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Jamal Z, Yu Z, Zafar N, Li D. Reconsidering Routine Histopathological Examination of Gallbladder Specimens in Cholecystectomy: Optimizing Clinical Practice and Resource Management. Cureus 2024; 16:e64762. [PMID: 39156251 PMCID: PMC11329314 DOI: 10.7759/cureus.64762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2024] [Indexed: 08/20/2024] Open
Abstract
Introduction Cholecystectomy, the surgical removal of the gallbladder, is a common procedure worldwide. Despite no visible anomalies, routine histopathological examination (HPE) of gallbladder specimens post-surgery is standard practice to exclude pathologies, notably gallbladder cancer (GBC). Incidence rates of GBC vary geographically and ethnically. Surgical intervention is recommended for advanced GBC stages, while early stages may require cholecystectomy alone. Although rare, GBC and bile duct cancers pose increased risks in certain demographics, such as women and individuals over 65. Routine HPE practices vary globally based on resource availability and GBC incidence. This study assesses the necessity of routine HPE by evaluating the selective processing of gallbladder specimens suspected of GBC, prioritizing patient safety. Materials and methods This retrospective cohort study conducted at Redland Hospital, a district general hospital in Australia, investigated the necessity of routine HPE for excised gallbladder specimens. Adhering to routine HPE policy, the study encompassed all elective and emergency cholecystectomies performed from January 2023 to December 2023, excluding pediatric cases, concurrent surgical procedures, and those with suspected malignancy. Demographic data, surgery indications, intraoperative findings, histopathological results, and incidental gallbladder cancer (IGC) outcomes were analyzed. Pathology reports and case documentation were reviewed for cancerous pathology indicators. Results Over the one-year study period from January 2023 to December 2023, a total of 266 gallbladder specimens were subjected to HPE post-cholecystectomy. Of these, 201 were female and 65 were male, yielding a male-to-female ratio of 3:1. Elective cholecystectomy was performed on 56.4% (150) of patients, while 43.6% (116) underwent emergency procedures. Laparoscopic cholecystectomy (LC) was the primary surgical approach, except for one case requiring conversion to an open procedure. None of the patients exhibited GBC; however, 3.3% (9) displayed premalignant histopathological features in their specimens. Conclusion In conclusion, adopting a selective approach, where only gallbladder specimens with macroscopic abnormalities undergo HPE, seems prudent, especially in regions with low GBC incidence. Our study, which revealed no cases of GBC, supports this approach. It not only reduces the risk of missing incidental carcinoma in clinically unsuspected cases but also proves cost-effective and reduces the histopathology department workload without compromising patient outcomes. Therefore, we advocate for routine macroscopic examination of gallbladder specimens for abnormalities before HPE submission, particularly in cholecystectomy patients with gallstone disease.
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Affiliation(s)
- Zohaib Jamal
- Department of Surgery, Redland Hospital, Bayside Health Service, Redland, AUS
| | - Zirong Yu
- Department of Surgery, Redland Hospital, Bayside Health Service, Redland, AUS
| | - Nowera Zafar
- Department of Surgery, Redland Hospital, Bayside Health Service, Redland, AUS
| | - Damon Li
- Department of Surgery, Redland Hospital, Bayside Health Service, Redland, AUS
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Kumar A, Sarangi Y, Gupta A, Sharma A. Gallbladder cancer: Progress in the Indian subcontinent. World J Clin Oncol 2024; 15:695-716. [PMID: 38946839 PMCID: PMC11212610 DOI: 10.5306/wjco.v15.i6.695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/25/2024] [Accepted: 05/15/2024] [Indexed: 06/24/2024] Open
Abstract
Gallbladder cancer (GBC) is one of the commonest biliary malignancies seen in India, Argentina, and Japan. The disease has dismal outcome as it is detected quite late due to nonspecific symptoms and signs. Early detection is the only way to improve the outcome. There have been several advances in basic as well as clinical research in the hepatobiliary and pancreatic diseases in the West and other developed countries but not enough has been done in GBC. Therefore, it is important and the responsibility of the countries with high burden of GBC to find solutions to the many unanswered questions like etiopathogenesis, early diagnosis, treatment, and prognostication. As India being one of the largest hubs for GBC in the world, it is important to know how the country has progressed on GBC. In this review, we will discuss the outcome of the publications from India highlighting the work and the developments taken place in past several decades both in basic and clinical research.
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Affiliation(s)
- Ashok Kumar
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Yajnadatta Sarangi
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Annapurna Gupta
- Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Aarti Sharma
- Division of Haematology, Mayo Clinic Arizona, Phoenix, AZ 85054, United States
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3
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Akbulut S, Sarici KB, Toprak S, Tuncer A, Ciftci F, Karadag N, Gurluler E, Karabulut E, Colak C, Yilmaz S. Histopathological Evaluation of Gallbladder Specimens Obtained From Living Liver Donors. Transplant Proc 2023:S0041-1345(22)00868-5. [PMID: 36604250 DOI: 10.1016/j.transproceed.2022.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 11/19/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Cholecystectomy is routinely performed during living donor hepatectomy both to see the structure of the biliary tract and to determine the demarcation line based on the biliary tract junction. This study aims to present the general histopathological features of the gallbladder specimen obtained from living liver donors (LLD). METHODS Data from 2577 LLDs who underwent living donor hepatectomy (n = 2511) or aborted living donor hepatectomy (n = 66) in our Liver Transplantation Institute between September 2005 and June 2021 were analyzed retrospectively. Age, gender, macroscopic (length, diameter, and wall thickness), and microscopic (histopathological) features of the gallbladder of the LLDs were recorded for use in this study. RESULTS A total of 2493 LLDs (men: 1486, women: 1007) with a median age of 29 years (interquartile range [IQR]: 13) met the inclusion criteria in this study. The median length, width and wall thickness of the gallbladder specimens were measured as 70 mm (IQR: 20), 50 mm (IQR: 20), and 2 mm (IQR: 1), respectively. The most common histopathological findings are normal structure (2026; 81.3%), chronic cholecystitis (n = 446; 17.9%), adenomyomatosis (n = 9), and papillary hyperplasia (n = 6), respectively. The most common pathologic findings in the gallbladder lumen are cholesterolosis (n = 207; 0.4%), cholelithiasis (n = 53), cholesterol polyp (n = 31), and noncholesterol polyp (n = 19), respectively. Significant differences were detected between the male and female genders in terms of age (P < .001), height (P < .001), weight (P < .001), body mass index (P < .001), gallbladder width (P = .001), gallbladder length (P < .001), histopathological finding (content) (P < .001), and lymph node around the gallbladder (P = .015). CONCLUSIONS The results we obtained in this study are true gallbladder pathologies that can be detected in healthy people. In this study, it was shown that the diameter and size of the gallbladder were larger in men, whereas the incidence of cholesterolosis and cholelithiasis was higher in women.
