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Carcinoma involving the gallbladder: a retrospective review of 23 cases - pitfalls in diagnosis of gallbladder carcinoma.
[carcinoma of the gallbladder]
Carcinoma
of
the
gallbladder
(
GBC
)
clinically
mimics
benign
gallbladder
diseases
and
often
escapes
detection
until
advanced
stage
.
Despite
the
frequency
of
cholecystectomy
,
diagnosis
of
GBC
remains
problematic
in
many
situations
.
We
sought
to
identify
pathologic
features
that
contribute
to
the
difficulty
in
recognition
of
GBC
.
We
identified
23
patients
(
ranged
from
45
to
86
years
,
male
to
female
ratio
1
:
4
.
5
)
with
carcinoma
involving
the
gallbladder
referred
to
an
academic
medical
center
over
a
period
of
10
years
for
study
.
This
includes
10
cases
of
primary
GBC
,
6
cases
of
metastatic
tumor
to
gallbladder
,
6
cases
of
directly
invasive
adenocarcinoma
arising
elsewhere
in
the
biliary
tree
,
and
one
case
of
unidentified
origin
adenocarcinoma
.
Primary
tumors
include
adenocarcinoma
not
otherwise
specified
(
NOS
)
in
6
cases
,
papillary
adenocarcinoma
in
2
cases
,
and
single
cases
of
undifferentiated
carcinoma
and
combined
adenocarcinoma
and
neuroendocrine
carcinoma
(
NEC
)
.
Metastatic
tumors
to
gallbladder
were
from
a
wide
range
of
primary
sites
,
predominantly
the
gastrointestinal
tract
.
These
cases
illustrate
seven
potential
pitfalls
which
can
be
encountered
.
These
include
:
1
)
mistakenly
making
a
diagnosis
of
adenocarcinoma
of
gallbladder
when
only
benign
lesions
such
as
deeply
penetrating
Rokitansky-
Aschoff
sinuses
are
present
(
overdiagnosis
)
,
2
)
misdiagnosing
well-differentiated
invasive
carcinoma
with
minimal
disease
as
benign
disease
(
underdiagnosis
)
,
3
)
differentiating
between
primary
NEC
of
gallbladder
and
metastasis
,
4
)
confusing
primary
mucinous
adenocarcinoma
of
gallbladder
with
pseudomyxoma
peritonei
from
a
low
grade
appendiceal
neoplasm
disseminated
to
gallbladder
,
5
)
confusing
gangrenous
necrosis
related
to
cholecystitis
with
geographic
tumoral
necrosis
,
6
)
undersampling
early
,
grossly
occult
disease
,
and
7
)
misinterpreting
extracellular
mucin
pools
.
Clinical
history
and
a
high
index
of
suspicion
are
prerequisite
to
detecting
GBC
.
Detection
of
GBC
at
an
early
stage
is
difficult
because
the
symptoms
mimic
benign
gallbladder
diseases
.
Misinterpretation
of
subtle
microscopic
abnormalities
contributes
diagnostic
failures
in
early
cases
.
Careful
attention
to
any
evidence
of
mural
thickening
,
thorough
sampling
,
particularly
in
older
patients
,
and
close
examination
of
any
deeply
situated
glandular
structures
are
critical
.
Correlations
with
radiographic
and
clinical
findings
are
important
helps
to
avoid
misdiagnosis
in
this
commonly
resected
organ
.
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"often escapes detection until advanced stage"
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carcinoma of the gallbladder
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