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Raj G, Singh B, Raj R, Singh R. Lymph Nodal Metastatic Pattern in Carcinoma Gallbladder with Multidetector Computed Tomography: An Institutional Experience. ASIAN JOURNAL OF ONCOLOGY 2020. [DOI: 10.1055/s-0040-1714306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Abstract
Objective This work aimed to study the distribution of lymph nodal metastatic pattern in carcinoma gallbladder with multidetector computed tomography (CT).
Materials and Methods A retrospective observational study was conducted including 80 patients with carcinoma gallbladder who underwent triple-phase CT angiography or single-phase contrast-enhanced CT scan of the abdomen between January 2019 and November 2019.
Results In our study, 75 (93.7%) out of 80 cases showed metastasis to lymph nodes, with distribution as follows: periportal (69), peripancreatic (62), and aortocaval (47). The most common involved combination included all three lymph nodal groups (periportal, peripancreatic, and aortocaval), involving 40 (50%) cases. The combination of only periportal and peripancreatic lymph nodes was seen in 17 (21%) cases. Isolated periportal lymph nodes were seen in eight cases (10%) cases. The combination of only periportal and aortocaval lymph nodes was seen in four (5%) cases. Isolated peripancreatic lymph nodes were seen in three (3.7%) cases. The combination of periportal and aortocaval was seen in four (5%) cases followed by peripancreatic and aortocaval lymph nodes that was seen in two (2.5%) cases. Isolated aortocaval lymph nodes were seen in one (1.2%) case.
Conclusion Periportal lymph nodes were the single most commonly involved station followed by peripancreatic and aortocaval lymph nodes. The combination of periportal, peripancreatic, and aortocaval lymph nodes was seen most commonly. The second most commonly involved combination was found to be periportal and peripancreatic lymph nodes followed by isolated periportal lymph nodes.
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Affiliation(s)
- Gaurav Raj
- Department of Radiodiagnosis, Dr. Ram Manohar Lohiya Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Bhanupriya Singh
- Department of Radiodiagnosis, Dr. Ram Manohar Lohiya Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Richa Raj
- Department of Radiodiagnosis, Dr. Ram Manohar Lohiya Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Ragini Singh
- Department of Radiodiagnosis, Dr. Ram Manohar Lohiya Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Zhang M, Wu C, Zuo B, Gong W, Zhang Y, Yang Y, Zhou D, Weng M, Qin Y, Jiang A, Zheng Y, Quan Z. Trends of gallbladder cancer incidence, mortality, and diagnostic approach in urban Shanghai between 1973 and 2009. TUMORI JOURNAL 2020; 106:392-399. [PMID: 31950882 DOI: 10.1177/0300891619890232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
PURPOSE To describe and interpret secular time trends in gallbladder cancer (GBC) incidence, mortality, and diagnostic approach using 37 years of cancer registry data in urban Shanghai. METHODS Data on registration of GBC in urban Shanghai during 1973 and 2009 were collected by the Shanghai Cancer Registry. To describe time trends and to identify specific time points when significant changes occurred, we used joinpoint regression analysis. RESULTS The age-standardized rates (ASRs) of incidence increased from 1.1/100,000 (1973-1975) to 2.9/100,000 (2006-2009) in men and from 1.7/100,000 (1973-1975) to 3.9/100,000 (2006-2009) in women. ASRs of incidence increased significantly with estimated annual percent changes (EAPCs) of 2.8% in men and 2.5% in women. The mortality trends increased significantly, with EAPCs of 2.8% in men and 2.5% in women. The increasing incidence and mortality rates were primarily observed in men ⩾60 years of age and in women ⩾70 years of age. Notable downward trends in incidence and mortality were identified among women age 60-69 years over the last decade. The percentage of GBC diagnosed by pathology increased steadily over the years while the percentage of GBC diagnosed by imaging, surgery, and biochemistry sharply increased from 1987 onwards. CONCLUSIONS Thirty-seven years of cancer registry data document a tremendous increase in incidence/mortality and a slight decline in incidence/mortality over the last decades for GBC, especially among women, in Shanghai. The development of diagnostic approaches and aging population may play important roles.
