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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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Goyal S, Prasad G, Chaudhary D, Sakhuja P, Srivastava S, Aggarwal AK. Role of Guided FNA in Gallbladder Cancer: A Retrospective 3-Year Study. J Cytol 2023; 40:12-18. [PMID: 37179960 PMCID: PMC10167836 DOI: 10.4103/joc.joc_224_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 10/14/2022] [Accepted: 12/15/2022] [Indexed: 02/17/2023] Open
Abstract
Background A majority of the patients with gall bladder cancer (GBCa) present at an advanced stage and have poor survival. The aim is to retrospectively study the role of guided FNA in the diagnosis of GBCa in a superspecialty institute and to describe the cytomorphologic spectrum of gall bladder (GB) lesions in the North Indian population. Materials and Methods All suspected cases of GBCa who underwent guided FNA from the primary GB mass or metastatic liver space-occupying lesion from 2017 to 2019 were included. The aspirate smears were retrieved and analyzed for cytomorphological features independently by two cytopathologists. The neoplastic lesions were classified according to the WHO 2019 classification. Results Of 489 cases, fine needle aspiration cytology (FNAC) was diagnostic in 463 cases (94.6%), of which 417 (90.1%) were positive for malignancy, 35 (7.5%) were inflammatory, and 11 (2.4%) were inconclusive for malignancy. Adenocarcinoma not otherwise specified (NOS) was the most common type seen in 330 cases (79.1%) and 87 (20.9%) were unusual variants. These included papillary adenocarcinoma (22, 5.2%), mucinous adenocarcinoma (12, 2.8%), signet ring carcinoma (2,0.4%), adenosquamous carcinoma (8, 1.9%), squamous cell carcinoma (10, 2.4%), neuroendocrine neoplasms (7, 1.7%), undifferentiated carcinoma (24, 5.7%) and non-Hodgkin lymphoma (2,0.4%), respectively. Immunohistochemistry on the cell block confirmed the diagnosis wherever possible. Histopathology was discordant in 5 out of 33 cases. Conclusion Guided FNAC is a sensitive investigation that plays a crucial role in confirming the diagnosis and deciding the further treatment options in advanced-stage GBCa patients. The uncommon variants of GBCa can be reliably categorized on cytology.
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Affiliation(s)
- Surbhi Goyal
- Department of Pathology, GIPMER, New Delhi, India
| | | | | | - Puja Sakhuja
- Department of Pathology, GIPMER, New Delhi, India
| | | | - Anil K. Aggarwal
- Department of Gastrointestinal Surgery, GIPMER, New Delhi, India
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Pericleous S, Doran SLF, Wotherspoon A, Terlizzo M, Riddell A, Brown G, Shur J, Chua S, Hujairi N, Middleton N, Cunningham D, Kumar S, Bhogal RH. The Diagnostic Accuracy of 18 F-FGD-PET/CT for Cancer of the Gallbladder: A Retrospective Study. World J Nucl Med 2022; 21:112-119. [PMID: 35865160 PMCID: PMC9296241 DOI: 10.1055/s-0042-1750332] [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] [Indexed: 12/24/2022] Open
Abstract
Background Gallbladder cancer has a poor prognosis and imaging can have variable diagnostic accuracy. We assessed the ability of preoperative 18 F-fluorodeoxyglucose positron emission tomography computed tomography ( 18 F-FDG-PET/CT) imaging to predict a postoperative histological diagnosis of gallbladder cancer. Method A retrospective analysis was undertaken in a cohort of patients, who had suspected gallbladder cancer on cross-sectional imaging and that underwent preoperative FDG-PET/CT scan. The discriminatory power of FDG-PET/CT was determined in receiver operator characteristic (ROC) analysis and diagnostic accuracy parameters were estimated at different thresholds of maximum standard unit value (SUV max ) . Results Twenty-two patients were included in the study; 7 had malignant and 15 benign diagnoses. There was no statistically significant difference between the measured SUV max between the two groups ( p = 0.71). With an area under the curve of 0.486, the ROC curve did not indicate any discriminatory power of FDG-PET/CT at any potential threshold of SUV max. Conclusion This study indicates that the diagnosis of primary gallbladder cancer cannot be accurately confirmed with FDG PET/CT scanning.
