Incidental Gall Bladder Adenocarcinoma in Cholecystectomy Specimens; A Single Center Experience and Review of the Literature

Abstract

BACKGROUND Gallbladder adenocarcinoma is the most common malignant tumor of the biliary tract. Most of gall bladder cancers are detected incidentally only after pathological examination of the surgical specimens. In this study we investigated the characteristics of incidental gallbladder cancers in our center and also reviewed the current literature regarding the diagnosis and treatment of such incidentally detected tumors in the gall bladder. METHODS We retrospectively reviewed all of the cholecystectomy specimens in the archives of Pathology Department in the hospitals affiliated to Shiraz University of Medical Sciences in the study period (2010-2016). Clinicopathological characteristics were extracted from the patients’ clinical charts, which included symptoms, radiological findings, laboratory data, and surgical procedures as well as outcome. RESULTS During these 7 years we identified 18 cases of incidental gall bladder cancer, consisted of 13 women and 5 men with the age range of 32 to 85 (62.5 ± 14.2) years detected after pathological study of the resected gall bladders among more than 4800 resected gall bladders. During the period, only two patients were operated on with the impression of gall bladder adenocarcinoma, which was not included in the study. Ten cases were T1 and eight were T2 at the time of surgery. They have been followed up for 1-7 years, during which, six cases of T2 died. All of the T1 cases are alive and symptom free. CONCLUSION By increasing laparoscopic cholecystectomies in our center we observed 0.37% incidental cases of gall bladder adenocarcinoma. Preoperative diagnosis of this cancer in early stages is very difficult and needs high degree of suspicion. The most important predictor of prognosis is the stage of the cancer at the time of surgery. To the best of our knowledge, this is the first report of incidental gall bladder cancer from Iran.

Safe, selective histopathological examination of gallbladder specimens: a systematic review

“…An additional 18 studies were identified during manual cross‐referencing, resulting in a total of 73 articles, including 232 155 patients, that were eligible for data analysis. These studies were then divided into those performed in countries with a low incidence (39) 6,18–55 and countries with a high incidence (34) 7,56–88 of GBC. Characteristics of all included studies are presented in Table S1 (supporting information).…”

“…5). Three studies 23,28,52 (5633 patients) from countries with a low incidence of GBC in which the surgeon systematically De Zoysa et al 20 Almuslamani et al 22 Genç et al 23 Ghimire et al 24 Byars and Pursnani 25 Cavallaro et al 26 Chin et al 27 Romero-González et al 28 Bawahab et al 29 De Werra et al 30 Ferrarese et al 31 Koshenkov et al 32 Ozgur et al 33 Panebianco et al 34 Elshaer et al 35 Ghnnam et al 36 van Vliet et al 6 Amiraslanov et al 37 Bali et al 38 Emmett et al 39 Lilic et al 40 Basak et al 41 Düzköylü et al 43 Patel et al 44 Al-Qahtani et al 45 Tatli et al 46 Uysal et al 47 Wrenn et al 48 Al Manasra et al 49 Benkhadoura et al 50 Charfi et al 51 Corten et al 52 Dincel et al 53 Geramizadeh et al 54 Olthof et al 55 456 of 129 059 Total Heterogeneity:…”

Incidental Gallbladder Carcinoma Diagnosed After Laparoscopic Cholecystectomy

“…[7] The incidence of IGBC is reported to be between 0.11% and 3%. [6,[8][9][10][11][12][13] We found the incidence of IGBC in our study to be 0.4%. In recent years, the incidence of IGBC has increased because of an increase in the number of patients undergoing LC.…”

Incidental gallbladder cancer: a retrospective clinical study of 40 cases

“…It was determined that IGBCs were higher in advanced age and female sex. While the GBC average age at diagnosis is 65 years and up, the IGBC average age appears to be a few years lower [ 15 ]. We observed that our patients had a mean age of 62.3 years, a few years lower than those reported in the literature.…”