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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
.
Diseases
Validation
Diseases presenting
"wide range"
symptom
22q11.2 deletion syndrome
acute rheumatic fever
adrenomyeloneuropathy
alexander disease
allergic bronchopulmonary aspergillosis
alpha-thalassemia
aromatase deficiency
benign recurrent intrahepatic cholestasis
cadasil
carcinoma of the gallbladder
congenital toxoplasmosis
cowden syndrome
cystinuria
dystrophic epidermolysis bullosa
epidermolysis bullosa simplex
erdheim-chester disease
fabry disease
gm1 gangliosidosis
harlequin ichthyosis
homocystinuria without methylmalonic aciduria
hydrocephalus with stenosis of the aqueduct of sylvius
legionellosis
neonatal adrenoleukodystrophy
oral submucous fibrosis
pendred syndrome
phenylketonuria
pleomorphic liposarcoma
primary effusion lymphoma
primary hyperoxaluria type 1
proteus syndrome
pyruvate dehydrogenase deficiency
scrub typhus
systemic capillary leak syndrome
thoracic outlet syndrome
triple a syndrome
trochlear dysplasia
well-differentiated liposarcoma
werner syndrome
x-linked adrenoleukodystrophy
zellweger syndrome
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