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

BACKGROUND/AIMS: Early detection of gallbladder (GB) cancer is essential for better survival rates. Most cases of GB cancer are diagnosed incidentally via pathology of the cholecystectomy specimen. Data on the clinical characteristics of early GB cancer are lacking. The aim of the current study was to investigate the clinical characteristics of early GB cancer to aid earlier diagnosis. METHODS: Sixty-four patients who were diagnosed with early GB cancer after surgical resection at the Samsung Medical Center were enrolled in this study. Clinical characteristics, preoperative diagnoses, preoperative tumor size, laboratory findings including carbohydrate antigen 19-9 (CA19-9) levels, imaging features, and survival rate were investigated. RESULTS: Clinical symptoms and serum tumor markers such as carcinoembryonic antigen and CA19-9 levels were not helpful indicators of early GB cancer. Radiologic modalities showed abnormal findings in every case of early GB cancer; a polypoid mass was the most common feature. Less common features included GB wall thickening, cholecystitis, and GB stones. The clinical outcome of early GB cancer was excellent. CONCLUSIONS: Screening with imaging modalities such as computed tomography (CT) or ultrasonography (US) is helpful in detecting early GB cancer. Even in the presence of GB wall thickening, cholecystitis, or GB stones on the CT or US, any abnormal findings should prompt careful examination and intensive follow up, considering the possibility of occult gallbladder cancer.
Carcinoembryonic Antigen ; Cholecystectomy ; Cholecystitis ; Diagnosis ; Gallbladder ; Gallbladder Neoplasms* ; Humans ; Mass Screening ; Pathology ; Survival Rate ; Biomarkers, Tumor ; Ultrasonography

BACKGROUND/AIMS: The objective of our study was to identify useful computed tomography (CT) findings for differentiating fundal type adenomyomatosis from localized chronic cholecystitis involving the fundus of the gallbladder. METHODS: We retrospectively identified cases of 41 patients with pathologically proven adenomyomatosis (n=21) or chronic cholecystitis (n=20) who had fundal thickening of the gallbladder on preoperative abdominal CT. Analysis of the CT findings included evaluation of the thickness, contour, border, intralesional cystic area, adjacent gallbladder wall thickening, presence of inner layer enhancement, enhancement grade, enhancement pattern, and presence of stones. Statistical analyses were performed using the Mann-Whitney U test and Fisher exact test. RESULTS: Oval contour, inner layer enhancement and intralesional cystic area were more frequently noted in adenomyomatosis than in chronic cholecystitis (p<0.05 for each finding). Flat contour and adjacent gallbladder wall thickening were more frequently observed in chronic cholecystitis than in adenomyomatosis. No differences between adenomyomatosis and chronic cholecystitis in terms of the thickness, enhancement grade, enhancement pattern and presence of stones were apparent. CONCLUSIONS: CT may help to differentiate fundal type adenomyomatosis from localized chronic cholecystitis involving the fundus of the gallbladder.
Adenomyoma/*pathology/radiography ; Adult ; Aged ; Cholecystitis/*pathology/radiography ; Chronic Disease ; Diagnosis, Differential ; Female ; Gallbladder ; Gallbladder Neoplasms/*pathology/radiography ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tomography, X-Ray Computed

Extrahepatic metastasis of hepatocellular carcinoma (HCC) is occasionally seen in the lung, bone, adrenal gland, and lymph nodes. It is well known that HCC sometimes invades the biliary system. Since there is no peritoneum between the gallbladder and the liver fossa, a gallbladder cancer easily invades the liver; however, HCC seldom invades the gallbladder because it rarely destroys the muscle layer or the collagen fibers of the gallbladder wall. Routes of gallbladder metastasis of HCC include direct invasion, extension to the biliary system, and invasion of the adjacent hepatic vascular system. Some cases of gallbladder metastasis of HCC without direct invasion have been reported. We report here a case of HCC that directly invaded the gallbladder, and that resembled gallbladder carcinoma invading the liver.
Adult ; Carcinoma, Hepatocellular/*diagnosis/pathology/ultrasonography ; Diagnosis, Differential ; Gallbladder Neoplasms/diagnosis/*secondary ; Humans ; Liver Neoplasms/*diagnosis/pathology/ultrasonography ; Male ; Neoplasm Invasiveness ; Tomography, X-Ray Computed