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Affiliation(s)
- Stephanos Pericleous
- Department of HPB Surgery, Academic Department of Surgery, Royal Marsden Hospital, London, United Kingdom
| | - Sophie L. F. Doran
- Department of HPB Surgery, Academic Department of Surgery, Royal Marsden Hospital, London, United Kingdom
| | - Andrew Wotherspoon
- Department of Histopathology, Royal Marsden Hospital, London, United Kingdom
| | - Monica Terlizzo
- Department of Histopathology, Royal Marsden Hospital, London, United Kingdom
| | - Angela Riddell
- Department of Radiology and Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Gina Brown
- Department of Radiology and Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Joshua Shur
- Department of Radiology and Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Sue Chua
- Department of Radiology and Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Nabil Hujairi
- Department of Radiology and Nuclear Medicine, Royal Marsden Hospital, London, United Kingdom
| | - Nicos Middleton
- School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - David Cunningham
- Department of Oncology, Royal Marsden Hospital, London, United Kingdom
| | - Sacheen Kumar
- Department of Surgery, Academic Department of Surgery, Royal Marsden Hospital, London, United Kingdom
| | - Ricky H. Bhogal
- Department of HPB Surgery, Academic Department of Surgery, Royal Marsden Hospital, London, United Kingdom
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Berger Y, Sullivan BJ, Leigh NL, Bekhor EY, Dhorajiya P, Mani M, Magge DR, Cha DE, Sarpel U, Hiotis SP, Labow DM, Ward SC, Golas BJ, Cohen NA. Gallbladder Cancer: A Single-Institution 10-Year Experience-Analysis of Adenocarcinoma Subtypes and Tumors Arising from Intracholecystic Papillary Neoplasms. Ann Surg Oncol 2022; 29:5167-5175. [PMID: 35437668 DOI: 10.1245/s10434-022-11719-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/21/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Gallbladder cancer accounts for 1.2% of global cancer diagnoses. Literature on biliary-type adenocarcinoma (BTA), and specifically carcinoma arising from intracholecystic papillary-tubular neoplasms (ICPNs), is limited. This study describes a retrospective, single-institution experience with gallbladder cancer, focusing on histological subtypes and prognosis. METHODS A retrospective review was performed of patients who underwent cholecystectomy for a malignant neoplasm of the gallbladder between 2007 and 2017. Demographic, clinicopathologic, and operative variables, as well as survival outcomes, were analyzed. RESULTS From a total of 145 patients, BTAs were most common (93, 64%). Compared with non-BTAs, BTAs were diagnosed at a lower American Joint Committee on Cancer stage (p = 0.045) and demonstrated longer median recurrence-free survival (38 vs. 16 months, p = 0.014; median follow-up 36 months). Tumors arising from ICPNs (18, 12%) were more commonly associated with BTA (14 cases). Compared with BTAs not associated with ICPNs (29 patients), associated cases demonstrated lower pathologic stage (p = 0.006) and lower rates of liver and perineural invasion (0% vs. 49% and 14% vs. 48%, respectively; p < 0.05). Cumulative 5-year survival probability was higher for patients with gallbladder neoplasm of any subtype associated with ICPNs compared with those that were not associated with ICPNs (54% vs. 41%, p = 0.019; median follow-up 23 months). This difference was also significant when comparing BTAs associated with ICPNs and non-associated cases (63% vs. 52%, p = 0.005). CONCLUSIONS This study demonstrated unique pathological and prognostic features of BTAs and of carcinomas arising from ICPNs. Histopathological variance may implicate prognosis and may be used to better guide clinical decision making in the treatment of these patients.
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Affiliation(s)
- Yael Berger
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA.
| | - Brianne J Sullivan
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Natasha L Leigh
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Eliahu Y Bekhor
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Pooja Dhorajiya
- The Lillian and Henry M. Stratton-Hans Popper Department of Pathology, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Malary Mani
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Deepa R Magge
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Da Eun Cha
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Umut Sarpel
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Spiros P Hiotis
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Daniel M Labow
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Stephen C Ward
- The Lillian and Henry M. Stratton-Hans Popper Department of Pathology, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Benjamin J Golas
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
| | - Noah A Cohen
- Division of Surgical Oncology, Department of Surgery, Mount Sinai Hospital/Icahn School of Medicine, New York, NY, USA
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Chandel K, Lal A, Srinivas RK, Chatterjee D, Gupta V. Gallbladder Neuroendocrine Carcinoma: A Case Report with Radiological–Pathological Correlation. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1742676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractNeuroendocrine tumors (NET) of the biliary system, specifically the gallbladder (GB), are extremely rare, accounting for only 0.2% of all NETs. The majority of GBNETs are discovered by chance during a histological examination of GB samples at autopsy, after cholecystectomy, or after surgery for other suspected biliary pathology. GBNETs are thought to develop from preexisting endocrine cells in the GB's neck or from induced endocrine cells caused by intestinal metaplasia of the body and fundus. We present a case of squamous cell carcinoma of the GB with neuroendocrine differentiation due to its rarity.
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Affiliation(s)
- Karamvir Chandel
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anupam Lal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rohit K. Srinivas
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Gupta
- Department of Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Rout N, Hota SK, Dash S, Samantaray S, Mallik RN, Agrawal O. Diagnostic Utility of Ultrasound-Guided Fine-Needle Aspiration Cytology in Gall Bladder Lesions: An Experience from a Tertiary Care Cancer Center in Eastern India. J Cytol 2021; 38:145-150. [PMID: 34703091 PMCID: PMC8489701 DOI: 10.4103/joc.joc_166_20] [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] [Received: 08/27/2020] [Revised: 09/17/2020] [Accepted: 05/20/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction Gallbladder cancer (GBC) is the most common malignancy, representing 80-95% of biliary tract cancers. Although ultrasonography-guided fine-needle aspiration cytology (USG-FNAC) has emerged as an effective diagnostic the tool for the precise diagnosis of gallbladder lesions, data on its diagnostic utility and cytomorphological categorization of gallbladder lesions are lacking. Aims To study the diagnostic utility of USG-FNAC in gallbladder lesions. Materials and Methods This study was the conducted prospectively on patients who came with clinical and radiological evidence of gallbladder space-occupying lesion and then advised to USG-FNAC over 2 years and 6 months from January 2018 to June 2020. Results A total of 314 cases were included. The mean age was 56 years, with a range of 17-88 years. Women predominated over men (Male:Female = 1:2.3). Primary adenocarcinoma of the gallbladder was most common. On cyto-histological correlation, the sensitivity, specificity, and diagnostic accuracy of USG-FNAC of gallbladder lesions were found to be 98.82, 87.23, and 96.3%, respectively. Conclusion The USG-FNAC of gallbladder lesion was found to be an easy, quick, cost-effective, and presumptive diagnostic procedure. It should be opted as an initial preoperative diagnostic modality in high incidence areas to avoid inappropriate management with unnecessary morbidity and cost. Moreover, a close cytological examination of the architectural pattern and the cytomorphological features would help in the sub-typing and prognosticating the tumor.
