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Fakhri AA, Rodrigue PD, Fakhri AF. Extramedullary Plasmacytoma of the Gallbladder Detected on Fluorine 18-fluorodeoxyglucose Positron Emission Tomography/Computed Tomography. J Clin Imaging Sci 2016; 6:40. [PMID: 27761300 PMCID: PMC5070038 DOI: 10.4103/2156-7514.191127] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 08/22/2016] [Indexed: 01/12/2023] Open
Abstract
Extramedullary plasmacytoma is rare in patients with diagnosed multiple myeloma. Soft tissue plasmacytoma of the gallbladder is particularly uncommon and has been described in only a handful of cases. Diagnosis of gallbladder plasmacytoma with fluorine 18-fluorodeoxyglucose (F18-FDG) positron emission tomography/computed tomography (PET/CT) has not previously been reported. We present a 65-year-old female with a history of multiple myeloma who underwent a restaging F18-FDG-PET/CT which showed a focal area of hypermetabolic activity, corresponding to a nodular lesion within the posterior gallbladder wall. The patient underwent successful cholecystectomy, with surgical pathology revealing gallbladder plasmacytoma. A follow-up scan was negative for active malignancy. This is a novel case of gallbladder plasmacytoma diagnosed on whole-body F18-FDG PET/CT – thus demonstrating the clinical value of this imaging modality in staging, restaging, and surveillance for patients with multiple myeloma.
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Affiliation(s)
- Asif Ali Fakhri
- Department of Nuclear Medicine and Molecular Imaging, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Paul David Rodrigue
- Department of Nuclear Medicine and Molecular Imaging, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Amena Fatima Fakhri
- Department of Nuclear Medicine and Molecular Imaging, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
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Mrak K, Lackner C, Mischinger HJ, Kornprat P. Metachronous gallbladder metastasis from renal cell carcinoma-a rare clinical manifestation. Wien Klin Wochenschr 2016; 128:669-71. [PMID: 27624324 DOI: 10.1007/s00508-016-1058-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 07/08/2016] [Indexed: 12/29/2022]
Abstract
Renal cell carcinoma (RCC) represents a rare tumor entity accounting for approximately 3 % of all malignancies in the adult population. Approximately 30 % of all patients suffering from RCC develop metastases after nephrectomy and another 30 % of patients suffer from synchronous metastases at the date of diagnosis. Gallbladder metastases represent an extremely rare clinical condition and up to date there are only 35 published cases of gallbladder metastasis from RCC. Surgical resection should be the treatment of choice in any case based on the reported data in literature. In spite of the small series of cases, survival can be improved even in patients suffering from additional sites of metastases.
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Affiliation(s)
- Karl Mrak
- Department of Surgery, Division of General Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria.
| | - Carolin Lackner
- Institute of Pathology, Medical University Of Graz, Graz, Austria
| | - Hans-Jörg Mischinger
- Department of Surgery, Division of General Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Peter Kornprat
- Department of Surgery, Division of General Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
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53
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The role of endoscopic ultrasound in the diagnosis of gallbladder diseases. J Med Ultrason (2001) 2016; 44:63-70. [PMID: 27619811 DOI: 10.1007/s10396-016-0742-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 08/15/2016] [Indexed: 12/13/2022]
Abstract
Endoscopic ultrasound (EUS) has recently played an increasing role in the diagnosis of gallbladder diseases. This review aims to summarize the role of EUS in the diagnosis of gallbladder lesions. EUS provides high-resolution images that can improve the diagnosis of gallbladder polypoid lesions and microlithiasis, in addition to evaluating gallbladder thickness and staging of gallbladder carcinoma. Contrast-enhancing agents may be useful for the differential diagnosis of gallbladder lesions, but the evidence of their effectiveness is still limited and further studies are required in this area to establish its usefulness. Endoscopic ultrasound combined with fine needle aspiration has played an increasing role in providing histological diagnosis of gallbladder tumors in addition to gallbladder thickening.
