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Rana P, Gupta P, Kalage D, Soundararajan R, Kumar-M P, Dutta U. Grayscale ultrasonography findings for characterization of gallbladder wall thickening in non-acute setting: a systematic review and meta-analysis. Expert Rev Gastroenterol Hepatol 2022; 16:59-71. [PMID: 34826262 DOI: 10.1080/17474124.2021.2011210] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The accurate characterization of gallbladder wall thickening (GWT) into benign or malignant on ultrasound (US) is a significant challenge. METHODS We searched the MEDLINE and EMBASE databases for studies reporting two-dimensional grayscale US in benign and malignant GWT. The pooled prevalence was calculated using a generalized linear mixed method with a random-effects model. The pooled sensitivity and specificity were calculated using a bivariate random-effects model. RESULTS Of the 7309 studies screened by titles, 73 studies with 18,008 patients were included. The most common findings in xanthogranulomatous cholecystitis (XGC) were lack of wall disruption and intramural hypoechoic nodules while adenomyomatosis (ADM) was frequently associated with intramural cysts and intramural echogenic foci. Echogenic foci, lack of gallbladder wall disruption, and hypoechoic nodules had a sensitivity of 89%, 77%, and 66% and specificity of 86%, 51%, and 80%, respectively for the diagnosis of benign GWT. Focal thickening and indistinct liver interface had a sensitivity of 75% and 55% and specificity of 64% and 69%, respectively for the diagnosis of malignant GWT. CONCLUSION intramural features (echogenic foci, hypoechoic nodules), gallbladder wall disruption, and liver interface are useful US features for the characterization of GWT.
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Affiliation(s)
- Pratyaksha Rana
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daneshwari Kalage
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raghuraman Soundararajan
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Hunt TM, Waletzko MR, Knudsen JM, Atwell TD, Chupka NM. The Effectiveness of Identifying Primary Gallbladder Adenocarcinoma Utilizing Contrast-Enhanced Ultrasound: A Case Report. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/87564793211018959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gallbladder carcinoma is rare and difficult to detect in the early stages of the disease process, due to lack of symptoms. Sonography is typically the first modality of choice for assessing gallbladder pathology due to its high sensitivity, portability, real-time imaging capability, and non-ionizing technique. Conventional gray-scale and color Doppler sonographic imaging may be ambiguous for diagnosing solid tumors, such as gallbladder carcinoma. In this case, gallbladder carcinoma was definitively diagnosed utilizing contrast-enhanced ultrasound, allowing for quick patient treatment options and an optimal surgical outcome.
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Surgical Choice for Different Types of Gallbladder Adenomyomatosis: An Initial Experience of 20 Years Laparoscopic Cholecystectomy. Surg Laparosc Endosc Percutan Tech 2021; 30:151-155. [PMID: 32108730 DOI: 10.1097/sle.0000000000000776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES The objective of this study was to compare the difference of clinical biochemical statistics in different types of gallbladder adenomyomatosis (GA). To investigate the different effects of patients between the 3 different types of GA. MATERIALS AND METHODS Retrospective analysis of the clinical data of the adenomyomatosis patients that come from our hospital between 2010 to 2018. According to the preoperative image (all cases are performed as elective surgery), it could be divided into 3 groups: group A: fundal (localized) type; group B: segmental type; group C: diffuse type. The number of each group is 136, 27, 17. We analyze the biochemical statistics (total bilirubin, direct bilirubin, serum bile acid, alanine aminotransferase, aspartate aminotransferase, cholinesterase, etc.) of the 3 groups to explore the difference in operative mode, operative time and prognosis between these 3 groups. RESULTS (1) In the liver function statistics, aspartate aminotransferase has the statistical significance (F=4.974, P=0.012); (2) And the diffuse adenomyomatosis might have a higher bile acid (F=6.048, P=0.005); (3) The segmental and diffuse adenomyomatosis is easier to be combined with stones (F=19.226, P<0.001); (4) The fundal adenomyomatosis seems to have a better prognosis: fewer hospital stay (F=4.519, P=0.018), fewer drainage time (F=6.575, P=0.004) and fewer complications (χ=29.429, P<0.001). CONCLUSIONS GA is a disease characterized by epithelial proliferation and hypertrophy of the muscles of the gallbladder wall with an outpouching of the mucosa into or through the thickened muscular layer and cannot be regarded as a precancerous lesion based on available evidence. As for asymptomatic GA, conservative treatment is recommended with ultrasound examinations twice a year. The fundal type GA can be treated by partial laparoscopic cholecystectomy. The segmental and diffuse-type should undergo a total laparoscopic cholecystectomy.