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Affiliation(s)
- Sami Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey; Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey.
| | - Kemal Baris Sarici
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Serhat Toprak
- Department of Pathology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Adem Tuncer
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Felat Ciftci
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Nese Karadag
- Department of Pathology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ercument Gurluler
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ertugrul Karabulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Cemil Colak
- Department of Biostatistics and Medical Informatics, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Sezai Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya, Turkey
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Ortiz-Hernández A, Castro Flores JA, Álvarez-Hernández DA, Pérez Aldrett F, Herrera González LP, Méndez Ibarra JU. Acute cholecystitis complicated with gallbladder empyema due to Mycobacterium tuberculosis in a patient with diabetes mellitus: a case report. Ther Adv Infect Dis 2022; 9:20499361221129161. [PMID: 36248186 PMCID: PMC9558873 DOI: 10.1177/20499361221129161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 09/09/2022] [Indexed: 11/25/2022] Open
Abstract
Acute cholecystitis severity ranges from mild to very severe, and its most dreadful complication is gallbladder empyema. It can be caused by several etiologic agents, but Mycobacterium tuberculosis is not common among them. Here we present a 61-year-old female who lives in an area of high tuberculosis endemicity and has type 2 diabetes mellitus. She came to our hospital with a 2-day history of moderate-to-severe colicky right upper quadrant abdominal pain and other clinical manifestations compatible with AC. Imaging studies confirmed the diagnosis. An emergency open cholecystectomy was performed and the gallbladder was sent for histopathologic examination. M. tuberculosis was identified by molecular studies and the treatment was adjusted. The patient recovered uneventfully. The clinical history and physical examination are essential for raising the index of suspicion, but complementary evaluation with imaging studies is necessary to confirm the diagnosis and evaluate its complications. Tuberculosis is a major health problem worldwide, and health professionals should be aware of its clinical spectrum to approach and manage common and uncommon presentations within their scope of attention.
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Affiliation(s)
| | - Jorge Andrés Castro Flores
- Faculty of Medicine, Autonomous University of
San Luis Potosí, San Luis Potosí, México,Hospital General ISSSTE, San Luis Potosí,
México
| | - Diego-Abelardo Álvarez-Hernández
- Faculty of Health Sciences, Anáhuac University
México, Huixquilucan, México,Faculty of Infectious and Tropical Diseases,
London School of Hygiene & Tropical Medicine, London, UK
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5
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Bastiaenen VP, van Vliet JLP, de Savornin Lohman EAJ, Corten BJGA, de Jonge J, Kraima AC, Swank HA, van Acker GJD, van Geloven AAW, In 't Hof KH, Koens L, de Reuver PR, van Rossem CC, Slooter GD, Tanis PJ, Terpstra V, Dijkgraaf MGW, Bemelman WA. Safety and economic analysis of selective histopathology following cholecystectomy: multicentre, prospective, cross-sectional FANCY study. Br J Surg 2022; 109:355-362. [PMID: 35245363 PMCID: PMC10364776 DOI: 10.1093/bjs/znab469] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 12/12/2021] [Accepted: 12/22/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND There is ongoing debate concerning the necessity of routine histopathological examination following cholecystectomy. In order to reduce the pathology workload and save costs, a selective approach has been suggested, but evidence regarding its oncological safety is lacking. METHODS In this multicentre, prospective, cross-sectional study, all gallbladders removed for gallstone disease or cholecystitis were systematically examined by the surgeon for macroscopic abnormalities indicative of malignancy. Before sending all specimens to the pathologist, the surgeon judged whether histopathological examination was indicated. The main outcomes were the number of patients with hypothetically missed malignancy with clinical consequences (upper limit two-sided 95 per cent c.i. below 3:1000 considered oncologically safe) and potential cost savings of selective histopathological examination. RESULTS Twenty-two (2.19:1000) of 10 041 specimens exhibited malignancy with clinical consequences. In case of a selective policy, surgeons would have held back 7846 of 10041 (78.1 per cent) gallbladders from histopathological examination. Malignancy with clinical consequences would have been missed in seven of 7846 patients (0.89:1000, upper limit 95% c.i. 1.40:1000). No patient benefitted from the clinical consequences, while two were harmed (futile additional surgery). Of 15 patients in whom malignancy with clinical consequences would have been diagnosed, one benefitted (residual disease radically removed), two potentially benefitted (palliative systemic therapy), and four experienced harm (futile additional surgery). Estimated cost savings established by replacing routine for selective histopathological examination were €703 500 per 10 000 patients. CONCLUSION Selective histopathological examination following cholecystectomy is oncologically safe and could reduce pathology workload, costs, and futile re-resections.
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Affiliation(s)
- Vivian P Bastiaenen
- Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Jaap L P van Vliet
- Department of Surgery, Haaglanden Medical Centre, 2512 VA The Hague, The Netherlands
| | | | | | - Joske de Jonge
- Department of Surgery, Tergooi Hospital, 1213 XZ Hilversum, The Netherlands
| | - Anne C Kraima
- Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.,Department of Surgery, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands
| | - Hilko A Swank
- Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands.,Department of Surgery, Albert Schweitzer Hospital, 3318 AT Dordrecht, The Netherlands
| | - Gijs J D van Acker
- Department of Surgery, Haaglanden Medical Centre, 2512 VA The Hague, The Netherlands
| | | | - Klaas H In 't Hof
- Department of Surgery, Flevo Hospital, 1315 RA Almere, The Netherlands
| | - Lianne Koens
- Department of Pathology, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Philip R de Reuver
- Department of Surgery, Radboud University Medical Centre, 6525 GA Nijmegen, The Netherlands
| | | | - Gerrit D Slooter
- Department of Surgery, Máxima Medical Centre, 5504 DB Veldhoven, The Netherlands
| | - Pieter J Tanis
- Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Valeska Terpstra
- Department of Pathology, Haaglanden Medical Centre, 2512 VA The Hague, The Netherlands
| | - Marcel G W Dijkgraaf
- Department of Epidemiology and Data Science, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
| | - Willem A Bemelman
- Department of Surgery, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
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6
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Altiok M, Özdemir HG, Kurt F, Gul MO, Gumus S. Incidental gallbladder cancer: a retrospective clinical study of 40 cases. Ann Surg Treat Res 2022; 102:185-192. [PMID: 35475225 PMCID: PMC9010968 DOI: 10.4174/astr.2022.102.4.185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 01/23/2022] [Accepted: 02/10/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Merih Altiok
- Department of Surgical Oncology, Balcalı Training and Research Hospital, Cukurova University, Adana, Turkey
| | - Hanife Gülnihal Özdemir
- Department of Pathology, Cengiz Gokcek Gynecology, Obstetrics, and Pediatrics Hospital, Gaziantep, Turkey
| | - Feyzi Kurt
- Department of General Surgery, Seyhan Government Hospital, Adana, Turkey
| | - Mehmet Onur Gul
- Department of Surgical Oncology, Balcalı Training and Research Hospital, Cukurova University, Adana, Turkey
| | - Serdar Gumus