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Affiliation(s)
- Niranjan Rout
- Department of Oncopathology, Acharya Harihar Post-Graduate Institute of Cancer, Cuttack, Odisha, India
| | - Subhransu Kumar Hota
- Department of Pathology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Sashibhusan Dash
- Department of Oncopathology, Acharya Harihar Post-Graduate Institute of Cancer, Cuttack, Odisha, India
| | - Sagarika Samantaray
- Department of Oncopathology, Acharya Harihar Post-Graduate Institute of Cancer, Cuttack, Odisha, India
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Su L, Zhang J, Zhang X, Zheng L, Zhu Z. Identification of cell cycle as the critical pathway modulated by exosome-derived microRNAs in gallbladder carcinoma. Med Oncol 2021; 38:141. [PMID: 34655361 PMCID: PMC8520510 DOI: 10.1007/s12032-021-01594-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 09/29/2021] [Indexed: 11/26/2022]
Abstract
Gallbladder cancer (GBC), the most common malignancy in the biliary tract, is highly lethal malignant due to seldomly specific symptoms in the early stage of GBC. This study aimed to identify exosome-derived miRNAs mediated competing endogenous RNAs (ceRNA) participant in GBC tumorigenesis. A total of 159 differentially expressed miRNAs (DEMs) was identified as exosome-derived miRNAs, contains 34 upregulated exo-DEMs and 125 downregulated exo-DEMs based on the expression profiles in GBC clinical samples downloaded from the Gene Expression Omnibus database with the R package. Among them, 2 up-regulated exo-DEMs, hsa-miR-125a-3p and hsa-miR-4647, and 5 down-regulated exo-DEMs, including hsa-miR-29c-5p, hsa-miR-145a-5p, hsa-miR-192-5p, hsa-miR-194-5p, and hsa-miR-338-3p, were associated with the survival of GBC patients. Results of the gene set enrichment analysis showed that the cell cycle-related pathways were activated in GBC tumor tissues, mainly including cell cycle, M phase, and cell cycle checkpoints. Furthermore, the dysregulated ceRNA network was constructed based on the lncRNA-miRNA-mRNA interactions using miRDB, TargetScan, miRTarBase, miRcode, and starBase v2.0., consisting of 27 lncRNAs, 6 prognostic exo-DEMs, and 176 mRNAs. Together with prognostic exo-DEMs, the STEAP3-AS1/hsa-miR-192-5p/MAD2L1 axis was identified, suggesting lncRNA STEAP3-AS1, might as a sponge of exosome-derived hsa-miR-192-5p, modulates cell cycle progression via affecting MAD2L1 expression in GBC tumorigenesis. In addition, the biological functions of genes in the ceRNA network were also annotated by Gene Ontology and Kyoto Encyclopedia of Genes and Genomes. Our study promotes exploration of the molecular mechanisms associated with tumorigenesis and provide potential targets for GBC diagnosis and treatment.
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Affiliation(s)
- Li Su
- Department of Integrated Traditional and Western Medicine in Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People's Republic of China.
- Center of Integrated Traditional and Western Medicine in Oncology, Anhui Medical University, Hefei, 230022, People's Republic of China.
| | - Jicheng Zhang
- Anhui University of Traditional Chinese Medicine, Hefei, 230012, People's Republic of China
| | - Xinglong Zhang
- Anhui University of Traditional Chinese Medicine, Hefei, 230012, People's Republic of China
| | - Lei Zheng
- Department of Integrated Traditional and Western Medicine in Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People's Republic of China
- Center of Integrated Traditional and Western Medicine in Oncology, Anhui Medical University, Hefei, 230022, People's Republic of China
| | - Zhifa Zhu
- Department of Integrated Traditional and Western Medicine in Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, 230022, People's Republic of China
- Center of Integrated Traditional and Western Medicine in Oncology, Anhui Medical University, Hefei, 230022, People's Republic of China
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Wen LJ, Chen JH, Xu HJ, Yu Q, Deng Y, Liu K. The clinical profiles, management, and prognostic factors of biliary mixed neuroendocrine nonneuroendocrine neoplasms: A systematic review of the literature. Medicine (Baltimore) 2020; 99:e23271. [PMID: 33327249 PMCID: PMC7738038 DOI: 10.1097/md.0000000000023271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Mixed neuroendocrine nonneuroendocrine neoplasms (MiNENs) originating from the biliary system (gallbladder, biliary tract, or ampulla of Vater) are extremely rare and have not been discussed in detail or systematically. We aimed to present the demographics, clinicopathological characteristics, management, and prognostic factors of biliary MiNENs. METHODS A systematic search of electronic biomedical databases (Web of Science, PUBMED, and Embase) was performed to identify eligible studies. Survival was analyzed with the Kaplan-Meier method. Log-rank tests were used to evaluate the differences between groups, and the effects of various clinical and histopathological features on prognosis were analyzed by univariate and multivariate Cox regression. RESULTS Fifty-three publications (patients, n = 67) were included. The median overall survival time was 21.0 months. Fifty-one patients (76.1%) underwent radical surgery and median survival for 41 months (P < .001). Twenty-two patients who received adjuvant radiochemotherapy treatment after radical surgery had a median survival for 43 months (P = .076). Radical resection (P < .001), Ki-67 index (P = .011), tumor stage (P < .001), neuroendocrine (NEC) grade (P = .011), and non-NEC grade (P = .017) were independent statistically significant prognostic factors according to univariate analysis; radical resection (P = .010) and small morphological subtype (P = .036) were independent statistically significant prognostic factors associated with higher overall survival according to multivariate analysis, and radical resection (P = .005) and age < 65 years (P = .026) were associated with higher recurrence free survival time. CONCLUSION Radical resection is essential for long-term survival. Aggressive multimodality therapy with adjuvant radiochemotherapy and biotherapy may improve survival of biliary MiNENs. Further randomized controlled trials are needed to determine the standard treatment.