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Kai K, Tanaka T, Ide T, Kawaguchi A, Noshiro H, Aishima S. Immunohistochemical analysis of the aggregation of CD1a-positive dendritic cells in resected specimens and its association with surgical outcomes for patients with gallbladder cancer. Transl Oncol 2020; 14:100923. [PMID: 33129106 PMCID: PMC7590585 DOI: 10.1016/j.tranon.2020.100923] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/05/2020] [Accepted: 10/13/2020] [Indexed: 02/05/2023] Open
Abstract
We examined CD1a-positive dendritic cell (CD1a-DC) infiltration in gallbladder cancer. The group with high CD1a-DC infiltration had fewer patients with distant metastasis. A high level of CD1a-DC infiltration was associated with longer overall survival. High CD1a-DC infiltration was also associated with longer disease-specific survival. S100-DC and tumor-infiltrating lymphocyte statuses were without effect on survival.
Gallbladder cancer (GBC) is an aggressive malignancy with a poor prognosis. Antigen-presenting dendritic cells (DCs) play a central role in antitumor immunity. DCs expressing CD1a (CD1a-DCs) are considered immature DCs. The aim of this study was to evaluate the clinical impact of CD1a-DC infiltration into GBC tissue. Seventy-five patients with GBC (excluding non-invasive and intramucosal cancer) were enrolled. Immunohistochemistry for CD1a, S100 and CD8 was performed using representative surgically resected specimens. The cases were divided into a high CD1a-DC group (27 cases, 36%) and low CD1a-DC group (48 cases, 64%) according to the degree of CD1a-DC infiltration/aggregation. The high CD1a-DC group contained fewer patients with distant metastasis (P = 0.039) and more patients given postoperative chemotherapy (P = 0.038). The high CD1a-DC group had significantly longer overall survival (P = 0.001) and disease-specific survival (P = 0.002) than the low CD1a-DC group. In contrast, S100-DC and CD8+ tumor-infiltrating lymphocyte statuses were without effect on OS or DSS. The results of multivariate analyses indicated that the degree of infiltration/aggregation of CD1a-DCs was an independent prognostic factor associated with a favorable prognosis after surgery.
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Affiliation(s)
- Keita Kai
- Department of Pathology, Saga University Hospital, Nabeshima 5-1-1, Saga 849-8501, Japan.
| | - Tomokazu Tanaka
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - Takao Ide
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - Atsushi Kawaguchi
- Center for Comprehensive Community Medicine, Saga University Faculty of Medicine, Saga, Japan
| | - Hirokazu Noshiro
- Department of Surgery, Saga University Faculty of Medicine, Saga, Japan
| | - Shinichi Aishima
- Department of Pathology, Saga University Hospital, Nabeshima 5-1-1, Saga 849-8501, Japan; Department of Pathology & Microbiology, Saga University Faculty of Medicine, Saga, Japan
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Moon J, Shin YC, Heo TG, Choi PW, Kim JI, Jung SW, Jun H, Jung SM, Um E. Differentiation of gallbladder adenomyomatosis from early-stage gallbladder cancer before surgery. Ann Hepatobiliary Pancreat Surg 2019; 23:334-338. [PMID: 31824998 PMCID: PMC6893059 DOI: 10.14701/ahbps.2019.23.4.334] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 10/01/2019] [Accepted: 10/02/2019] [Indexed: 11/17/2022] Open
Abstract
Backgrounds/Aims This study aimed to compare the perioperative and clinical outcomes in patients undergoing laparoscopic cholecystectomy for gallbladder adenomyomatosis (GBA) or early-stage gallbladder cancer (GBC). Methods The perioperative and clinical outcomes of 194 patients diagnosed with GBA and 30 patients diagnosed with GBC who underwent laparoscopic cholecystectomy in our institution from January 2011 to December 2017 were retrospectively compared. Results There were no significant differences between the GBA and GBC groups in sex (male:female ratio 1.0:0.8 vs. 1.0:0.7, p=0.734), BMI (23.9±3.4 vs. 24.0±3.8 kg/m2, p=0.916), or preoperative liver function tests. Patients in the GBC group were significantly older (50.5±14.1 vs. 65.9±10.6 years, p<0.001) and had a higher ASA grade (40.3 vs. 63.4% grade II or III, p=0.043) than patients in the GBA group. Although there was no significant difference in preoperative diagnostic methods (p=0.442), the GBC group showed a significantly higher rate of misdiagnosis on preoperative imaging compared with postoperative histopathologic findings (30.9% vs. 53.3%, p=0.011). There were significantly more patients with gallstones in the GBA group than in the GBC group (68.6% vs. 40.0%, p=0.004). Conclusions In older patients hospitalized for biliary colic without gallstones but with a thickened gallbladder wall with inflammation on preoperative diagnostic exam, the possibility of early-stage GBC should be considered.
