Early diagnosis of gallbladder malignancy

A rare case of early carcinoma of the gallbladder

A 38-year-old woman was diagnosed preoperatively to have a benign polyp of the gallbladder with a delineated polypoid mass, as demonstrated with drip infusion cholangiography and ultrasonography. Cholecystectomy was performed. Postoperatively, however, this tumor proved to be an early stage carcinoma of the gallbladder. In the neck of the gallbladder, there was a protruded polypoid elastic tumor of 1.1 X 0.9 cm in width and 2.5 cm in height. The tumor was supported by a stem of 0.1 cm in diameter and 0.2 cm in height. Histopathological examination revealed a well differentiated papillotubular adenocarcinoma, which exhibited no invasion of the stem itself or its basal region. This is a rare case of early carcinoma of the gallbladder (Stage I) which grew only towards the lumen of the gallbladder cavity, and did not invade the wall. Postoperatively, cholecystectomy alone was thought to be sufficient for cure.

[Therapy and prognosis of 300 primary extrahepatic bile duct cancers]

A total of 300 patients (66% women, 34% men) had carcinoma of the bile ducts; 64% were located in the gallbladder and 36% in the bile ducts. In 77.3% the carcinomas had metastasized or were conglomerate tumors, while in 22.7% a curative resection was performed. In 35.3% a palliative operation or resection was indicated. An exploratory laparotomy was performed in 42%, but 75% of the patients died within 6 months. After 1 year 10.2% had survived. After curative resection 46 patients survived on the average over 17.6 months, while 12 patients survived an average of 5.1 years.

[Primary carcinoma of the extrahepatic bile ducts (author's transl)]

From 1957--1977 193 patients were treated at the surgical clinic of the University of Tübingen for carcinoma of the extrahepatic bile ducts. Gall bladder carcinoma made up 139 cases; 54 were of bile duct carcinoma. The tumors were no longer operable in two-thirds of the patients with extrahepatic bile ducts cancer. The life expectancy rate of five years for patients with gall bladder carcinoma held for 7%. Up to now only one patient with a bile duct malignancy has survived longer than five years. In the last decade essentially no improvement of median life expectancy has occurred despite improved operating techniques. Due to uncharacteristic, misleading upper abdominal symptoms, patients who suffer gall bladder or bile duct cancer are unfortunately accurately diagnosed only after the carcinoma has overcome organ borders or is already metastatic. There is reasonable hope for improved early prognosis of extrahepatic bile duct carcinoma with ERCP (Endoscopic Retrograde Cholangio-Pancreaticography) and computer-tomography. Because the possibility of a relationship between gall bladder stones and/or the chronic inflammation of gall bladder and bile ducts and the development of cancer is not out of the question, widespread prophylactic cholecystectomy and gall passage cleansing should be employed.