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Affiliation(s)
- Li-Jia Wen
- Department of Hepatopancreatobiliary Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province
| | - Jun-Hong Chen
- College of Clinical Medicine, Jilin University, Changchun
| | - Hong-Ji Xu
- Department of Hepatopancreatobiliary Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province
| | - Qiong Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun 130021, Jilin Province, China
| | - Yu Deng
- Department of Hepatopancreatobiliary Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province
| | - Kai Liu
- Department of Hepatopancreatobiliary Surgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province
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Gupta P, Marodia Y, Bansal A, Kalra N, Kumar-M P, Sharma V, Dutta U, Sandhu MS. Imaging-based algorithmic approach to gallbladder wall thickening. World J Gastroenterol 2020; 26:6163-6181. [PMID: 33177791 PMCID: PMC7596646 DOI: 10.3748/wjg.v26.i40.6163] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/12/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023] Open
Abstract
Gallbladder (GB) wall thickening is a frequent finding caused by a spectrum of conditions. It is observed in many extracholecystic as well as intrinsic GB conditions. GB wall thickening can either be diffuse or focal. Diffuse wall thickening is a secondary occurrence in both extrinsic and intrinsic pathologies of GB, whereas, focal wall thickening is mostly associated with intrinsic GB pathologies. In the absence of specific clinical features, accurate etiological diagnosis can be challenging. The survival rate in GB carcinoma (GBC) can be improved if it is diagnosed at an early stage, especially when the tumor is confined to the wall. The pattern of wall thickening in GBC is often confused with benign diseases, especially chronic cholecystitis, xanthogranulomatous cholecystitis, and adenomyomatosis. Early recognition and differentiation of these conditions can improve the prognosis. In this minireview, the authors describe the patterns of abnormalities on various imaging modalities (conventional as well as advanced) for the diagnosis of GB wall thickening. This paper also illustrates an algorithmic approach for the etiological diagnosis of GB wall thickening and suggests a formatted reporting for GB wall abnormalities.
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Affiliation(s)
- Pankaj Gupta
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Yashi Marodia
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Akash Bansal
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Naveen Kalra
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Vishal Sharma
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Usha Dutta
- Department of Gastroenterology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
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Selhi PK, Singh Y, Jain S, Kaur H, Sood N. Diagnostic role of fine needle aspiration cytology (FNAC) in the evaluation of gall bladder lesions: an institutional experience. Diagn Cytopathol 2020; 48:1081-1085. [PMID: 32506819 DOI: 10.1002/dc.24517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Carcinoma of the gall bladder is the most common malignancy of the biliary tract. Ultrasonography guided Fine Needle Aspiration Cytology (FNAC) plays a crucial role in early detection of gall bladder (GB) lesions. Early diagnosis of GB lesions is a necessity in view of rising trend in GB carcinoma related mortality in India. The aim of this study is to determine the diagnostic accuracy of pre-operative ultrasonography guided FNAC in the diagnosis of GB masses. METHODS This was a retrospective observational study performed at a tertiary care university hospital over a period of one and a half years. A total of 47 patients with clinico-radiological suspicion of GB malignancy were subjected to USG guided FNA. 20 of these patients underwent diagnostic Trucut biopsy in addition to FNA. RESULTS Forty-one out of 47 patients analyzed were positive for malignancy with female preponderance; MF ratio of 0.6:1. There were 29 females (61.8%) and 18 males (38.2%) in the range of 34 to 85 years. Cytomorphology was inconclusive for malignancy in two patients and unsatisfactory in one case. Two were labeled as chronic cholecystitis and one as acute cholecystitis. Adenocarcinoma was the most common malignancy found in 36 patients (76.6%). CONCLUSION USG guided FNAC is a rapid, safe and successful diagnostic procedure with high sensitivity for diagnosis of GB lesions. In the present scenario of increasing incidence of GB malignancy, FNAC has proved to be a useful first choice of investigation in the detection of GB lesions.