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Tubay M, Zelasko S. Multimodality Imaging of the Gallbladder: Spectrum of Pathology and Associated Imaging Findings. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0148-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Seong M, Kang TW, Kim M, Kim SS, Jang KM, Kim YK, Kim SH. Tumefactive gallbladder sludge: the MRI findings. Clin Radiol 2016; 71:402.e9-402.e15. [PMID: 26874658 DOI: 10.1016/j.crad.2016.01.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 12/22/2015] [Accepted: 01/04/2016] [Indexed: 01/02/2023]
Abstract
AIM To evaluate the conventional and diffusion-weighted magnetic resonance imaging (MRI) images of tumefactive gallbladder sludge. MATERIALS AND METHODS The institutional review board approved this retrospective study. Between January 2006 and January 2015, 3478 patients were diagnosed with gallbladder sludge by ultrasonography (US). Of them, 12 patients (eight male, four female; mean age, 63.6 years) with 12 tumefactive gallbladder sludge lesions, who underwent subsequent MRI for further evaluation within 1 month, were included in this study. Data regarding the clinical features, presence of enhancement, and signal intensities of the T2-, T1-, and diffusion-weighted images were collected. RESULTS All cases of tumefactive sludge were detected incidentally. None of the patients had any predisposing factors for biliary sludge. The tumefactive gallbladder sludge was predominantly seen as a well-defined mass-like lesion. It showed hyperintensity on T1-weighted images (91.7%, 11/12), and variable signal intensities on T2-weighted images. Most of the tumefactive sludge lesions showed no enhancement on the dynamic phases (90%, 9/10). There were no cases with diffusion restriction. Among the patients with follow-up US data (n=7), all the lesions were found to have either disappeared or decreased in size. CONCLUSION Although tumefactive gallbladder sludge on US can mimic gallbladder cancer, its hyperintensity on a T1-weighted image, and the absence of enhancement and diffusion restriction on MRI images can be helpful for differentiating it from a tumorous condition.
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Affiliation(s)
- M Seong
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - T W Kang
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - M Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - S S Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - K M Jang
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Y K Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - S H Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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56
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Lee NK, Kim S, Moon JI, Shin N, Kim DU, Seo HI, Kim HS, Han GJ, Kim JY, Lee JW. Diffusion-weighted magnetic resonance imaging of gallbladder adenocarcinoma: analysis with emphasis on histologic grade. Clin Imaging 2016; 40:345-51. [PMID: 27133665 DOI: 10.1016/j.clinimag.2016.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/08/2015] [Accepted: 01/15/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate the value of diffusion-weighted imaging (DWI) for differentiating gallbladder adenocarcinoma from adenoma, and predicting histologic grades of gallbladder adenocarcinoma. MATERIALS AND METHODS Fourty-three gallbladder adenocarcinomas and 8 adenomas were included. We compared apparent diffusion coefficient (ADC) values between adenocarcinoma and adenoma, and ADC values of gallbladder adenocarcinoma among the histologic grade. RESULTS Gallbladder adenocarcinoma (1.041×10(-3)mm(2)/s) showed significantly lower ADC values than adenoma (2.039×10(-3)mm(2)/s) (P<.001). Well-differentiated adenocarcinoma (1.290×10(-3)mm(2)/s) showed significantly higher ADC values than higher-grades (1.104×10(-3) and 0.915×10(-3)mm(2)/s in moderately- and poorly-differentiated, respectively) (P<.001). CONCLUSION DWI can help to differentiate gallbladder adenocarcinoma from adenoma, and well-differentiated from higher-grade adenocarcinoma.