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Affiliation(s)
- Mingdi Zhang
- Department of Breast Surgery, Shanghai Gynecology Hospital of Fudan University, Shanghai, China.,Department of General Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chunxiao Wu
- Shanghai Cancer Registry, Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Prevention and Control, Shanghai, China
| | - Bin Zuo
- Department of Orthopedic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Gong
- Department of General Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Zhang
- Department of General Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yong Yang
- Department of General Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Di Zhou
- Department of General Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Mingzhe Weng
- Department of General Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiyu Qin
- Department of General Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Alex Jiang
- Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Ying Zheng
- Shanghai Cancer Registry, Department of Cancer Control and Prevention, Shanghai Municipal Center for Disease Prevention and Control, Shanghai, China
| | - Zhiwei Quan
- Department of General Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Thakrar R, Monib S, Pakdemirli E, Thomson S. Calcified gallbladder cancer: is it preventable? J Surg Case Rep 2019; 2019:rjz069. [PMID: 30949330 PMCID: PMC6439505 DOI: 10.1093/jscr/rjz069] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 02/12/2019] [Accepted: 02/24/2019] [Indexed: 02/07/2023] Open
Abstract
A case of a newly diagnosed calcified gallbladder cancer is presented, who had pre-existing porcelain gallbladder. Due to the advanced stage of the disease at presentation, the patient had a poor outcome. The investigation and management of gallbladder carcinoma is discussed as well as the relationship with porcelain gallbladder. We conclude that there is only a weak association between porcelain gallbladder and gallbladder cancer, but because gallbladder cancer typically presents late, a stratified approach to offering cholecystectomy to asymptomatic porcelain gallbladder is reasonable.
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Affiliation(s)
- Reena Thakrar
- General Surgery Department, West Hertfordshire Hospitals NHS Trust, UK
| | - Sherif Monib
- General Surgery Department, West Hertfordshire Hospitals NHS Trust, UK
| | - Emre Pakdemirli
- Radiology Department, West Hertfordshire Hospitals NHS Trust, UK
| | - Simon Thomson
- General Surgery Department, West Hertfordshire Hospitals NHS Trust, UK
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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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Gómez-López JR, De Andrés-Asenjo B, Ortega-Loubon C. A porcelain gallbladder and a rapid tumor dissemination. Ann Med Surg (Lond) 2014; 3:119-22. [PMID: 25568797 PMCID: PMC4284441 DOI: 10.1016/j.amsu.2014.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/02/2014] [Accepted: 09/04/2014] [Indexed: 11/30/2022] Open
Abstract
Introduction Porcelain gallbladder is a very rare entity that consists of a calcification of the gallbladder wall, and is associated with carcinoma in 12.5–62% of patients, although recent studies suggest weaker association. Case report We describe an 80-year-old woman who presented with colicky abdominal pain in the right upper quadrant, radiating to the back and associated with vomiting. Physical examination revealed jaundice, murphy's sign was negative. Hepatic-biliary tract ultrasound revealed porcelain gallbladder, she was referred to the surgical team for a scheduled cholecystectomy. A month later, she presented diffuse abdominal pain. Imaging studies showed a disseminated process affecting liver's segments, capsule, and hilum; and lungs. An aggressive surgical treatment was dismissed, and was referred to the oncology department. Discussion There is controversy in the harboring risk of malignancy of the porcelain gallbladder. While it seems that the current data points towards a lower risk of degeneration, it is also demonstrated that patients with gallbladder wall calcifications are indeed statistically at risk of gallbladder cancer. Laparoscopic cholecystectomy has become a safe and efficient approach recommended for patients with gallbladder symptoms directly related or unrelated to gallbladder wall calcifications. In this case, a pathological gallbladder, very quickly evolved into an inoperable tumor with a poor prognosis. Conclusion This report heightens that with US evidence of porcelain gallbladder, an urgent CT scan should be carried out to assess an underlying malignancy, and a simple cholecystectomy should be done urgently rather than on a routine elective list to prevent possible malignant change if possible. We report a patient with advanced gallbladder porcelain. Porcelain gallbladder is a very rare entity found in <1% of cholecystectomies. It consists of calcification of the gallbladder wall. The rapid progression of cancer in a porcelain gallbladder is more unusual.