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Affiliation(s)
- Pavneet Kaur Selhi
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Yasmeen Singh
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sonia Jain
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Harpreet Kaur
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Neena Sood
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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Seok J, Hyun SJ, Jeong WJ, Ahn SH, Kim H, Jung YH. The Difference in the Clinical Features Between Carcinoma ex Pleomorphic Adenoma and Pleomorphic Adenoma. EAR, NOSE & THROAT JOURNAL 2019; 98:504-509. [PMID: 31189352 DOI: 10.1177/0145561319855376] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Carcinoma ex pleomorphic adenoma (CXPA) arises from the primary or recurrent benign pleomorphic adenoma. The purpose of this study was to evaluate the clinical features that could be referenced in the differentiation. The medical records of 221 patients with pleomorphic adenoma and 15 patients with CXPA were retrospectively reviewed. Clinical characteristics, computed tomography and magnetic resonance imaging findings, and surgical pathology were analyzed. Patients with CXPA were older (55.1 vs 42.3; P < .01). Carcinoma ex pleomorphic adenoma was observed at higher rates in the minor salivary glands (24.9% vs 2.7%) and higher incidence of regional lymph node enlargement (P = .04). While all CXPA showed a low-to-intermediate mean apparent diffusion coefficient value (ADC), most of pleomorphic adenoma had an intermediate-to-high (P = .01). From this study, the following features should be considered as the clinical features of CXPA: (1) old age; (2) minor salivary gland tumor; (3) regional lymph node enlargement (>5 mm); and (4) low ADC findings.
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Affiliation(s)
- Jungirl Seok
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Se Jin Hyun
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea.,Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Woo-Jin Jeong
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Soon-Hyun Ahn
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyojin Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Young Ho Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
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12
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Ayabe RI, Wach M, Ruff S, Martin S, Diggs L, Wiemken T, Hinyard L, Davis JL, Luu C, Hernandez JM. Primary Gallbladder Neuroendocrine Tumors: Insights into a Rare Histology Using a Large National Database. Ann Surg Oncol 2019; 26:3577-3585. [PMID: 31102094 DOI: 10.1245/s10434-019-07440-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Primary gallbladder neuroendocrine tumors (NETs) are rare, poorly understood cancers infrequently encountered at even the largest of tertiary referral centers. We therefore sought to identify a large cohort of patients with gallbladder NETs using a national database, with the aim of defining treatment modalities employed and survival associated with these uncommon malignancies. METHODS Patients with primary gallbladder NETs were identified in the National Cancer Database, and clinicopathologic characteristics were recorded. A univariate log-rank survival analysis was completed for patients who underwent resection. Parameters found to be significant were entered into a multivariate accelerated failure time analysis. For context, survival comparisons were included for patients who underwent resections for NETs at any gastrointestinal site and for gallbladder adenocarcinoma. RESULTS Overall, 754 patients with gallbladder NETs were identified. Patients were predominantly female (n = 518, 69%), White (n = 503, 67%), presented with stage IV disease (n = 295, 39%) and had high-grade lesions (n = 312, 41%). The majority underwent resection (n = 480, 64%), primarily simple cholecystectomy (n = 431, 90%), whereas a minority received multimodal therapy (n = 145, 21%). Among patients who underwent resection, older age (p = 0.001), large cell histology (p = 0.012), and positive margins (p = 0.030) were independently associated with worse overall survival. Patients with gallbladder NETs had improved survival relative to those with gallbladder adenocarcinoma (p = 0.001), but significantly worse survival than patients with NETs from other gastrointestinal sites (p < 0.001). CONCLUSIONS Primary gallbladder NETs are aggressive lesions that carry a worse prognosis than NETs of other gastrointestinal sites. Older age, positive margins, and large cell histology are associated with abbreviated survival after resection.
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Affiliation(s)
- Reed I Ayabe
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Michael Wach
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Samantha Ruff
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sean Martin
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Laurence Diggs
- Division of General Surgery, Department of Surgery, Saint Louis University Hospital, St. Louis, MO, USA
| | - Timothy Wiemken
- Saint Louis University Center for Health Outcomes Research (SLUCOR), St. Louis, MO, USA
| | - Leslie Hinyard
- Saint Louis University Center for Health Outcomes Research (SLUCOR), St. Louis, MO, USA
| | - Jeremy L Davis
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Carrie Luu
- Division of General Surgery, Department of Surgery, Saint Louis University Hospital, St. Louis, MO, USA
| | - Jonathan M Hernandez
- Surgical Oncology Program, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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13
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Chandra S, Chandra H, Shukla SK, Sahu S. Fine-needle aspiration cytology of gallbladder with an attempt of cytomorphological classification. Cytojournal 2019; 16:1. [PMID: 30820231 PMCID: PMC6367906 DOI: 10.4103/cytojournal.cytojournal_5_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/09/2018] [Indexed: 01/30/2023] Open
Abstract
Background: Image-guided fine-needle aspiration has emerged as an effective diagnostic tool for precise diagnosis of deep-seated lesions. Although occasional studies have made an attempt to classify the gallbladder carcinoma on cytology, literature lacks the standardized cytological nomenclature system used for it. The present study was conducted to study the role of fine-needle aspiration cytology (FNAC) in diagnosis of gallbladder lesions with an attempt of cytomorphological classification. Methods: The study included cases of image-guided FNAC of the gallbladder over a period of 3½ years. An attempt was made to categorize gallbladder lesions on basis of architectural and cytomorphological features along with analysis of management. Results: The study included 433 cases and lesions were categorized on FNAC into five categories ranging from Category 1 (inadequate), Category 2 (negative for malignancy), Category 3 (atypical cells), Category 4 (highly atypical cells suggestive of malignancy), and Category 5 (positive for malignancy). The most common architectural pattern observed on FNAC of neoplasm was sheets and acini with predominance of columnar cells and adenocarcinoma being the most common malignancy. The histopathological diagnosis was available in 93 cases with cytohistopathological concordance of 94.4% in malignant cases. Conclusions: Image-guided FNAC plays an important role in diagnosis of gallbladder lesions with minimal complications. The cytomorphological classification of gallbladder lesions provides an effective base for accurate diagnosis and management. Category 3 and 4 are the most ambiguous category on FNAC which should be managed by either repeat FNAC or surgery in the light of worrisome radiological features. The vigilant examination of architectural pattern and cytomorphological features of the smears may be helpful in clinching the diagnosis and precisely subtyping malignant tumors along with prognostication of these tumors.