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Affiliation(s)
- Jisum Moon
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Yong Chan Shin
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Tae-Gil Heo
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Pyong Wha Choi
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jae Il Kim
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung Won Jung
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Heungman Jun
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung Min Jung
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Eunhae Um
- Department of Surgery, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
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Pang L, Zhang Y, Wang Y, Kong J. Pathogenesis of gallbladder adenomyomatosis and its relationship with early-stage gallbladder carcinoma: an overview. Braz J Med Biol Res 2018; 51:e7411. [PMID: 29791592 PMCID: PMC6002143 DOI: 10.1590/1414-431x20187411] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Accepted: 03/13/2018] [Indexed: 01/30/2023] Open
Abstract
The exact pathogenesis of gallbladder adenomyomatosis is still lacking and some controversies over its diagnosis and treatment exist. Originally recognized as a precancerous lesion, adenomyomatosis is currently recognized by recent studies as a benign alteration of the gallbladder that is often associated with cholecystitis and cholecystolithiasis. Gallbladder carcinoma is an extremely malignant disease with a 5-year survival rate of less than 5%. Therefore, it is important to diagnose, differentiate, and confirm the relationship between adenomyomatosis and early-stage gallbladder carcinoma. However, the early clinical symptoms of adenomyomatosis are extremely similar to those of gallbladder stones and cholecystitis, increasing the difficulty to identify and treat this disease. This article summarizes the research progress on gallbladder adenomyomatosis, aiming to improve the understanding of the pathogenesis of adenomyomatosis and further provide insight for its clinical diagnosis and treatment.
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Affiliation(s)
- Liwei Pang
- Department of Biliary and Minimally Invasive Surgery, China
Medical University Shengjing Hospital Shenyang, Liaoning, China
| | - Yan Zhang
- Department of Biliary and Minimally Invasive Surgery, China
Medical University Shengjing Hospital Shenyang, Liaoning, China
| | - Yuwen Wang
- Department of Surgery, The Sixth People's Hospital of Shenyang,
Liaoning, China
| | - Jing Kong
- Department of Biliary and Minimally Invasive Surgery, China
Medical University Shengjing Hospital Shenyang, Liaoning, China
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Indication and Usefulness of Bile Juice Cytology for Diagnosis of Gallbladder Cancer. Gastroenterol Res Pract 2018; 2018:5410349. [PMID: 29849591 PMCID: PMC5932440 DOI: 10.1155/2018/5410349] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 02/06/2018] [Accepted: 03/11/2018] [Indexed: 12/15/2022] Open
Abstract
Aim We examined the effectiveness of bile juice cytology for distinguishing between benign and malignant gallbladder lesions of the protruding type with various sampling points, sampling methods, and macroscopic forms in order to discuss the effectiveness of the endoscopic transpapillary gallbladder drainage (ETGD) cytology. Methods We studied 162 cases of patients with a lesion localized within the gallbladder. At first, we examined the effectiveness for diagnosis of ETBD cytology using ERC and then that of the first ETGD cytology after placing the ETGD. Next, we examined the diagnostic effectiveness of the washed ETGD cytology by using the ETGD. Finally, we examined complications. Results In the final diagnoses, we identified 33 cases of adenocarcinoma, 10 cases of adenoma, 63 cases of ADM, 35 cases of nonneoplastic polyp, and 21 cases of chronic cholecystitis. It was found that the sensitivity of ETBD cytology was 3.6% and that of ETGD cytology was 59.1%. In the comparison of diagnostic effectiveness of cytologic diagnosis using samples of bile juice from the gallbladder collected by different methods, the sensitivities were 38.9% and 73.3% for the first and washed ETGD cytologies, respectively. In the comparison of the diagnostic effectiveness of gallbladder bile juice cytology using samples collected for different forms of lesion and by different methods, the sensitivities were 38.9% and 73.3%, respectively, for the first and washed ETGD cytologies for flat gallbladder wall thickening, while it was impossible to diagnose for lesions of GB polyp. Conclusion For diagnosis of gallbladder cancer, we consider that the ETGD cytology should be taken into consideration for lesions of flat gallbladder wall thickening, for which it is difficult to distinguish between benign and malignant lesions.
