Gallbladder Cancer: An Analysis of a Series of 139 Patients With Invasion Restricted to the Subserosal Layer

Aretxabala, Xabier de; Roa, I.; Burgos, L.; Losada, Héctor; Roa, Juan Carlos; Mora, Javier; Hepp, J; León, Jorge; Maluenda, Fernando

doi:10.1016/j.gassur.2005.11.003

Cited by 71 publications

(58 citation statements)

References 13 publications

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“…In this study of 606 invasive carcinomas, which represents the largest cohort to be analyzed for this purpose to date, squamous differentiation was detected in 7% of the cases. This figure varied significantly in the literature, ranging from 1 to 12%, [24][25][26][27] presumably mostly due to the definitional differences. Our study demonstrates that pure squamous cell carcinomas, which we defined as invasive carcinomas composed entirely of squamous differentiation, are very uncommon, constituting only 1% of the cases.…”

Section: Discussionmentioning

confidence: 98%

“…Rather, squamous differentiation in the gallbladder is seen mostly as a secondary component in association with conventional adenocarcinomas. 9,13,14,21,23,25,29,45,46 This focal squamous differentiation can vary in amount from very minimal, presumably with no (or negligible) clinical/biological significance, to extensive. We employed the arbitrary cutoff of 'o25%' to determine the negligibility of this secondary differentiation, as has been done for the mixed differentiation carcinomas of other organs, and classified such cases as adenocarcinoma with focal squamous change (1% of the cases), and reserved the diagnosis of adenosquamous carcinoma for only those that have 25-99% of the tumor showing squamous differentiation (4% of gallbladder carcinomas).…”

Section: Discussionmentioning

confidence: 99%

“…The clinical presentation of adenosquamous carcinoma/squamous cell carcinoma group in this study did not seem to be too different than ordinary gallbladder adenocarcinomas, and the impression in the literature is in accordance with this observation. 9,[13][14][15]21,23,25,29 The patients are in their mid 60s-the youngest patient in this study was 26-and it occurs predominantly in females (F/M ¼ 3.8), similar to gallbladder adenocarcinomas (F/ M ¼ 3.8). As is the case for most gallbladder carcinomas, preoperatively, most patients (485%) are not suspected to have cancer, and instead undergo cholecystectomy with the diagnosis of cholecystitis.…”

Section: Discussionmentioning

confidence: 99%

“…9,13,14,[21][22][23] These definitional differences may partly be responsible for the variations in reported incidence of these tumors, which ranges from 1 to 12%. 14,18,[24][25][26][27][28] Although the limited nature of the data and the definitional variations precluded proper characterization of these tumors, some common threads could be observed: it had been speculated that adenosquamous carcinomas/ squamous cell carcinomas are at least as aggressive as ordinary gallbladder adenocarcinomas. 9,11,[13][14][15]23,29 It has been observed that the squamous component of gallbladder carcinomas proliferates at a higher rate than the glandular component; 14 however, despite their high proliferation rate, these tumors appeared to less frequently present with lymph node metastasis than gallbladder adenocarcinomas.…”

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confidence: 99%

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Gallbladder Squamous Cell Carcinoma with Chronic Right Upper Quadrant Discomfort

Park¹,

Lee²,

Hong³

et al. 2018

Clin Ultrasound

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The information in the literature on squamous cell and adenosquamous carcinomas of the gallbladder is highly limited. In this study, 606 resected invasive gallbladder carcinoma cases were analyzed. Squamous differentiation was identified in 41 cases (7%). Those without any identifiable glandular-type invasive component were classified as pure squamous cell carcinomas (8 cases) and those with the squamous component constituting 25-99% of the tumors were classified as adenosquamous carcinomas (26 cases) and included into the analysis. The remaining 7 that had o25% squamous component were classified as adenocarcinoma with focal squamous change and excluded. The clinicopathological characteristics of adenosquamous carcinoma/squamous cell carcinomas were documented and contrasted with that of ordinary gallbladder adenocarcinomas. The average patient age was 65 years (range 26-81); female/male ratio, 3.8. In only 13%, there was a preoperative clinical suspicion of malignancy. Grossly, 58% presented as thickening and hardening of the wall and 6% were polypoid. In 12%, mucosa adjacent to the tumor revealed squamous metaplasia. All pure squamous cell carcinomas had prominent keratinization. Giant cells and tumor-infiltrating eosinophils were observed in 29 and 51% of the squamous cell carcinomas/adenosquamous carcinomas versus 10% (P ¼ 0.02) and 6% (P ¼ 0.001) in gallbladder adenocarcinomas, respectively. All but three cases had 'advanced' (pT2 and above) carcinomas. Follow-up was available in 31 patients: 25 died of disease (median ¼ 5 months, range 0-20), and 6 were alive (median ¼ 64 months, range 5-112.5). The survival of patients with squamous cell carcinomas/adenosquamous carcinomas was significantly worse than that of gallbladder adenocarcinomas (P ¼ 0.003), and this adverse prognosis persisted when compared with stage-matched advanced gallbladder adenocarcinoma cases (median ¼ 11.4 months, P ¼ 0.01). In conclusion, squamous differentiation was noted in 7% of gallbladder carcinomas. The incidence of adenosquamous carcinoma (defined as 25-99% of the tumor being squamous) was 4%, and that of pure squamous cell carcinoma (without any documented invasive glandular component) was 1%. Pure squamous cell carcinomas often showed prominent keratinization. The overall prognosis of adenosquamous carcinoma/squamous cell carcinoma appears to be even worse than that of ordinary adenocarcinomas. Most patients died within a few months; however, those few who were alive beyond 2 years in this cohort experienced long-term survival.