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Affiliation(s)
- Smita Chandra
- Address: Department of Pathology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Harish Chandra
- Department of Pathology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Sushil Kumar Shukla
- Address: Department of Pathology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
| | - Shantanu Sahu
- Department of Surgery, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India
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14
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Al-Abbadi MA. Is it time to standardize fine needle aspiration of gall bladder lesions and what city name it will be stamped with? Cytojournal 2019; 16:2. [PMID: 30820232 PMCID: PMC6367907 DOI: 10.4103/cytojournal.cytojournal_21_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 06/22/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mousa A. Al-Abbadi
- Address: Department of Pathology, Microbiology, and Forensic Medicine, School of Medicine, The University of Jordan, Amman, Jordan
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15
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Cross-sectional Imaging of Gallbladder Carcinoma: An Update. J Clin Exp Hepatol 2019; 9:334-344. [PMID: 31360026 PMCID: PMC6637089 DOI: 10.1016/j.jceh.2018.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Accepted: 04/20/2018] [Indexed: 02/06/2023] Open
Abstract
Gallbladder Carcinoma (GBCA) is the most common biliary tract malignancy. As the disease is often diagnosed clinically in an advanced stage, the survival rates are dismal. Imaging studies allow for an early diagnosis of malignancy, though the findings may be indistinguishable from non-malignant disease processes affecting the gallbladder. Attempts have been made to make a specific diagnosis of GBCA at an early stage on imaging studies. Ultrasonography (US) is the most commonly employed technique for gallbladder evaluation. Gallbladder wall thickening is the most common finding of early GBCA and in this context, US is non-specific. Recently, contrast enhanced ultrasound has been shown to be effective in differentiating benign from malignant disease. Multidetector computed tomography represents the most robust imaging technique in evaluation of GBCA. It provides relatively sensitive evaluation of mural thickening, though it is not entirely specific and issues in differentiating GBCA from xanthogranulomatous cholecystitis do arise. Due to its superior soft tissue resolution, Magnetic Resonance Imaging (MRI) provides excellent delineation of gallbladder and biliary tree involvement. When coupled with functional MRI techniques, such as diffusion-weighted and perfusion imaging, it provides a useful problem solving tool for interrogating the malignant potential of nonspecific gallbladder lesions and detection of metastases. Positron emission tomography has a role in detection of distant metastases and following patients following treatment for malignancy. We review the current role of various imaging modalities in evaluating patients with GBCA.
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Vallonthaiel AG, Yadav R, Jain D, Mathur SR, Iyer VK. Mucinous adenocarcinoma of gallbladder: Subcategorisation on fine-needle aspiration cytology. Diagn Cytopathol 2018; 47:110-113. [PMID: 30375181 DOI: 10.1002/dc.24102] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 09/05/2018] [Accepted: 10/05/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Mucinous adenocarcinoma (MC) of gallbladder is a rare histological subtype of gallbladder carcinoma (CaGB) which presents at an advanced stage and is associated with a poor prognosis compared to the conventional CaGB. This variant has been described mostly as reports or series, except for a single detailed histological and immunohistochemical analysis. Till date, there are no studies describing the cytomorphology of MC in detail. Hence, we undertook this study to analyse the cytomorphological features of MC. METHODS A retrospective cytomorphological analysis was performed on MC identified out of all CaGB diagnosed on cytology over a period of last 4 years. The architectural and cellular features were recorded in a structured proforma. RESULTS Thirty-three cases (33/987, 3.3%) were identified as MC. Extracellular mucin >90% was seen only in 3 cases whereas the remaining 30 had 50%-90% mucin. The predominant architectural pattern was tight epithelial fragments (14/33). The tumour cells were mostly of intermediate size (31/33) and had moderate amount of cytoplasm (31/33). Majority of the cases showed moderate nuclear pleomorphism (28/33) and nuclear chromatin was fine granular (17/33) or vesicular (14/33). Most of the cases had single and small nucleoli (26/33). Presence of inflammation composed predominantly of polymorphs was noted in 25 cases. Majority of the cases showed no (15/33) or scant necrosis (13/33). CONCLUSION The morphological features of MC can very well be demonstrated on cytology. As they are associated with poor prognosis compared to conventional CaGB, cytopathologists should try to document the subtype.