- Department of Surgical Oncology, Hatay Training and Research Hospital, Hatay, Turkey
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7
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Rahul, Haldeniya K, Singh A, Bhatt N, Mishra P, Singh RK, Saxena R. Determinants of curative resection in incidental gallbladder carcinoma with special reference to timing of referral. Ann Hepatobiliary Pancreat Surg 2021; 25:492-499. [PMID: 34845121 PMCID: PMC8639303 DOI: 10.14701/ahbps.2021.25.4.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/21/2021] [Accepted: 05/21/2021] [Indexed: 11/22/2022] Open
Abstract
Backgrounds/Aims Re-resection of incidental gallbladder carcinoma (IGBC) is possible in a select group of patients. However, the optimal timing for re-intervention lacks consensus. Methods A retrospective analysis was performed for a prospective database of 91 patients with IGBC managed from 2009 to 2018. Patients were divided into three groups based on the duration between the index cholecystectomy and re-operation or final staging: Early (E), < 4 weeks; Intermediate (I), > 4 weeks and < 12 weeks; and Late (L), > 12 weeks. Demographic data, tumor characteristics, and operative details of patients were analyzed to determine factors affecting the re-resectability of IGBC. Results Twenty-two patients in ‘E’, 48 in ‘I’, and 21 in ‘L’ groups were evenly matched. Nearly two thirds were asymptomatic. Curative resection was possible in 48 (52.7%) patients. Metastasis was detected during staging laparoscopy (SL)/laparotomy in 26 (28.6%) patients. The yield of SL was more in the ‘L’ group (30.8%) than in the ‘I’ (11.1%) or ‘E’ (nil) group, avoiding unnecessary laparotomy in 13.6%. Only 28.5% of patients in the ‘L’ group could undergo curative resection (R0/R1 resection), significantly less than that in the ‘E’ (50.0%) or ‘I’ group (64.6%) (both p < 0.001). On multivariate analysis, presentation in intermediate period and tumor differentiation increased the chance of curative resection (p < 0.05). Conclusions Asymptomatic patients in the ‘I’ group with well differentiated IGBC have the best chance of obtaining a curative resection.
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Affiliation(s)
- Rahul
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Kulbhushan Haldeniya
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ashish Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Neha Bhatt
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Prabhakar Mishra
- Department of Biostatistics & Health Informatics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajneesh Kumar Singh
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Rajan Saxena
- Department of Surgical Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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8
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Echelard P, Roy SF, Trinh VQH, Garant MP, Collin Y, Nguyen BN, Geha S. Age, operation time and surgical approach can be used to detect incidental gallbladder carcinoma in cholecystectomy specimens from low-incidence settings. Histopathology 2021; 79:667-673. [PMID: 34061406 DOI: 10.1111/his.14423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 05/17/2021] [Accepted: 05/30/2021] [Indexed: 11/27/2022]
Abstract
AIMS Gallbladders resected for non-neoplastic diseases are systemically examined microscopically to rule out incidental dysplasia and carcinoma. The main aim of this study was to test whether a pre-grossing algorithm can detect incidental gallbladder carcinoma. The secondary aim was to test whether the algorithm can detect high-grade dysplasia. METHODS AND RESULTS A retrospective study of clinical, pathological and radiological findings in cholecystectomy recipients was performed on a test set to develop a classification and regression tree algorithm. Cholecystectomy cases were included; exclusion criteria were age <18 years, missing pathology reports, preoperative suspicion of neoplastic disease, and cholecystectomy for non-gallbladder oncological disease. Five thousand nine hundred and eighty-two cholecystectomies from 2006 to 2018 were included in the study, with 18 cases of incidental gallbladder carcinoma and 11 cases of high-grade dysplasia. Three hundred and ninety controls were randomly selected for the testing set. Patient age, surgical approach, operation duration, dilatation of the biliary tract and gallbladder gross anomalies were statistically significant distinguishing factors in multivariate analysis (P < 0.00-0.026). Unsupervised testing with a conditional inference tree suggested that age, procedure type and operation duration can be used to identify incidental gallbladder carcinoma from controls, whereas high-grade dysplasia also requires grossing parameters to identify half of the cases (5/11). CONCLUSION Readily available clinical parameters and postoperative data can be used to detect incidental gallbladder carcinoma. High-grade dysplasia mostly requires grossing and microscopic examination.
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Affiliation(s)
- Philippe Echelard
- Department of Pathology, University of Sherbrooke, Sherbrooke, Canada
| | - Simon F Roy
- Department of Pathology and Cellular Biology, University of Montreal, Montreal, Quebec, Canada
| | - Vincent Q-H Trinh
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Yves Collin
- Department of Surgery, University of Sherbrooke, Sherbrooke, Canada
| | - Bich N Nguyen
- Department of Pathology and Cellular Biology, University of Montreal, Montreal, Quebec, Canada
| | - Sameh Geha
- Department of Pathology, University of Sherbrooke, Sherbrooke, Canada
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Khan S, Rashikh MA, Rehman KU, Berjis H. Selective or Routine Histology of Cholecystectomy Specimens for Diagnosing Incidental Carcinoma of Gallbladder and Correlation with Careful Intraoperative Macroscopic Examination? A Systematic Review. Asian Pac J Cancer Prev 2021; 22:651-659. [PMID: 33773526 PMCID: PMC8286689 DOI: 10.31557/apjcp.2021.22.3.651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/23/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Selective or Routine histology of cholecystectomy specimens for benign gallbladder disease has always been a matter of debate because of the low prevalence and bad prognosis associated with gall bladder carcinoma. The objective of this study is to ascertain whether selective histology can be preferred over Routine histology without any harm. METHODS This systematic review is conducted according to PRISMA's checklist; relevant articles were searched in the database until September 1 2020 in PubMed, Scopus, Science Direct, and Web of Science databases, manually, with search queries and without date restrictions. Studies included in this systematic review involved patients who underwent cholecystectomy for benign gallbladder disease and were diagnosed with gallbladder carcinoma incidentally either after selective or routine histology of the gallbladder. RESULTS A total of 24 routine or selective histology recommending studies were selected for the systematic review after following the inclusion and exclusion criteria. These studies comprised 77,213 numbers of patients and 486 numbers of Malignancies. These studies correlate the number of IGBC diagnosed histologically with the number of IGBC's that were suspected by the surgeons intraoperative by macroscopy. Routine recommending studies show a significant number of IGBC diagnosed histologically as missed by surgeons whereas the selective recommending studies show most of the histologically diagnosed IGBC already suspected by the surgeons intraoperative. When comparing the macroscopic details of the IGBC's between routine and selective studies, we found that there was significant overlap. Most of the findings missed by the surgeons as suspicious in routine studies were suspected by the surgeons involved in selective histology recommending studies. Thereby, favouring selective histology and emphasizing the need for careful intraoperative macroscopy for suspecting IGBC. CONCLUSION Selective Histological examination of cholecystectomy specimens can be preferred if a careful intraoperative macroscopic examination is done and patient risk factors are taken into consideration.