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Affiliation(s)
| | | | - Christian Ortega-Loubon
- Department of Cardiac Surgery, University Clinic Hospital of Valladolid, Spain
- Corresponding author. Department of General Surgery, University Clinic Hospital of Valladolid, Avenue Ramón y Cajal 3, 47003 Valladolid, Spain. Tel.: +34 983420000.
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Imazu H, Mori N, Kanazawa K, Chiba M, Toyoizumi H, Torisu Y, Koyama S, Hino S, Ang TL, Tajiri H. Contrast-enhanced harmonic endoscopic ultrasonography in the differential diagnosis of gallbladder wall thickening. Dig Dis Sci 2014; 59:1909-16. [PMID: 24664415 DOI: 10.1007/s10620-014-3115-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Accepted: 03/12/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND AND AIMS Differentiation of gallbladder (GB) carcinoma from benign GB wall thickening is challenging. The recent introduction of second-generation ultrasonic contrast agents has made contrast harmonic imaging with EUS possible. The aim of our study was to evaluate the utility of contrast-enhanced harmonic EUS (CH-EUS) for the differential diagnosis of GB wall thickening. METHODS Thirty-six consecutive patients with GB wall thickening imaged by CH-EUS and then underwent surgery were enrolled in this study. After the lesions were observed with conventional harmonic EUS (H-EUS), CH-EUS was performed with intravenous injection of 0.015 ml/kg of Sonazoid. Three reviewers with various levels of experience of EUS (Reviewer A: experienced endosonographer, B: EUS trainee, C: experienced gastroenterologist with expertise in transabdominal ultrasound but no EUS experience) were blinded to findings of recorded video of H-EUS and CH-EUS. The diagnostic accuracy of H-EUS and CH-EUS for malignant GB wall thickening was compared. RESULTS Final diagnoses based on surgical histology were GB carcinoma in 16, cholecystitis in 11, adenomyomatosis in 6 and cholesterolosis in 3. Overall sensitivity, specificity and accuracy for diagnosing malignant GB wall thickening of H-EUS and CH-EUS were 83.3 versus 89.6, 65 versus 98% (p < 0.001) and 73.1 versus 94.4% (p < 0.001). The inter-observer agreement for H-EUS was moderate (κ = 0.51), whereas that for CH-EUS was substantial (κ = 0.77). The inhomogeneous enhanced pattern on CH-EUS was a strong predictive factor of malignant GB wall thickening. CONCLUSION CH-EUS has the potential to improve the preoperative diagnostic accuracy and inter-observer agreement in the differential diagnosis of GB wall thickening.
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Affiliation(s)
- Hiroo Imazu
- Department of Endoscopy, The Jikei University School of Medicine, 3-25-8 Nishishinbashi, Minato-ku, Tokyo, 105-8461, Japan,
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Nadeem H, Jayakrishnan TT, Groeschl RT, Zacharias A, Clark Gamblin T, Turaga KK. Cost Effectiveness of Routine Laparoscopic Ultrasound for Assessment of Resectability of Gallbladder Cancer. Ann Surg Oncol 2014; 21:2413-9. [DOI: 10.1245/s10434-014-3487-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Indexed: 02/07/2023]
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Abstract
Gallbladder cancer remains a relatively rare malignancy with a highly variable presentation. Gallbladder cancer is the most common biliary tract malignancy with the worst overall prognosis. With the advent of the laparoscope, in comparison with historical controls, this disease is now more commonly diagnosed incidentally and at an earlier stage. However, when symptoms of jaundice and pain are present, the prognosis remains dismal. From a surgical perspective, gallbladder cancer can be suspected preoperatively, identified intraoperatively, or discovered incidentally on final surgical pathology.
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Affiliation(s)
- Jessica A Wernberg
- Department of General Surgery, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, USA.
| | - Dustin D Lucarelli
- Department of General Surgery, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, USA
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Gallbladder Wall Calcification and Gallbladder Cancer. J Am Coll Surg 2013; 216:1223-4. [DOI: 10.1016/j.jamcollsurg.2013.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 03/05/2013] [Indexed: 11/21/2022]
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