladder carcinoma cases with the same TNM stage as GSC, including stage I A (n = 17) and stage II A (n = 5), were classified to control group. The prognosis analysis was further made between GSC group (n = 3) and control group (n = 22). 3 GSC cases were all male, the age ranged from 60 to 68 years, and the mean and median age was (64±4.65 years). One case accompanied with gallstone (33.3%, 1/3), one and two cases with elevated CEA (50.0%, 1/2) and CA19-9 (100%, 2/2) level respectively. Except for sex ratio, the clinicopathological features of GSC are similar to those of GC. Although the (1−2−5−) years overall survival (67%, 0, 0) and the mean and median survival (15±3.15 month) for GSC were similar to that of GC groups, it was significantly lower than that of control group (100%, 68%, 39%; 46±8.27 months) respectively. The clinicopathological features of GSC are similar to those of GC. The prognosis of GSC is extremely poorer than that of the other gallbladder cancer with the same stage. A better survival is possibly achieved in case the GSC patient received radical resection in early stage.
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ABSTRACT: Background Gallbladder cancer (GBC) is a rare malignancy, yet certain groups are at higher risk. Knowledge of predisposing factors may facilitate earlier diagnosis by enabling targeted investigations into otherwise non-specific presenting signs and symptoms. Detecting GBC in its initial stages offers patients their best chance of cure. Methods PubMed was searched for recent articles (2008-2012) on the topic of risk factors for GBC. Of 1490 initial entries, 32 manuscripts reporting on risk factors for GBC were included in this review. ResultsNew molecular perspectives on cholesterol cycling, hormonal factors and bacterial infection provide fresh insights into the established risk factors of gallstones, female gender and geographic locality. The significance of polyps in predisposing to GBC is probably overstated given the known dysplasia-carcinoma and adenoma-carcinoma sequences active in this disease. Bacteria such as Salmonella species may contribute to regional variations in disease prevalence and might represent powerful targets of therapy to reduce incidences in high-risk areas. Traditional risk factors such as porcelain gallbladder, Mirizzi's syndrome and bile reflux remain important as predisposing factors. Conclusions Subcentimetre gallbladder polyps rarely become cancerous. Because gallbladder wall thickening is often the first sign of malignancy, all gallbladder imaging should be scrutinized carefully for this feature.
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ABSTRACT: The purpose of this study was to reveal differences in clinical diagnosis of gallbladder cancer among patients with or without adenomyomatosis (ADM) by analyzing demonstrated tumor patterns on imaging and diagnostic opportunities. Ninety-seven patients with gallbladder cancer were enrolled. Demonstrated imaging patterns were classified into mass lesion (ML), wall thickening (WT), and papillary lesion (PL). Clinical status during periodic follow up and other diagnostic opportunities were determined from medical records. All adenomyomatosis-associated cases were diagnosed at the T2 or higher stage. The distribution of demonstrated imaging patterns was significantly different between the adenomyomatosis-associated and non-adenomyomatosis-associated groups (p = 0.0002). No adenomyomatosis-associated gallbladder cancer had the PL pattern, which was readily identifiable and characteristic of early-stage cancer. The WT pattern presented difficulties for diagnosis, and the ML pattern was relatively specific, although most of these cases were at advanced stages. Approximately 40 % of ADM patients were found to be in advanced stages of gallbladder cancer, in spite of undergoing periodic follow up. This study revealed the difficulty of early diagnosis of primary gallbladder cancer in the setting of concurrent ADM. Current results suggest the possible utility of preventive cholecystectomy for management of asymptomatic ADM patients.
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