Incidental Gall Bladder Carcinoma in Patients Undergoing Laparoscopic Cholecystectomy

Abstract

BACKGROUND: Gall stones are the most common biliary pathology. Cholelithiasis, whether symptomatic or asymptomatic, needs cholecystectomy due to 70-98% association of gall bladder carcinoma with gall stones. Despite this, the prevalence of carcinoma gall bladder is 2-5% with 0.3-0.5% being incidentally diagnosed in patients undergoing cholecystectomy. In such cases, clinical judgment and high index of suspicion in a rural setup is a worthy tool. AIMS AND OBJECTIVES: The study was undertaken to determine incidence of cholelithiasis and gall bladder carcinoma in various age groups among patients undergoing cholecystectomy and to standardize stage wise treatment of gall bladder carcinoma, specifically in relation to incidentally diagnosed gall bladder carcinoma. MATERIALS AND METHODS: A total of 189 patients undergoing cholecystectomy over a period of two and a half years were analyzed in a rural hospital, attached to medical college. Patients with gall bladder carcinoma were followed 3 monthly until death or till 31 ST Oct 2013. RESULTS: Maximum number of patients were in age group of 51-60 years (22.2%) with female to male ratio of 1.9:1. Pain in right hypochondrium was the most common symptom (76.2%) patients. Cholelithiasis was present in 75% patients with gall bladder carcinoma. Incidental diagnosis of gall bladder carcinoma in patients undergoing cholecystectomy for benign disease was 1.5%. Overall incidence of gall bladder carcinoma in patients undergoing cholecystectomy was 4.2%. After confirming the final diagnosis by histopathology, ultrasound showed only 62.5% sensitivity, 97.79% specificity, 55.56% positive predictive value, 98.33% negative predictive value and 96.3% accuracy to diagnose gall bladder carcinoma. Among three incidentally diagnosed patients, operated by laparoscopic cholecystectomy, two were alive at 8 and 13 months of follow-up respectively. CONCLUSION: A sound knowledge of various modes of presentation of cholelithiasis and gall bladder carcinoma, combined with clinical judgment, high suspicion in high risk areas and confirmation by newer diagnostic modalities like USG and CT is required for early diagnosis and treatment and prevention of complications.

Incidental Detection of Precancerous and Malignant Gall Bladder Lesions in Routine Cholecystectomy Specimens

“…Very few lesions were found to have no associated cholelithiasis. (6) Similarly, Gupta et al (7) also found high prevalence of gall stones in all GB lesions. In concordance with the literature, we found gallstones in 3 of the 5(75%) cases of GB adenomas, 100% cases of isolated dysplasia and 9 of the 10(90%) cases of GBC.…”

“…In our study 90% cases of GBC had associated gall stones, as observed by other authors. (3)(4)(5)(6)(7) Bhawna et al in their study have also illustrated that GB dysplasia, tubular adenomas, carcinoma in situ and invasive carcinoma were frequently associated with gall stones. Very few lesions were found to have no associated cholelithiasis.…”

“…On USG, about 40-60% cases are detected only when a solid intraluminal mass is present. (7) Diffuse GB wall thickening is considered as a non-specific finding which can be observed even in chronic inflammatory conditions. (10) In present study 40% cases showed diffusely thickened wall on radiological examination.…”