Gallbladder
Malignant gallbladder tumors
Gallbladder carcinoma

Author: Hanni Gulwani, M.D. (see Authors page)

Revised: 9 February 2018, last major update September 2012

Copyright: (c) 2003-2018, PathologyOutlines.com, Inc.

PubMed Search: Gallbladder carcinoma[TI] free full text[sb] pathology

Cite this page: Gulwani, H. Gallbladder carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/gallbladdercarcinoma.html. Accessed February 24th, 2018.
Definition / general
  • Relatively uncommon
  • Age 60+ years (mean 72 years), 75% women, usually not resectable
  • Metastases to peritoneum and liver, pericholedochal lymph nodes of lesser omentum, occasionally to lungs and pleura
  • 90% are adenocarcinoma, 5% squamous cell or adenosquamous, 5% undifferentiated
Epidemiology
  • 2.5 per 100,000 population
  • Lower incidence in Asia, where pyogenic and parasitic disease of biliary tree are more common
  • More common in American Indians and Hispanics; very rare in blacks
  • 6,500 annual deaths in U.S. but largest cause of cancer death for women in Chile
Diagrams / tables

Images hosted on other servers:

Dysplasia vs. reactive atypia

Clinical features
  • Associated with gallstones (2/3); also adenomyomatosis, anomalous connection between common bile duct and pancreatic duct, cholecystoenteric fistula, Peutz-Jeghers syndrome, polyposis coli / Gardner syndrome, porcelain gallbladder, ulcerative colitis
  • Often invades liver, common bile duct, stomach, duodenum and transverse colon
  • 70% involve liver at diagnosis, 50% involve regional lymph nodes

5 year survival:
Diagnosis
  • Adenomyomatosis positive gallbladder cancer is more often diagnosed clinically in the advanced stages; therefore, preventive cholecystectomy in cases of asymptomatic adenomyomatosis should be considered (Virchows Arch 2011;459:573)
  • Intraoperative bile cytology useful to detect in situ and early invasive carcinoma (Cancer 2005;105:277)
Prognostic factors

Molecular markers, poor prognosis:
Case reports
Treatment
  • Cholecystectomy (T1 tumors), uncertain for more advanced tumors
  • Tumor may recur at trochar site after laparoscopic cholecystectomy
Gross description
  • Fibrosis and thickening of wall, may be papillary and diffuse
  • Often associated with gallstones > 3 cm
  • Tumor may not be obvious, although liver spread is usually evident at time of diagnosis
Gross images

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Various images

Microscopic (histologic) description
  • Infiltrative (diffuse thickening and induration of wall with possible fistula formation due to deep ulceration) or exophytic (irregular, cauliflower mass that grows into lumen and invades wall)
  • Well formed glands in papillary architecture with wide lumina, atypical cuboidal cells, high grade
  • May extend to Rokitansky-Aschoff sinuses (but this does not signify deep invasion)
  • Superficial portion is often better differentiated than deeper portion
  • May have foci of intestinal differentiation
Microscopic (histologic) images

Images hosted on other servers:


Various images

Positive stains
Molecular / cytogenetics description
Differential diagnosis
  • Reactive atypia (see table above)