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Affiliation(s)
- Shujaat Khan
- Department of Pathology, College of Medicine, Dawadmi, Shaqra University, Saudi Arabia.
| | - Mohammad Azhar Rashikh
- Department of Pharmacology, College of Medicine, Dawadmi, Shaqra University, Saudi Arabia.
| | - Khalil Ur Rehman
- Department of Internal Medicine, College of Medicine, Dawadmi, Shaqra University, Saudi Arabia.
| | - Hinanna Berjis
- Department of Anesthesiology, Ministry of Health, Dammam, Saudi Arabia.
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10
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Salita A, Rosado M, Mack K, Pui J, Zekman R, Dinnan K. Metastatic lobular carcinoma of the breast found incidentally on pathology following cholecystectomy for chronic cholecystitis: A case report. Int J Surg Case Rep 2021; 80:105612. [PMID: 33636408 PMCID: PMC7918255 DOI: 10.1016/j.ijscr.2021.01.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 01/30/2021] [Accepted: 01/31/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Traditional oncologic pattern of spread of breast cancer is metastasis to axillary lymph nodes, lung, liver and bone (Doval et al., 2006 [1]). Here we present a case of unknown synchronous breast cancer in a patient that was revealed on histopathologic assessment following elective cholecystectomy. CASE SUMMARY A 57 year old female presented for an elective laparoscopic cholecystectomy secondary to biliary colic. Histopathologic assessment of the gallbladder revealed metastatic adenocarcinoma with signet ring features, consistent with metastatic lobular carcinoma. The patient went on to have a complete oncologic workup that revealed invasive ductal carcinoma with components of high grade ductal carcinoma in situ in the left breast, lobular carcinoma in the right breast, and metastatic lobular carcinoma to left and right axillary lymph nodes as well as diffuse osseous metastatic disease. CONCLUSIONS Metastatic disease to the gallbladder found incidentally on elective cholecystectomy is a rare presentation of synchronous breast cancer.
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Affiliation(s)
- Alona Salita
- Beaumont, 28050 Grand River Avenue, Farmington Hills, MI, 48336, United States.
| | - Marcos Rosado
- Beaumont, 28050 Grand River Avenue, Farmington Hills, MI, 48336, United States.
| | - Kita Mack
- Beaumont, 28050 Grand River Avenue, Farmington Hills, MI, 48336, United States.
| | - John Pui
- Beaumont, 28050 Grand River Avenue, Farmington Hills, MI, 48336, United States.
| | - Richard Zekman
- Beaumont, 28050 Grand River Avenue, Farmington Hills, MI, 48336, United States.
| | - Kelly Dinnan
- Beaumont, 28050 Grand River Avenue, Farmington Hills, MI, 48336, United States.
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Hasan A, Nafie K, Aldossary MY, Ismail A, Monazea K, Baheeg M, Rady K, Elhawary R, Ibrahim AA. Unexpected histopathology results following routine examination of cholecystectomy specimens: How big and how significant? Ann Med Surg (Lond) 2020; 60:425-430. [PMID: 33251000 PMCID: PMC7677112 DOI: 10.1016/j.amsu.2020.11.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Routine histopathological examination (RHPE) of all gallbladder specimens is required to detect the presence of gallbladder carcinoma (GBC) or any other pathology. The work aims to study the incidence and the clinical significance of detecting unusual gallbladder findings upon the RHPE of the referred cholecystectomy specimens to a histopathology laboratory section at a referral hospital in Saudi Arabia during one year period. MATERIALS AND METHODS From May 2019 to May 2020, all histopathology reports of 444 consecutive gallbladder specimens after elective and emergency cholecystectomies were retrospectively analyzed and divided into two groups; usual findings and unusual findings which were reviewed blindly by two other pathology consultants. Frequencies, descriptive statistics, normality test, and correlations were run. The Interrater reliability between clinical and histopathological diagnosis was assessed statistically by kappa test. RESULTS The results of histopathological examination of these gallbladder specimens showed that chronic cholecystitis was found in 296 out of 444 total cases (66.7%), acute cholecystitis in 52 cases (11.7%), and other associated usual findings in 85 cases (19%). Three cases (0.7%) of incidental carcinomas and other three cases (0.7%) of dysplasia. Eosinophilic carcinomas were detected in two cases (0.45%), gallbladder complete septum was found in one case, and one case of Phrygian cap anomaly. All patients with gallbladder carcinoma were diagnosed incidentally during the histopathological examination. CONCLUSIONS RHPE of cholecystectomy materials are required to confirm the final diagnosis and document any other pathology. Failure to detect incidental occult carcinoma may be catastrophic, given the poor prognosis.
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Affiliation(s)
- Abdulkarim Hasan
- Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Laboratory & blood bank Department, Prince Mishari bin Saud Hospital, Baljurashi, Saudi Arabia
| | - Khalid Nafie
- Laboratory & blood bank Department, Prince Mishari bin Saud Hospital, Baljurashi, Saudi Arabia
| | | | - Amal Ismail
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Saudi Arabia
| | - Khaled Monazea
- Department of Surgery, Faculty of Medicine, Al-Azhar University, Assiut branch, Egypt
| | - Mohamad Baheeg
- Department of Surgery, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Kamal Rady
- Department of Anatomy and Embryology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Reda Elhawary
- Department of Pathology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Adel A. Ibrahim
- Department of Surgical Oncology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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12
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Nagarajan G, Kundalia K. Should every cholecystectomy specimen be sent for histopathology to identify incidental gall bladder cancer? Indian J Cancer 2020; 57:2-3. [PMID: 32129293 DOI: 10.4103/ijc.ijc_1027_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ganesh Nagarajan
- Consultant HPB and GI Surgical Oncologist, P D Hinduja Hospital, Mumbai, Maharashtra, India
| | - Kaushal Kundalia
- Fellow in HPB and Liver Transplant Surgery, Kings College London, London, United Kingdom
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13
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Lundgren L, Henriksson M, Andersson B, Sandström P. Cost-effectiveness of gallbladder histopathology after cholecystectomy for benign disease. BJS Open 2020; 4:1125-1136. [PMID: 33136336 PMCID: PMC7709377 DOI: 10.1002/bjs5.50325] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Indexed: 12/16/2022] Open
Abstract
Background The prevalence of incidental gallbladder cancer is low when performing cholecystectomy for benign disease. The performance of routine or selective histological examination of the gallbladder is still a subject for discussion. The aim of this study was to assess the cost‐effectiveness of these different approaches. Methods Four management strategies were evaluated using decision‐analytical modelling: no histology, current selective histology as practised in Sweden, macroscopic selective histology, and routine histology. Healthcare costs and life‐years were estimated for a lifetime perspective and combined into incremental cost‐effectiveness ratios (ICERs) to assess the additional cost of achieving an additional life‐year for each management strategy. Results In the analysis of the four strategies, current selective histology was ruled out due to a higher ICER compared with macroscopic selective histology, which showed better health outcomes (extended dominance). Comparison of routine histology with macroscopic selective histology resulted in a gain of 12 life‐years and an incremental healthcare cost of approximately €1 000 000 in a cohort of 10 000 patients, yielding an estimated ICER of €76 508. When comparing a macroscopic selective strategy with no
histological assessment, 50 life‐years would be saved and
the ICER was estimated to be €20 708 in a cohort of 10 000
patients undergoing cholecystectomy. Conclusion A macroscopic selective strategy appears to be the most cost‐effective approach.