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Gallbladder Squamous Cell Carcinoma with Chronic Right Upper Quadrant Discomfort

Park¹,

Lee²,

Hong³

et al. 2018

Clin Ultrasound

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“…Quel que soit le stade, il faut associer à la résection du parenchyme hépatique, un curage ganglionnaire complet du pédicule hépatique, de la faux de l'artère hépatique et de la région coeliaque [9,20,23].…”

Section: Curage Ganglionnaireunclassified

Cholangiocarcinome vésiculaire de découverte fortuite sur pièce de cholécystectomie : faut-il réopérer ?

Peschaud¹

2012

Cancérodig.

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Le cancer de la vésicule biliaire est rare, de pronostic sévère et souvent diagnostiqué de manière fortuite sur pièce de cholé-cystectomie. La survie des cancers découverts fortuitement est cependant meilleure que lorsque le diagnostic est fait en pré-opératoire, car il s'agit le plus souvent de « petits cancers ».Le compte-rendu opératoire détaillé, l'analyse complète du compte-rendu anatomo-pathologique de la pièce de cholé-cystectomie, complétés d'un bilan d'extension, permettent de classer la lésion selon le stade TNM qui sera déterminant pour décider de la prise en charge ultérieure et notamment de l'indication d'une réintervention chirurgicale carcinologique.Seuls les adénocarcinomes n'envahissant pas la musculeuse (T1a) et avec des marges de résections chirurgicales saines peuvent être considérés comme ayant eu une résection satisfaisante. Toutes les autres lésions nécessiteront une réinter-vention comportant une résection hépatique, un curage ganglionnaire, une recoupe du canal cystique (plus ou moins associée à une résection de la voie biliaire principale) ainsi qu'une exérèse des orifices de trocarts lorsque la cholécystec-tomie avait été réalisée par laparoscopie. La réintervention ne doit laisser aucun résidu tumoral si l'on veut espérer un bénéfice en termes de survie pour le patient. Mots-clésCancer, Vésicule biliaire, Découverte fortuite, Réintervention ❚ AbstractCancer of the gallbladder cancer is rare and associated with a poor prognosis. It is frequently fortuitously discovered on a specimen after cholecystectomy. Survival with such cancers fortuitously discovered is often better than when diagnosed pre-operatively, as they are often of small size.A detailed operative report, the whole analysis of the pathological report of the surgical specimen, followed with a staging of the lesion according to the TNM classification will be of utmost importance to decide of the further management and especially if surgical re-operation is indicated. Resection can be considered as satisfactory only if the adenocarcinoma is not invading the musculosa (T1a) and shows safe resection margins. All other lesions should be re-operated with hepatic resection, lymph node dissection, resection of the cystic duct (more or less associated to the resection of the main biliary tract) as well as the exeresis of the trocar orifices if cholecystectomy has been performed by laparoscopy. Surgical re-operation should not leave any tumoral residue if a benefit in terms of survival is expected for the patient.

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Malignant Biliary Diseases

Koti

Bridgewater

2018

Sherlock's Diseases of the Liver and Biliary System

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Gallbladder Cancer: An Analysis of a Series of 139 Patients With Invasion Restricted to the Subserosal Layer

Cited by 71 publications

References 13 publications

Gallbladder Squamous Cell Carcinoma with Chronic Right Upper Quadrant Discomfort

Gallbladder Squamous Cell Carcinoma with Chronic Right Upper Quadrant Discomfort

Cholangiocarcinome vésiculaire de découverte fortuite sur pièce de cholécystectomie : faut-il réopérer ?

Malignant Biliary Diseases

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