The polypoid lesions of gallbladder have explosively increased with enhanced feasibility of transabdominal ultrasonography. Most of small polyps less than 10 mm are benign and remain static for a long period. In small polyps, three to six month intervaled ultrasonography is warranted in the initial follow-up, but the duration of follow-up period is not clarified. The polypoid lesions larger than 10 mm show a quite different feature. They showed a remarkable risk of malignancy (34-88%) and should be treated by surgery. Furthermore, age more than 50 years and combined gallstone are important factors predicting malignancy in polypoid lesions of gallbladder. In addition, other factors including solitary polyp and the presence of symptoms are considered as risk factors. Laparoscopic cholecystectomy is a golden standard therapy for these polyps unless the suspicion of malignancy is high. The gallbladder polyps remain a problem of concern to both doctors and patient with the worry of malignancy. Thus, the comprehensive understanding of natural coruse of gallbladder polyp and risk factors of malignancy should be kept in mind.
Cholecystectomy, Laparoscopic ; Gallbladder Diseases/classification/*pathology/surgery ; Gallbladder Neoplasms/diagnosis ; Humans ; Polyps/classification/*pathology/surgery ; Risk Factors

Adenocarcinoma ; diagnosis ; pathology ; surgery ; Adenocarcinoma, Mucinous ; diagnosis ; pathology ; surgery ; Adult ; Aged ; Carcinoma, Squamous Cell ; diagnosis ; pathology ; surgery ; Cholecystectomy ; methods ; Female ; Follow-Up Studies ; Gallbladder Neoplasms ; diagnosis ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Survival Rate

Cystic lymphangioma of the gallbladder is quite a rare tumor with only a few cases having been reported in the literature. We describe here a rare case of cystic lymphangioma of the gallbladder, which was unusual in that the patient presented with biliary pain and an abnormal liver test. Ultrasonography and computed tomography of the abdomen showed a multi-septated cystic mass in the gallbladder fossa and an adjacent compressed gallbladder. Endoscopic retrograde cholangiography showed there was no communication between the bile tract and the lesion, and there were no other abnormal findings with the exception of a laterally compressed gallbladder. After performing endoscopic sphincterotomy, a small amount of sludge was released from the bile duct. The histological findings were consistent with a cystic lymphangioma originating from the subserosal layer of the gallbladder. This unusual clinical presentation of a gallbladder cystic lymphangioma was attributed to biliary sludge, and this was induced by gallbladder dysfunction that was possibly from compression of the gallbladder due to the mass.
Adult ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystectomy, Laparoscopic ; Female ; Gallbladder Neoplasms/*diagnosis/pathology/surgery ; Humans ; Lymphangioma, Cystic/*diagnosis/pathology/surgery ; Tomography, X-Ray Computed ; Ultrasonography

OBJECTIVETo summarize the clinical features and outcomes of unsupected gallbladder carcinoma ( UGC) detected during or after laparoscopic cholecystectomy.

METHODSMedical records of 8005 patients, who underwent laparoscopic cholecystectomy in Peking Union Medical College Hospital between June 1993 and June 2011, were reviewed. Patients that pathologically diagnosed as UGC were retrospectively studied in terms of clinical features, preoperative and postoperative diagnosis, surviving period, and complications.

RESULTSIn the 8005 patients who received laparoscopic cholecystectomy, 36 (0.45%) were diagnosed as UGC during (25 patients) or after (11 patients) laparoscopic cholecystectomy. The gallbladder cancer was staged as T1 in 16 patients, T2 in 11 patients, and T3 in 9 patients. The 1-, 3-, and 5-year survival rates of all the patients were 88.9% (32/36), 63.9% (23/36), and 58.3% (21/36). The 5-year survival rates in T1 stage, T2 stage, and T3 stage patients were 100%, 75.0%, and 0.0%, respectively.