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Affiliation(s)
| | - Rajni Yadav
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Sandeep R Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - V K Iyer
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Zou XP, Wang JY, Jiang YY, Chen G, Mo WJ, Feng ZB. Clinicopathological features and survival of gallbladder squamous cell carcinoma: analysis of 121 cases. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2018; 11:3208-3221. [PMID: 31949696 PMCID: PMC6962876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 05/09/2018] [Indexed: 06/10/2023]
Abstract
PURPOSE The aim of the present study is to promote deeper pathological and clinical understanding of gallbladder squamous cell carcinoma (GBSCC) and provide new evidence for its diagnosis and treatment. METHODS Two cases of GBSCC from the First Affiliated Hospital of Guangxi Medical University were collected. A comprehensive analysis was conducted based upon these 2 cases and another 119 GBSCC cases from the literature. Survival analysis was performed using the Kaplan-Meier method. RESULTS Among all the patients, GBSCC was frequently diagnosed in older women with a mean age of 62.8 years old. Abdominal pain was the most common symptom. The majority of GBSCC cases were combined with cholelithiasis. Keratinization was frequently observed microscopically. Among 90 cases with histology data, most showed high or, high-moderate differentiation (60%, 54/90). More cases were diagnosed in advanced TNM stages (85.4%, 82/96). In 73 cases, the follow-up time was 0.5-125 months, with a mean survival time 47.3 months and a median survival time of 12 months. Survival analysis indicated that patients with polypoid lesions (P = 0.047) and receiving R0 radical operation (P < 0.001) had better prognoses. CONCLUSION Given the scarcity and implicit clinical manifestations of GBSCC, early diagnosis is challenging. The key to better survival is a radical operation with no remaining lesion.
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Affiliation(s)
- Xiao-Ping Zou
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University Nanning, Guangxi Zhuang Autonomous Region, China
| | - Jie-Yu Wang
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University Nanning, Guangxi Zhuang Autonomous Region, China
| | - Yao-Ying Jiang
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University Nanning, Guangxi Zhuang Autonomous Region, China
| | - Gang Chen
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University Nanning, Guangxi Zhuang Autonomous Region, China
| | - Wei-Jia Mo
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University Nanning, Guangxi Zhuang Autonomous Region, China
| | - Zhen-Bo Feng
- Department of Pathology, The First Affiliated Hospital of Guangxi Medical University Nanning, Guangxi Zhuang Autonomous Region, China
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18
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Fukuda T, Sakimoto Y, Narita K, Ariizumi M, Aizawa Y, Fukuda K. Mucinous carcinoma of the gallbladder with signet ring cells. Radiol Case Rep 2017; 12:701-705. [PMID: 29484053 PMCID: PMC5823477 DOI: 10.1016/j.radcr.2017.06.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 06/12/2017] [Accepted: 06/26/2017] [Indexed: 12/21/2022] Open
Abstract
Most gallbladder carcinomas are adenocarcinomas, of which mucinous carcinoma (MC) is a rare pathologic subtype. Signet ring cells are seldom found in MCs. We report an extremely rare case of gallbladder MC with signet ring cells. This is the first radiological case report about this rare type of histologic entity with detailed discussion of imaging findings in the English literature. In addition to the features of MC, linitis plastica-like invasion, which is the key feature of signet ring cells, was confirmed by both imaging and histopathologic analysis. Furthermore, radiologists should know how the imaging findings of MC differ from those of other major subtypes of adenocarcinoma, as there is a risk of delays in diagnosis and underestimation of tumor spread.
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Affiliation(s)
- Takeshi Fukuda
- Department of Radiology, The Jikei University Katsushika Medical Center, 6-41-2 Aoto, Katsushika-ku, Tokyo 125-8506, Japan
| | - Yoshihiro Sakimoto
- Department of Radiology, The Jikei University Katsushika Medical Center, 6-41-2 Aoto, Katsushika-ku, Tokyo 125-8506, Japan
| | - Kenichi Narita
- Department of Radiology, The Jikei University Katsushika Medical Center, 6-41-2 Aoto, Katsushika-ku, Tokyo 125-8506, Japan
| | - Mitsuko Ariizumi
- Department of Radiology, The Jikei University Katsushika Medical Center, 6-41-2 Aoto, Katsushika-ku, Tokyo 125-8506, Japan
| | - Yoshio Aizawa
- Department of Gastroenterology and Hepatology, The Jikei University Katsushika Medical Center, 6-41-2 Aoto, Katsushika-ku, Tokyo 125-8506, Japan
| | - Kunihiko Fukuda
- Department of Radiology, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-Ku, Tokyo 105-8471, Japan
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Mixed adenoneuroendocrine carcinoma derived from the cystic duct: A case report. Int J Surg Case Rep 2017; 39:29-33. [PMID: 28793278 PMCID: PMC5548340 DOI: 10.1016/j.ijscr.2017.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 07/10/2017] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Mixed adenoneuroendocrine carcinomas (MANECs) derived from cystic duct are extremely rare. PRESENTATION OF CASE An 80-year-old woman was admitted to the department of surgery, Onomichi general hospital with abnormal liver function and jaundice. Enhanced abdominal computed tomography (CT) detected a well-enhanced papillary tumor in the cystic duct, which protruded into the common bile duct. The intrahepatic bile duct was dilated due to tumor obstruction. The entire tumor showed high intensity in T2-weighted magnetic resonance imaging (MRI) imaging. Endoscopic retrograde cholangiopancreatography (ERCP) showed that the tumor ranged from part of communication of three ducts (cystic, common hepatic and common bile duct), to the middle of common bile duct. Biliary cytology determined a class V malignancy (adenocarcinoma). Endoscopic ultrasound determined that the tumor was primarily at the cystic duct with heterogeneous echoic pattern, which extended into the common bile duct. The preoperative diagnosis was cystic duct carcinoma (T3N0M0, StageIIIA). An extended cholecystectomy with regional lymph nodes dissection was performed. Histologically, the tumor had components of both well-differentiated tubular adenocarcinoma and neuroendocrine carcinoma, which is classified as MANECs according to the 2010 WHO classification of endocrine tumors. Eight months after surgery, multiple liver metastases were discovered, and treatment with adjuvant chemotherapy was initiated. DISSCUSION We present a rare case of MANECs derived from cystic duct. Until now, an established adjuvant systemic chemotherapy has not emerged, and curative resection, with poor long-term prognosis, remains the only treatment option. CONCLUSION Though standards of treatment for MANECs have not been established,multidisciplinary theraphy is necessary to improve outcome.