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Affiliation(s)
- L Lundgren
- Department of Surgery, County Council of Östergötland, Linköping, Sweden.,Department of Biomedicine and Clinical Sciences, Faculty of Health Sciences, Linköping, Sweden
| | - M Henriksson
- Centre for Medical Technology Assessment, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - B Andersson
- Department of Surgery, Skåne University Hospital, Lund, Sweden.,Department of Clinical Sciences, Surgery, Lund University, Lund, Sweden
| | - P Sandström
- Department of Surgery, County Council of Östergötland, Linköping, Sweden.,Department of Biomedicine and Clinical Sciences, Faculty of Health Sciences, Linköping, Sweden
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14
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Coimbra FJF, Torres OJM, Alikhanov R, Agarwal A, Pessaux P, Fernandes EDSM, Quireze-Junior C, Araujo RLC, Godoy AL, Waechter FL, Resende APD, Boff MF, Coelho GR, Rezende MBD, Linhares MM, Belotto M, Moraes-Junior JMA, Amaral PCG, Pinto RD, Genzini T, Lima AS, Ribeiro HSC, Ramos EJ, Anghinoni M, Pereira LL, Enne M, Sampaio A, Montagnini AL, Diniz A, Jesus VHFD, Sirohi B, Shrikhande SV, Peixoto RDA, Kalil AN, Jarufe N, Smith M, Herman P. BRAZILIAN CONSENSUS ON INCIDENTAL GALLBLADDER CARCINOMA. ACTA ACUST UNITED AC 2020; 33:e1496. [PMID: 32667526 PMCID: PMC7357549 DOI: 10.1590/0102-672020190001e1496] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/10/2019] [Indexed: 12/18/2022]
Abstract
Background: Incidental gallbladder cancer is defined as a cancer discovered by
histological examination after cholecystectomy. It is a potentially curable
disease. However, some questions related to their management remain
controversial and a defined strategy is associated with better prognosis.
Aim: To develop the first evidence-based consensus for management of patients with
incidental gallbladder cancer in Brazil. Methods: Sixteen questions were selected, and 36 Brazilian and International members
were included to the answer them. The statements were based on current
evident literature. The final report was sent to the members of the panel
for agreement assessment. Results: Intraoperative evaluation of the specimen, use of retrieval bags and routine
histopathology is recommended. Complete preoperative evaluation is necessary
and the reoperation should be performed once final staging is available.
Evaluation of the cystic duct margin and routine 16b1 lymph node biopsy is
recommended. Chemotherapy should be considered and chemoradiation therapy if
microscopically positive surgical margins. Port site should be resected
exceptionally. Staging laparoscopy before reoperation is recommended, but
minimally invasive radical approach only in specialized minimally invasive
hepatopancreatobiliary centers. The extent of liver resection is acceptable
if R0 resection is achieved. Standard lymph node dissection is required for
T2 tumors and above, but common bile duct resection is not recommended
routinely. Conclusions: It was possible to prepare safe recommendations as guidance for incidental
gallbladder carcinoma, addressing the most frequent topics of everyday work
of digestive and general surgeons.
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Affiliation(s)
| | | | - Orlando Jorge M Torres
- Department of Hepatopancreatobiliary Surgery, Federal University of Maranhão, São Luis, Brazil
| | - Ruslan Alikhanov
- Department of Hepatopancreatobiliary Surgery, Moscow Clinical Scientific Center, Moscow, Russia
| | - Anil Agarwal
- Department of Gastrointestinal Surgery, Govind Ballabh Pant Hospital, New Delhi, India
| | - Patrick Pessaux
- Department of Hepatopancreatobiliary Surgery, Nouvel Hopital Civil, University Hospital of Strasbourg, Strasbourg, France
| | - Eduardo de Souza M Fernandes
- Department of Hepatopancreatobiliary and Transplant Surgery, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - André Luis Godoy
- Department of Gastrointestinal Surgery, AC Camargo Cancer Center, São Paulo, Brazil
| | - Fabio Luis Waechter
- Department of Gastrointestinal Surgery, Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | | | | | - Gustavo Rego Coelho
- Department of Hepatopancreatobiliary Surgery, Hospital Walter Cantidio, Fortaleza, Brazil
| | | | | | - Marcos Belotto
- Department of Gastrointestinal Surgery, Santa Casa de São Paulo, São Paulo, Brazil
| | | | | | - Rinaldo Danesi Pinto
- Department of Gastrointestinal Surgery, Hospital Santa Catarina, Blumenal, Brazil
| | - Tercio Genzini
- Department of Hepatopancreatobiliary Surgery, Hospital Beneficiência Portuguesa, São Paulo, Brazil
| | - Agnaldo Soares Lima
- Department of Hepatopancreatobiliary Surgery, Santa Casa de Belo Horizonte, Brazil
| | | | - Eduardo José Ramos
- Department of Hepatopancreatobiliary Surgery, Hospital NS das Graças, Curitiba, Brazil
| | | | - Lucio Lucas Pereira
- Department of Gastrointestinal Surgery, Hospital Sírio-Libanês, Brasilia, Brazil
| | - Marcelo Enne
- Department of Hepatopancreatobiliary Surgery, Ipanema Hospital, Rio de Janeiro, Brazil
| | - Adriano Sampaio
- Department of Gastrointestinal Surgery, Santo Amaro University, São Paulo, Brazil
| | - André Luis Montagnini
- Department of Hepatopancreatobiliary Surgery, São Paulo Medical School, São Paulo, Brazil
| | - Alessandro Diniz
- Department of Gastrointestinal Surgery, AC Camargo Cancer Center, São Paulo, Brazil
| | | | - Bhawna Sirohi
- Department of Hepatopancreatobiliary and Oncology Surgery, Tata Memorial Hospital, Mumbai, India
| | - Shailesh V Shrikhande
- Department of Hepatopancreatobiliary and Oncology Surgery, Tata Memorial Hospital, Mumbai, India
| | | | - Antonio Nocchi Kalil
- Department of Gastrointestinal Oncology, Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | - Nicolas Jarufe
- Department of Hepatopancreatobiliary Surgery, Universidade Católica, Santiago, Chile
| | - Martin Smith
- Department of Hepatopancreatobiliary Surgery, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Paulo Herman
- Department of Hepatopancreatobiliary Surgery, São Paulo Medical School, São Paulo, Brazil
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15
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Corten B, Leclercq W, Roumen R, van Zwam P, Dejong C, Slooter G. Histological examination of the gallbladder following routine cholecystectomy? A selective analysis is justified. Eur J Surg Oncol 2020; 46:572-576. [DOI: 10.1016/j.ejso.2019.11.497] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 11/02/2019] [Accepted: 11/10/2019] [Indexed: 01/24/2023] Open
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16
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Cherif S, Rais H, Hakmaoui A, Sellami S, Elantri S, Amine A. Linking Helicobacter pylori with gallbladder and biliary tract cancer in Moroccan population using clinical and pathological profiles. Bioinformation 2019; 15:735-743. [PMID: 31831956 PMCID: PMC6900325 DOI: 10.6026/97320630015735] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 10/30/2019] [Accepted: 10/30/2019] [Indexed: 12/18/2022] Open
Abstract