CONCLUSIONSThe survival rate of UGC is associated with tumor stage, not with operation approaches. Laparoscopic cholecystectomy is appropriate for T1 patients.

Adult ; Aged ; Aged, 80 and over ; Cholecystectomy, Laparoscopic ; Female ; Gallbladder Neoplasms ; diagnosis ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Retrospective Studies

OBJECTIVETo discuss the principles of diagnosis and treatment of the polypoid lesion of gallbladder.

METHODSClinical and pathological features of 342 cases were analysed.

RESULTSTotally 328 patients with benign polypoid lesions (including 234 cholesterol polyps, and 74 adenomas), and 14 patients with malignant polypoid lesions (including 10 adenocarcinomas and 4 adenomas with malignant changes) were included. Two hundred and forty-seven cases (72.2%) had symptoms. Seventy-eight point six percent of patients with malignant polyps were over 50 years of age, and while 29.9 percent of patients with non-malignant polyps were over 50 years. The lesions were more than 1 cm in 91.7% of the malignant polyps and in only 13.2% of the benign polyps. One hundred percent of malignant polyps, and 46 percent of benign polyps were single polyp.

CONCLUSIONSCholesterol polyps, adenomas, and adenocarcinomas are the most common lesions in polypoid lesion of the gallbladder. Cholecystectomy should be done in patients with symptoms. The risk factors for malignancy are the age of the patient (> 50), the size (> 1 cm), and number (single) of the polypoid lesions. In asymptomatic patients, cholecystectomy can be justified after integrated analysis.

Adenocarcinoma ; diagnostic imaging ; surgery ; Adenomatous Polyps ; diagnostic imaging ; pathology ; surgery ; Adult ; Aged ; Aged, 80 and over ; Cholecystectomy, Laparoscopic ; Cholelithiasis ; diagnostic imaging ; surgery ; Diagnosis, Differential ; Female ; Gallbladder Diseases ; diagnostic imaging ; pathology ; surgery ; Gallbladder Neoplasms ; diagnostic imaging ; surgery ; Humans ; Male ; Middle Aged ; Polyps ; diagnostic imaging ; pathology ; surgery ; Retrospective Studies ; Ultrasonography

We report three cases of mucin-producing carcinoma of the gallbladder, along with the magnetic resonance (MR) findings, especially the findings on a MR cholangiopancreatography. In our cases, linear or curvilinear streaks were detected running along the long axis of an enlarged gallbladder (mucus thread sign). When such findings were seen, a mucin-producing carcinoma of the gallbladder should be included as a differential diagnosis. Thus, gadolinium-enhanced MR imaging is mandatory for the precise diagnosis of the mucin-producing carcinoma of the gallbladder.
Adenocarcinoma, Mucinous/*diagnosis/pathology/surgery ; *Cholangiopancreatography, Magnetic Resonance ; Cholecystectomy ; Contrast Media/diagnostic use ; Diagnosis, Differential ; Fatal Outcome ; Female ; Gadolinium DTPA/diagnostic use ; Gallbladder Neoplasms/*diagnosis/pathology/surgery ; Humans ; Male ; Middle Aged

Adenocarcinoma ; metabolism ; pathology ; Carcinoid Tumor ; metabolism ; pathology ; surgery ; Child ; Chromogranin A ; metabolism ; Common Bile Duct ; pathology ; surgery ; Common Bile Duct Neoplasms ; metabolism ; pathology ; surgery ; Diagnosis, Differential ; Duodenum ; pathology ; surgery ; Gallbladder ; pathology ; surgery ; Humans ; Keratins ; metabolism ; Lymphoma ; metabolism ; pathology ; Male ; Mucin-1 ; metabolism ; Neoplasm Invasiveness ; Rhabdomyosarcoma ; metabolism ; pathology ; Stomach ; pathology ; surgery ; Synaptophysin ; metabolism

Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory disease of the gallbladder. Not only does XGC occasionally present as a mass formation with adjacent organ invasion like a malignant neoplasm, it can also infrequently be associated with gallbladder cancer. In the situation, it is difficult to make a differential diagnosis between the diseases. Here, we describe a case of a simultaneous XGC and a carcinoma of the gallbladder in a 61-year-old woman. To the best of our knowledge, there are only a small number of reports on this combination of diseases.
Adenocarcinoma/complications/diagnosis/*pathology/surgery ; Biopsy, Needle ; Cholangiopancreatography, Endoscopic Retrograde ; Cholecystitis/complications/diagnosis/*pathology/surgery ; Endosonography ; Female ; Gallbladder Neoplasms/complications/diagnosis/*pathology/surgery ; Granuloma/complications/diagnosis/*pathology ; Humans ; Immunohistochemistry ; Middle Aged ; Neoplasm Staging ; Prognosis ; Risk Assessment ; Tomography, X-Ray Computed ; Xanthomatosis/complications/diagnosis/*pathology

The role of integrated 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography computed tomography (PET-CT) is uncertain in gallbladder cancer. The aim of this study was to show the role of PET-CT in gallbladder cancer patients. Fifty-three patients with gallbladder cancer underwent preoperative computed tomography (CT) and PET-CT scans. Their medical records were retrospectively reviewed. Twenty-six patients underwent resection. Based on the final outcomes, PET-CT was in good agreement (0.61 to 0.80) with resectability whereas CT was in acceptable agreement (0.41 to 0.60) with resectability. When the diagnostic accuracy of the predictions for resectability was calculated with the ROC curve, the accuracy of PET-CT was higher than that of CT in patients who underwent surgical resection (P=0.03), however, there was no difference with all patients (P=0.12). CT and PET-CT had a discrepancy in assessing curative resection in nine patients. These consisted of two false negative and four false positive CT results (11.3%) and three false negative PET-CT results (5.1%). PET-CT was in good agreement with the final outcomes compared to CT. As a complementary role of PEC-CT to CT, PET-CT tended to show better prediction about resectability than CT, especially due to unexpected distant metastasis.
Adult ; Aged ; Aged, 80 and over ; *Cholecystography ; Female ; Fluorodeoxyglucose F18/diagnostic use ; Gallbladder/pathology/surgery ; Gallbladder Neoplasms/*diagnosis/*surgery ; Humans ; Lymphatic Metastasis/diagnosis ; Male ; Middle Aged ; Neoplasm Staging ; *Positron-Emission Tomography ; Radiopharmaceuticals/diagnostic use ; Retrospective Studies ; Sensitivity and Specificity ; *Tomography, X-Ray Computed ; Treatment Outcome

OBJECTIVETo investigate the clinical characteristics of primary gallbladder carcinoma.

METHODSThe data of clinical manifestations, image characteristics, diagnosis and treatment of 110 patients with primary gallbladder carcinoma were analyzed.

RESULTSThe rate of diagnosis as early primary gallbladder carcinoma was only 8.2% (9/110) in this series. The majority of the patients were females (63/110) with an age ranging from 31 to 80 years. Clinical manifestations were not specific, and diagnosis was made mainly on image examination. Radical resection was performed for 57 patients, palliative resection for 41, the rest 12 patients failed to receive operation on reasons of distant metastasis, age or other reasons. Only 88 patients were followed with a mean survival time of 196 days ranging from 15 days to 5 years and 11 months.

CONCLUSIONThe primary gallbladder carcinoma is quite difficult to diagnose at the early stage, and its prognosis is usually poor. The diagnosis is made mainly depending on the medical history and image examinations.

Adult ; Aged ; Aged, 80 and over ; Cholecystectomy ; methods ; Female ; Follow-Up Studies ; Gallbladder Neoplasms ; diagnosis ; diagnostic imaging ; pathology ; surgery ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Staging ; Survival Rate ; Tomography, X-Ray Computed ; Ultrasonography