Xanthogranulomatous cholecystitis is an unusual inflammatory disease of the gallbladder characterized by severe proliferative fibrosis and the accumulation of lipid-laden macrophages in areas of destructive inflammation. Its macroscopic appearance may occasionally be confused with gallbladder carcinoma. We present a case of perforated xanthogranulomatous cholecystitis presenting as biloma. An 80-year-old woman was referred to our hospital with a 1-week history of abdominal pain and febrile sensation. Abdominal CT showed a biloma in the subhepatic area. The follow-up CT showed that the biloma increased in size. Therefore, ultrasonography-guided aspiration was performed. The aspirated fluid/serum bilirubin ratio was greater than 5, which was strongly suggestive of bile leakage complicated by perforated cholecystitis. She underwent a laparoscopic cholecystectomy with cyst aspiration and adhesiolysis. A histological diagnosis of perforated xanthogranulomatous cholecystitis was made.
Aged, 80 and over ; Bilirubin/blood ; Cholecystectomy ; Cholecystitis/*diagnosis/pathology/ultrasonography ; Drainage ; Female ; Gallbladder Neoplasms/diagnosis ; Granuloma/*diagnosis/pathology/ultrasonography ; Humans ; Tomography, X-Ray Computed ; Xanthomatosis/*diagnosis/pathology/ultrasonography

Metastasis of hepatocellular carcinoma occurs at a relatively late stage of the disease. Hematogenous and lymphatic metastases are the most common routes for dissemination of tumor cells. Hepatocellular carcinoma also extends into the adjacent portal vein and bile ducts. Since there is no peritoneum between the body of the gallbladder and the liver fossa, gallbladder cancer can easily cross the boundary. Gallbladder invasion of hepatocellular carcinoma, however, is quite rare. We report a case of hepatocellular- cholangiocarcinoma in a non-cirrhotic liver that invaded the gallbladder mimicking the gallbladder carcinoma complicated by cholecystitis and liver abscess.
Aged ; Bile Duct Neoplasms/*pathology ; *Bile Ducts, Intrahepatic ; Carcinoma, Hepatocellular/pathology/*secondary ; Cholangiocarcinoma/pathology/*secondary ; English Abstract ; Female ; Gallbladder Neoplasms/diagnosis/*secondary ; Humans ; Liver Neoplasms/*pathology ; Neoplasm Invasiveness

No abstract availble.
Carcinoma, Renal Cell/*diagnosis/pathology/*secondary ; Female ; Gallbladder Neoplasms/*diagnosis/pathology/*secondary ; Humans ; Immunohistochemistry ; Kidney Neoplasms/*pathology ; Middle Aged ; Tomography, X-Ray Computed

We present a case of an intraperitoneal bronchogenic cyst located at inferior surface of the liver, next to the gallbladder which clinically mimicked a gallbladder tumor. This is the first case reported in Korea, and we offer reviews of the related literatures. A 48-yr-old woman was admitted to our hospital because of intermittent abdominal pain in right upper quadrant. Computed tomography showed a large mass alongside the gallbladder. During laparotomy, the mass showed an ovoid cystic nature, which was attached to the normal gallbladder and liver bed. Cyst excision with cholecystectomy was performed, and histopathological examination revealed a bronchogenic cyst. Most bronchogenic cysts have a benign nature, but malignant changes have also been reported. Therefore, if a cystic tumor in the abdomen is suspected during preoperative diagnosis, a bronchogenic cyst should be considered in the differential diagnosis.
Adolescent ; Adult ; Aged ; Bronchogenic Cyst/*diagnosis/pathology ; Child, Preschool ; Diagnosis, Differential ; Female ; Gallbladder Neoplasms/*diagnosis/pathology ; Human ; Infant ; Korea ; Male ; Middle Aged ; 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

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