It is of interest to assess the clinical and pathological aspects of Gallbladder and biliary tract carcinomas confirmed by histological data. It is also of further interest to evaluate the link between Helicobacter pylori and biliary tract cancers. Eighty-nine (89) cases (mean age 60±12 years) of Gallbladder and biliary tract cancer confirmed by histological data were enrolled for the study at the Department of Pathology in Mohammed VI University Hospital, in Morocco. The data such as age, sex, clinical and histo pathological features were collected. Bile duct specimens were investigated for H. pylori using Giemsa and immuno histo chemistry staining. Results show that bile duct stones were found in 53.9% of cases. It is known using histological data that adeno carcinoma is common accounting for 70 % of all bile duct tumors. Moreover, Helicobacter pylori was detected in 54% of cases linking with the presence of bile duct stones characterized by the histological subtype, the macroscopic classification and lymph node's presence (p<0.001). Thus, data collected suggest the potential association of Helicobacter pylori with gallbladder cancer possibly through the formation of bile duct stones.
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Affiliation(s)
- Soumia Cherif
- Department of Pathology, ARRAZI Hospital, Biopathology Laboratory-Clinical Research Center, Mohammed VI University Hospital, Marrakech, Morocco
- Laboratory of Biochemistry, Environment, and Agrifood, Faculty of Sciences and Techniques-Mohammedia, Hassan II University, Morocco/URAC-36
- Department of Gynecology, Charite University Medicine, Campus Virchow, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Hanane Rais
- Department of Pathology, ARRAZI Hospital, Biopathology Laboratory-Clinical Research Center, Mohammed VI University Hospital, Marrakech, Morocco
| | - Abdelmalk Hakmaoui
- Department of Pathology, ARRAZI Hospital, Biopathology Laboratory-Clinical Research Center, Mohammed VI University Hospital, Marrakech, Morocco
| | - Souad Sellami
- Department of Pathology, ARRAZI Hospital, Biopathology Laboratory-Clinical Research Center, Mohammed VI University Hospital, Marrakech, Morocco
| | - Said Elantri
- Laboratory of Biochemistry, Environment, and Agrifood, Faculty of Sciences and Techniques-Mohammedia, Hassan II University, Morocco/URAC-36
| | - Abdessamad Amine
- Laboratory of Biochemistry, Environment, and Agrifood, Faculty of Sciences and Techniques-Mohammedia, Hassan II University, Morocco/URAC-36
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17
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Søreide K, Guest RV, Harrison EM, Kendall TJ, Garden OJ, Wigmore SJ. Systematic review of management of incidental gallbladder cancer after cholecystectomy. Br J Surg 2019; 106:32-45. [PMID: 30582640 DOI: 10.1002/bjs.11035] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 08/16/2018] [Accepted: 10/01/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gallbladder cancer is rare, but cancers detected incidentally after cholecystectomy are increasing. The aim of this study was to review the available data for current best practice for optimal management of incidental gallbladder cancer. METHODS A systematic PubMed search of the English literature to May 2018 was conducted. RESULTS The search identified 12 systematic reviews and meta-analyses, in addition to several consensus reports, multi-institutional series and national audits. Some 0·25-0·89 per cent of all cholecystectomy specimens had incidental gallbladder cancer on pathological examination. Most patients were staged with pT2 (about half) or pT1 (about one-third) cancers. Patients with cancers confined to the mucosa (T1a or less) had 5-year survival rates of up to 100 per cent after cholecystectomy alone. For cancers invading the muscle layer of the gallbladder wall (T1b or above), reresection is recommended. The type, extent and timing of reresection remain controversial. Observation time may be used for new cross-sectional imaging with CT and MRI. Perforation at initial surgery had a higher risk of disease dissemination. Gallbladder cancers are PET-avid, and PET may detect residual disease and thus prevent unnecessary surgery. Routine laparoscopic staging before reresection is not warranted for all stages. Risk of peritoneal carcinomatosis increases with each T category. The incidence of port-site metastases is about 10 per cent. Routine resection of port sites has no effect on survival. Adjuvant chemotherapy is poorly documented and probably underused. CONCLUSION Management of incidental gallbladder cancer continues to evolve, with more refined suggestions for subgroups at risk and a selective approach to reresection.
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Affiliation(s)
- K Søreide
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK.,Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - R V Guest
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - E M Harrison
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - T J Kendall
- Division of Pathology, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - O J Garden
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
| | - S J Wigmore
- Clinical Surgery, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK
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18
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Histopathological Examination of Gallbladder Specimens in Kumaon Region of Uttarakhand. J Gastrointest Cancer 2019; 51:121-129. [PMID: 30847742 DOI: 10.1007/s12029-018-00188-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Gall stones are one of the major causes of morbidity and mortality all over the world and common health problems throughout in developing countries. Cholecystectomy is one of the most common surgical practices and postoperative analysis of cholecystectomy specimen has a great value since histopathological reports may document some entities with significant clinical significances. Gallbladder carcinomas in cholecystectomy specimens are received in our histopathology laboratory to analyse their clinicopathological features. This was a descriptive study carried out at the histopathology section of the Department of Pathology at our hospital over a period of two years ranging from November 2016 to October 2018. Both intraoperative and postoperative histological examinations of the excised gallbladder facilitated the diagnosis of gallbladder cancer. Surgery-related variables and surgical approaches were evaluated according to the extent of tumor invasion. Twenty five cholecystectomy specimens of the acute and symptomatic chronic cholecystitis patients were analyzed. Standardization of the reporting were examined. Age, gender, presence of gall stone, cholesterolosis, adenomatous hyperplasia, gastric or intestinal metaplasia, dysplasia, histopathological type of gallbladder carcinoma, cellular differentiation, grading, lympho vascular invision, perineural invasion, lymph node invasion, involvement of cystic duct end margin, liver invasion, omental tissue invasion and T.N.M. staging were investigated. Reported rates of histopathological findings were comparable between patients aged twenty six years to seventy six years. Epithelial hyperplasia and metaplasia were found to be related to age. The correlation between cholesterolosis and gender or metaplasia was noted. We suggest that in India and other nations, high incidences of gallbladder carcinoma, all cholecystectomy specimens must be submitted to routine macroscopic and histopathology examination in the laboratory, as this is the only capability through which malignancies can be detected at an early, potentially curable stage. This incidental finding has altered the management and outcome of this dreadful disease.
