Gallbladder Carcinoma I — Versus Gallbladder Wall Edema

Cholecystosonography in approximately 40000 patients over five years in two university hospitals revealed 30 (75 %) of the 40 macroscopic primary carcinomas. In 3 cases the carcinoma was obscured by gallstones with shadowing, in 3 cases the origin of a tumour mass was misinterpreted, and in 4 cases the neoplastic growth mimicked gallbladder inflammatory changes or sludge. Malignancy was incorrectly diagnosed or suggested in 25 patients. The most frequent cause of a false positive report was acute or chronic inflammation, found at surgery in 16 gallbladders. Four carcinomas of the pancreatic head were believed to be gallbladder tumours. Cirrhosis with marked gallbladder wall thickening, gastric carcinomas with metastases, a common duct carcinoma, and two cases of sludge (with normal control studies) caused a false suggestion of gallbladder carcinoma. The most frequent ultrasonographic finding in gallbladder carcinomas was a mass filling the gallbladder (15 diagnosed cases), followed by wall thickening (9 cases), and polypoid or fungating tumour (6 cases). Real-time ultrasonography is a useful method for the preoperative diagnosis of gallbladder carcinoma, but considerable diagnostic problems in the differentiation from inflammatory diseases may be encountered.

Download Full-text

Differential Diagnosis of Gallbladder Wall Thickening by Two Phase Spiral CT: Gallbladder Carcinoma versus Cholecystitis

Journal of the Korean Radiological Society ◽

10.3348/jkrs.2001.44.4.497 ◽

2001 ◽

Vol 44 (4) ◽

pp. 497

Author(s):

Sun Park ◽

Soon Gu Cho ◽

Mi Young Kim ◽

Je Hong Woo ◽

Seok Hwan Shin ◽

...

Keyword(s):

Differential Diagnosis ◽

Gallbladder Carcinoma ◽

Spiral Ct ◽

Gallbladder Wall ◽

Wall Thickening ◽

Two Phase ◽

Gallbladder Wall Thickening

Download Full-text

Perfidious Gallbladders – A Diagnostic Dilemma with Xanthogranulomatous Cholecystitis

Annals of The Royal College of Surgeons of England ◽

10.1308/003588407x155833 ◽

2007 ◽

Vol 89 (2) ◽

pp. 168-172 ◽

Cited By ~ 24

Author(s):

Gandrapu NS Srinivas ◽

Surajit Sinha ◽

Nick Ryley ◽

Paul WJ Houghton

Keyword(s):

Laparoscopic Cholecystectomy ◽

Gallbladder Carcinoma ◽

Conversion Rate ◽

Average Length ◽

Care Pathway ◽

Bile Leak ◽

Common Bile Duct Stones ◽

Gallbladder Wall ◽

Xanthogranulomatous Cholecystitis ◽

Diagnostic Dilemma

INTRODUCTION Xanthogranulomatous cholecystitis (XGC) is an uncommon variant of chronic cholecystitis characterised by marked thickening of the gallbladder wall and dense local adhesions. Pre-operative and intra-operative diagnosis is difficult and it often mimics a gallbladder carcinoma (GBC). Laparoscopic cholecystectomy (LC) is frequently unsuccessful with a high conversion rate. A series of patients with this condition led us to review our experience with XGC and to try to develop a care pathway for its management. PATIENTS AND METHODS A retrospective review of the medical records of 1296 consecutive patients who had undergone cholecystectomy between January 2000 and April 2005 at our hospital was performed. Twenty-nine cases of XGC were identified among these cholecystectomies. The clinical, radiological and operative details of these patients have been analysed. RESULTS The incidence of XGC was 2.2% in our study. The mean age at presentation was 60.3 years with a female:male ratio of 1.4:1. Twenty-three patients (79%) required an emergency surgical admission at first presentation. In three patients, a GBC was suspected both radiologically and at operation (10.3%), but was later disproved on histology. Seventeen patients (59%) had obstructive jaundice at first presentation and required an endoscopic retrograde cholangiopancreatography (ERCP) before LC. Of these, five had common bile duct stones. Abdominal ultrasound scan showed marked thickening of the gallbladder wall in 16 cases (55%). LC was attempted in 24 patients, but required conversion to an open procedure in 11 patients (46% conversion rate). A total cholecystectomy was possible in 18 patients and a partial cholecystectomy was the choice in 11 (38%). The average operative time was 96 min. Three patients developed a postoperative bile leak, one of whom required ERCP and placement of a biliary stent. The average length of stay in the hospital was 6.3 days. CONCLUSIONS Severe xanthogranulomatous cholecystitis often mimics a gallbladder carcinoma. Currently, a correct pre-operative diagnosis is rarely made. With increased awareness and a high index of suspicion, radiological diagnosis is possible. Preoperative counselling of these patients should include possible intra-operative difficulties and the differential diagnosis of gallbladder cancer. Laparoscopic cholecystectomy is frequently unsuccessful and a partial cholecystectomy is often the procedure of choice.

Download Full-text