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Golse N, Lewin M, Rode A, Sebagh M, Mabrut JY. Gallbladder adenomyomatosis: Diagnosis and management. J Visc Surg 2017; 154:345-353. [DOI: 10.1016/j.jviscsurg.2017.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Kai K. Organ-specific concept and controversy for premalignant lesions and carcinogenesis of gallbladder cancer. Hepatobiliary Surg Nutr 2016; 5:85-7. [PMID: 26904562 DOI: 10.3978/j.issn.2304-3881.2016.01.03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
An analysis of premalignant lesions, risk factors and models of carcinogenesis of gallbladder cancer (GBC) involves the concept of organ specificity. In GBC, the dysplasia-carcinoma sequence and metaplasia-dysplasia-carcinoma sequence are considered to be more important models of carcinogenesis than the adenoma-carcinoma sequence. Cholecystectomy is recommended for gallbladder polyps ≥1.0 cm, and all pre-invasive adenomas and papillary neoplasms ≥1.0 cm are defined as intracholecystic papillary-tubular neoplasms (ICPTNs). Although adenomyomatosis (ADM) and xanthogranulomatous cholecystitis (XGC) are controversial lesions, a knowledge of their clinicopathological features would help clinicians to manage gallbladder lesions associated with ADM or XCG.
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Affiliation(s)
- Keita Kai
- Department of Pathology, Saga University Hospital, Saga 849-8501, Japan
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Kai K, Aishima S, Miyazaki K. Gallbladder cancer: Clinical and pathological approach. World J Clin Cases 2014; 2:515-521. [PMID: 25325061 PMCID: PMC4198403 DOI: 10.12998/wjcc.v2.i10.515] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/13/2014] [Accepted: 07/18/2014] [Indexed: 02/05/2023] Open
Abstract
Gallbladder cancer (GBC) shows a marked geographical variation in its incidence. Middle-aged and elderly women are more commonly affected. Risk factors for its development include the presence of gallstones, chronic infection and pancreaticobiliary maljunction. Controversy remains in regard to the theory of carcinogenesis from adenomyomatosis, porcelain gallbladder and adenoma of the gallbladder. The surgical strategy and prognosis after surgery for GBC differ strikingly according to T-stage. Discrimination of favorable cases, particularly T2 or T3 lesions, is useful for the selection of surgical strategies for individual patients. Although many candidate factors predicting disease progression, such as depth of subserosal invasion, horizontal tumor spread, tumor budding, dedifferentiation, Ki-67 labeling index, p53 nuclear expression, CD8+ tumor-infiltrating lymphocytes, mitotic counts, Laminin-5-gamma-2 chain, hypoxia-inducible factor-1a, cyclooxygenase-2 and the Hedgehog signaling pathway have been investigated, useful prognostic makers or factors have not been established. As GBC is often discovered incidentally after routine cholecystectomy and accurate preoperative diagnosis is difficult, close mutual cooperation between surgeons and pathologists is essential for developing a rational surgical strategy for GBC.
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