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19
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Olthof PB, Metman MJH, de Krijger RR, Scheepers JJ, Roos D, Dekker JWT. Routine Pathology and Postoperative Follow-Up are Not Cost-Effective in Cholecystectomy for Benign Gallbladder Disease. World J Surg 2018; 42:3165-3170. [PMID: 29696323 PMCID: PMC6132861 DOI: 10.1007/s00268-018-4619-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The incidence of gallstone disease is increasing and represents a strain on healthcare systems worldwide. Following cholecystectomy, gallbladder specimens are generally submitted for histopathologic examination and the diagnostic yield of this strategy remains questionable. This study aimed to evaluate the usefulness of routine pathologic examination of the gallbladder specimens and investigate the results of routine postoperative follow-up visits. METHODS All cholecystectomies performed between January 2011 and July 2017 at a single center were evaluated. All gallbladder specimens were routinely pathologically examined. The outcome parameters were the macro- and microscopic gallbladder anomalies at pathology and the reported symptoms during routine follow-up visits 2-6 weeks after surgery. RESULTS In the study period a total of 2763 patients underwent cholecystectomy, of which 2615 had a postoperative visit in the outpatient clinic. Seventy-three patients (3%) complained of persistent abdominal pain, and 29 of these patients were referred for further treatment, resulting in a resolution of symptoms in 97%. Of all gallbladder specimens, 199 (7%) displayed macroscopic anomalies and in four (2%) of these, gallbladder carcinoma was diagnosed. DISCUSSION Selective pathologic examination of gallbladder specimens in case of macroscopic anomalies appears justified. Also routine follow-up after cholecystectomy appears not useful since 97% of patients do not report any symptoms at follow-up. A selective pathology and follow-up strategy could save significant healthcare costs.
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Affiliation(s)
- Pim B Olthof
- Department of Surgery, Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands. .,Department of Experimental Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
| | - Madelon J H Metman
- Department of Surgery, Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
| | | | - Joris J Scheepers
- Department of Surgery, Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
| | - Daphne Roos
- Department of Surgery, Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
| | - Jan Willem T Dekker
- Department of Surgery, Reinier de Graaf Gasthuis, Reinier de Graafweg 5, 2625 AD, Delft, The Netherlands
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20
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Are Incidental Gallbladder Cancers Missed with a Selective Approach of Gallbladder Histology at Cholecystectomy? World J Surg 2018; 42:1092-1099. [PMID: 28900706 PMCID: PMC5843671 DOI: 10.1007/s00268-017-4215-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Incidental gallbladder cancer (IGBC) is an unexpected finding when a cholecystectomy is performed upon a benign indication, and the use of routine or selective histological analysis of gallbladder specimen is still debated. The aim of this study was to investigate whether the proportion of submitted gallbladder specimens for pathological investigation influences the proportion of IGBC found, and what possible factors preoperatively or perioperatively could influence the selection process. METHODS All cholecystectomies between January 2007 and September 2014 registered in the Swedish Registry of Gallstone Surgery and ERCP (GallRiks) were included. Proportion of histological analysis was divided into four subgroups (0-25%, >25-50%, >50-75%, >75-100%). RESULTS A total of 81,349 cholecystectomies were registered, and 36,010 (44.3%) gallbladder specimens were sent for histological analysis. A total of 213 cases of IGBC were discovered, which constituted 0.26% of all cholecystectomies performed and 0.59% of the number of gallbladder specimens sent for histological analysis. Hospitals submitting >75-100% of the gallbladder specimens had significantly more IGBC/1000 cholecystectomies performed (p = 0.003). Hospitals with the most selective approach had a significantly higher proportion of IGBC/1000 gallbladders that were sent for histological analysis (p < 0.001). Factors such as higher age (p < 0.001), female gender (p = 0.048) and macroscopic cholecystitis (p < 0.001) were more common in gallbladder specimens from hospitals that had a selective approach to histological analysis. CONCLUSION A routine approach to histological analysis in cholecystectomies with a benign indication for surgery can uncover a higher proportion of IGBC cases. When a selective approach is used, risk factors should be taken into account.
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21
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Charfi S, Gouiaa N, Mnif H, Chtourou L, Tahri N, Abid B, Mzali R, Boudawara TS. Histopathological findings in cholecystectomies specimens: A single institution study of 20 584 cases. Hepatobiliary Pancreat Dis Int 2018; 17:345-348. [PMID: 30173787 DOI: 10.1016/j.hbpd.2018.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/20/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The histopathological examination of cholecystectomy specimens has not been standardized with a debate concerning the routine and the selective approach. The aim of this study was to assess the information obtained from routine histopathological examination of cholecystectomy specimens. METHODS All histopathological reports of cholecystectomy specimens between January 2003 and December 2016 were analyzed, including a clinical diagnosis of benign gallstone disease or cholecystitis. RESULTS A total of 20,584 reports were examined. The mean age of patients was 54.2 years. Patients aged more than 60 years represent 37.6% of the study population. Of all patients, 15,973 (77.6%) were females. Incidental gallbladder cancers (GBC) were present in 155 cholecystectomies specimens (0.8%). 67.1% of GBC are at T2 and T3 stage. Granulomatous cholecystitis was diagnosed in only 19 cases (0.1%). GBC were more prevalent in older patients (P < 10-6) and cholesterolosis was more prevalent in young patients (P < 10-6). There was no gender predilection for GBC (P = 0.739). CONCLUSIONS The rate of incidental gallbladder carcinoma in our study is low, yet, we found a higher proportion of T2 and T3 carcinomas stage. Granulomatous cholecystitis may need further investigations and treatments. When a selective approch of histopathological examination of cholecystectomy specimens is used, it is important to take into account that clinical parameters are significantly associated with gallbladder cancer.