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Affiliation(s)
- Nam Kyung Lee
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, 602-739, Republic of Korea
| | - Suk Kim
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, 602-739, Republic of Korea.
| | - Jin Il Moon
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, 602-739, Republic of Korea
| | - Nari Shin
- Department of Pathology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, 602-739, Republic of Korea
| | - Dong Uk Kim
- Department of Internal Medicine, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, 602-739, Republic of Korea
| | - Hyung Il Seo
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, 602-739, Republic of Korea
| | - Hyun Sung Kim
- Department of Surgery, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, 602-739, Republic of Korea
| | - Ga Jin Han
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, 602-739, Republic of Korea
| | - Jin You Kim
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, 602-739, Republic of Korea
| | - Ji Won Lee
- Department of Radiology, Biomedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, 602-739, Republic of Korea
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Abstract
Gallbladder polyp (GP) and stroke share several metabolic disorders as risk factors. We assessed the association between GP and subsequent stroke risk. From 2000 to 2011, patients with GP aged >20 years were identified from the Longitudinal Health Insurance Database 2000. Of the 15,975 examined patients, 12,780 and 3195 were categorized into the non-GP and GP cohorts, respectively. The relative risks of stroke were estimated using the Cox proportional hazard model after adjusting for age, sex, and comorbidities. The overall incidence of stroke was higher in the GP cohort than in the non-GP cohort (6.66 vs 5.20/1000 person-yr), with an incidence rate ratio (IRR) of 1.28 (95% confidence interval [CI] = 1.15-1.42). The risk of stroke was 1.32-fold (95% CI = 1.06-1.63) in patients with GP compared with patients without GP after adjusting for age, sex, income level, urbanization level, occupation and comorbidities of gallstone, alcohol-related illness, diabetes, hyperlipidemia, hypertension, obesity, COPD, coronary heart disease, and asthma. Furthermore, the stroke risk was higher among elderly patients (with 1-yr intervals; adjusted HR [aHR] = 1.06, 95% CI = 1.05-1.07), the male sex (aHR = 1.62, 95% CI = 1.35-1.96), lower income level (aHR = 1.37, 95% CI = 1.02-1.85 for level I; aHR = 1.62, 95% CI = 1.25-2.10 for level II), living in second urbanized areas (aHR = 1.28, 95% CI = 1.00-1.63), alcohol-related illness (aHR = 1.56, 95% CI = 1.07-2.28), diabetes (aHR = 1.78, 95% CI = 1.41-2.24), and hypertension (aHR = 2.74, 95% CI = 2.19-3.42). GP is associated with stroke; however, GP may be less influential than other risk factors are, such as male sex, lower income level, alcohol-related illness, diabetes, and hypertension, on stroke development. Additional studies are required to clarify whether GP is a risk factor for or an epiphenomenon of stroke development.
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Affiliation(s)
- Chien-Hua Chen
- From the Digestive Disease Center, Show-Chwan Memorial Hospital, Changhua (C-HC); Hungkuang University, Taichung (C-HC); Meiho University of Technology, Pingtung (C-HC); School of Medicine, China Medical University (C-LL); Management Office for Health Data, China Medical University Hospital (C-LL); Graduate Institute of Clinical Medicine Science and School of Medicine, College of Medicine, China Medical University (C-HK); Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK)
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Kim SW, Kim HC, Yang DM, Ryu JK, Won KY. Gallbladder carcinoma: causes of misdiagnosis at CT. Clin Radiol 2015; 71:e96-109. [PMID: 26602932 DOI: 10.1016/j.crad.2015.10.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 09/03/2015] [Accepted: 10/19/2015] [Indexed: 12/12/2022]
Abstract
Gallbladder carcinomas can present with varied imaging features on computed tomography. The three major imaging features include (1) focal or diffuse wall thickening with or without irregularity of the gallbladder; (2) polypoidal intraluminal mass; and (3) large mass obscuring and replacing the gallbladder, often extending to the liver. Patterns of wall thickening or polypoid growth are often confused with various benign gallbladder diseases due to overlap of imaging findings. Moreover, gallbladder carcinomas that coexist with benign gallbladder diseases make accurate preoperative diagnosis more difficult. Recently, high-resolution ultrasound (HRUS) has been regarded as a problem-solving tool for gallbladder diseases. In this article, we will illustrate various imaging presentations of gallbladder cancer, along with imaging pitfalls and recently updated HRUS findings.
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Affiliation(s)
- S W Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea.
| | - H C Kim
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - D M Yang
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - J K Ryu
- Department of Radiology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - K Y Won
- Department of Pathology, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, South Korea
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