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Affiliation(s)
- Slim Charfi
- Department of Pathology, CHU Habib Bourguiba, Sfax 3029, Tunisia; Sfax Medical School, University of Sfax, Sfax 3029, Tunisia.
| | - Naourez Gouiaa
- Department of Pathology, CHU Habib Bourguiba, Sfax 3029, Tunisia; Sfax Medical School, University of Sfax, Sfax 3029, Tunisia
| | - Hela Mnif
- Department of Pathology, CHU Habib Bourguiba, Sfax 3029, Tunisia; Sfax Medical School, University of Sfax, Sfax 3029, Tunisia
| | - Lassaad Chtourou
- Sfax Medical School, University of Sfax, Sfax 3029, Tunisia; Department of Gastroenterology, CHU Habib Bourguiba, Sfax 3029, Tunisia
| | - Nabil Tahri
- Sfax Medical School, University of Sfax, Sfax 3029, Tunisia; Department of Gastroenterology, CHU Habib Bourguiba, Sfax 3029, Tunisia
| | - Bassem Abid
- Sfax Medical School, University of Sfax, Sfax 3029, Tunisia; Department of Surgery, CHU Habib Bourguiba, Sfax 3029, Tunisia
| | - Rafik Mzali
- Sfax Medical School, University of Sfax, Sfax 3029, Tunisia; Department of Surgery, CHU Habib Bourguiba, Sfax 3029, Tunisia
| | - Tahya Sellami Boudawara
- Department of Pathology, CHU Habib Bourguiba, Sfax 3029, Tunisia; Sfax Medical School, University of Sfax, Sfax 3029, Tunisia
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22
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Koppatz H, Nordin A, Scheinin T, Sallinen V. The risk of incidental gallbladder cancer is negligible in macroscopically normal cholecystectomy specimens. HPB (Oxford) 2018; 20:456-461. [PMID: 29248400 DOI: 10.1016/j.hpb.2017.11.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/11/2017] [Accepted: 11/22/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cholecystectomy is usually carried out for benign indications. Most perform routine histopathologic examination to detect incidental gallbladder cancer (GBC). METHODS Cholecystectomies performed at four hospitals in the Helsinki Metropolitan Area during 2010-2012 were analyzed retrospectively. Patients with preoperative suspicion of neoplasia, active malignancy, or in whom cholecystectomy was performed as a secondary procedure were excluded. RESULTS A total of 2034 cholecystectomies were included. In ten patients (0.5%), GBC was identified, each with an associated macroscopic finding, including local hardness (n = 1), a thickened wall (n = 5), acute inflammation and necrosis (n = 1), or suspected neoplasia (n = 3). No GBC was found in macroscopically normal gallbladders (n = 1464). Of the ten patients with GBC, five underwent subsequent liver resection, four had metastatic disease, and one had locally advanced inoperable disease. Three of the five patients who underwent liver resection were alive and disease-free at final follow-up (median 48 months). The remaining seven patients with GBC died of the disease, with a median survival of 14 months (range 10-48 months). CONCLUSIONS Routine histopathologic examination of a macroscopically normal gallbladder does not improve diagnosis of GBC. A histopathological examination is, however, mandatory when a macroscopic abnormality is present.
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Affiliation(s)
- Hanna Koppatz
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Arno Nordin
- Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Tom Scheinin
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ville Sallinen
- Department of Abdominal Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Department of Transplantation and Liver Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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Akbulut S, Karagul S, Ertugrul I, Aydin C, Yilmaz M, Yilmaz S. Histopathologic Findings of Cholecystectomy Specimens in Patients Who Underwent Donor Hepatectomy for Living Donor Liver Transplantation. Transplant Proc 2015; 47:1466-8. [PMID: 26093744 DOI: 10.1016/j.transproceed.2015.04.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to discuss the macroscopic and microscopic properties of gallbladder specimens obtained from living liver donors. METHODS The study retrospectively analyzed the clinical and histopathological data of 1088 donors who underwent living donor hepatectomy between March 2005 and September 2014 at Inonu University Faculty of Medicine, Liver Transplantation Center. Age, sex, macroscopic, and microscopic properties of the gallbladder (bladder length, diameter, content, and histopathological properties) were recorded by 2 researchers. RESULTS A total of 1009 donors aged 17 to 66 years (31.1 ± 9.5) met the inclusion criteria, whereas 79 donors were excluded due to missing data. In total, 587 donors were male (30.5 ± 9.1 years [16-63 years]) and 422 were female (31.8 ± 9.8 years [18-66 years]). Preoperative tests revealed Gilbert syndrome in 3 subjects, whereas other donors' biochemical tests were within normal ranges. The macroscopic examination of gallbladders revealed mean gallbladder wall thickness, length, and width of 1.82 ± 0.8 mm (1-10 mm), 72 ± 11.4 mm (40-120 mm), and 52.5 ± 14 mm (15-90 mm), respectively. The microscopic gallbladder examination showed that 740 donors had a normal gallbladder, 193 had chronic cholecystitis (1 donor had antral metaplasia and 1 had intestinal metaplasia), 40 had cholesterolosis (1 donor had both tubular adenoma and intestinal metaplasia), 15 had minimal chronic cholecystitis (1 donor had pyloric metaplasia), 14 had cholelithiasis, 2 had adenomyosis, 2 had muscular hypertrophy, 1 had papillary hyperplasia, 1 had microdiverticulitis, and 1 had mucosal lymphatic ectasia. CONCLUSION The results of this study reflect the actual gallbladder pathologies that can be detected in healthy people. Clearer conclusions can be reached about the epidemiological data on gallbladder as the number of living liver donors increases in the future.
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Affiliation(s)
- S Akbulut
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey.
| | - S Karagul
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - I Ertugrul
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - C Aydin
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - M Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
| | - S Yilmaz
- Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, 44280 Malatya, Turkey
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Jayasundara JASB, de Silva WMM. Histological assessment of cholecystectomy specimens performed for symptomatic cholelithiasis: routine or selective? Ann R Coll Surg Engl 2013; 95:317-22. [PMID: 23838492 PMCID: PMC4165132 DOI: 10.1308/003588413x13629960046471] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2012] [Indexed: 12/21/2022] Open
Abstract
Traditionally, all cholecystectomy specimens resected for symptomatic cholelithiasis were sent for histological evaluation. The objectives of such evaluation are to confirm the clinicoradiological diagnosis, identification of unsuspected findings including incidental gallbladder malignancy, audit and research purposes, and quality control issues. Currently, there is a developing trend to consider selective histological evaluation of surgical specimens removed for clinically benign disease. This article discusses the need for routine or selective histopathological evaluation of gallbladder specimens following cholecystectomy. Although several retrospective studies have suggested selective histological evaluation of cholecystectomy specimens performed for symptomatic cholelithiasis, the evidence is not adequate at present to recommend selective histological evaluation globally. However, it may be appropriate to consider selective histological evaluation on a regional basis in areas of extremely low incidence of gallbladder cancer only after unanimous agreement between the governing bodies of surgical and histopathological expertise.
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Affiliation(s)
- J A S B Jayasundara
- General Surgical Unit (Ward 19), National Hospital of Sri Lanka, Colombo 10, Sri Lanka.
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