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Kumar R, Srinivasan R, Gupta N, Dey P, Rajwanshi A, Nijhawan R, Lal A, Kalra N. Spectrum of gallbladder malignancies on fine-needle aspiration cytology: 5 years retrospective single institutional study with emphasis on uncommon variants. Diagn Cytopathol 2016; 45:36-42. [PMID: 27873474 DOI: 10.1002/dc.23636] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 10/19/2016] [Accepted: 10/31/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Ultrasound-guided fine-needle aspiration cytology (FNAC) is the standard modality for diagnosis of gallbladder malignant neoplasms. Adenocarcinoma is the most common malignancy; however, other types may also be encountered. The aim of this study was to perform a retrospective analysis of gallbladder malignancies diagnosed on FNAC in the last 5 years to document the cytomorphological spectrum and the variations thereof. METHODS The records of the Department of Cytology, PGIMER were searched from July 2010 to June 2015 and all cases of gallbladder malignancies were analyzed in detail for cytomorphological characteristics. Giemsa and Hematoxylin-Eosin stained slides were evaluated with immunocytochemistry on cell blocks wherever available. RESULTS A total of 791 gallbladder FNAC performed in cases of radiologically suspected gallbladder malignancies were evaluated. Gallbladder carcinoma (GBC) was more common in females with a male to female ratio of 1:2.3. Median age was 53.4 years (range 24-85 years); 81 cases (10.2%) were nondiagnostic and 31 (3.9%) were suspicious of malignancy. A total of 645 FNACs were positive for malignancy, out of which there were 619 (96%) adenocarcinoma and 26 cases with unusual malignancies. These included adenosquamous carcinoma (8, 1.2%), squamous cell carcinoma (7, 1.1%), small cell neuroendocrine carcinoma (9, 1.3%), and one case each of undifferentiated carcinoma and Non Hodgkin lymphoma respectively. The unusual malignancies were confirmed on cell block immunocytochemistry. CONCLUSION Adenocarcinoma is most common type of gallbladder malignancy; however, other unusual types of carcinomas occur and in such cases, FNAC supplemented by cell block immunocytochemistry is required for an accurate diagnosis. Diagn. Cytopathol. 2017;45:36-42. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Rajesh Kumar
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Radhika Srinivasan
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Nalini Gupta
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Pranab Dey
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Arvind Rajwanshi
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Raje Nijhawan
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Anupam Lal
- Department of Radiodiagnosisa and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Naveen Kalra
- Department of Radiodiagnosisa and Imaging, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Gallbladder Cancer in the 21st Century. JOURNAL OF ONCOLOGY 2015; 2015:967472. [PMID: 26421012 PMCID: PMC4569807 DOI: 10.1155/2015/967472] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 08/07/2015] [Accepted: 08/12/2015] [Indexed: 02/07/2023]
Abstract
Gallbladder cancer (GBC) is an uncommon disease in the majority of the world despite being the most common and aggressive malignancy of the biliary tree. Early diagnosis is essential for improved prognosis; however, indolent and nonspecific clinical presentations with a paucity of pathognomonic/predictive radiological features often preclude accurate identification of GBC at an early stage. As such, GBC remains a highly lethal disease, with only 10% of all patients presenting at a stage amenable to surgical resection. Among this select population, continued improvements in survival during the 21st century are attributable to aggressive radical surgery with improved surgical techniques. This paper reviews the current available literature of the 21st century on PubMed and Medline to provide a detailed summary of the epidemiology and risk factors, pathogenesis, clinical presentation, radiology, pathology, management, and prognosis of GBC.
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Naz S, Hashmi AA, Khurshid A, Faridi N, Edhi MM, Kamal A, Khan M. Diagnostic role of fine needle aspiration cytology (FNAC) in the evaluation of salivary gland swelling: an institutional experience. BMC Res Notes 2015; 8:101. [PMID: 25879702 PMCID: PMC4381422 DOI: 10.1186/s13104-015-1048-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 03/11/2015] [Indexed: 12/24/2022] Open
Abstract
Background Fine needle aspiration cytology (FNAC) is a cytodiagnostic method based on morphologic findings of individual and small group of cells aspirated using a fine needle. The aim of the present study is to evaluate the spectrum of salivary gland lesions in our setting and to assess the diagnostic accuracy of FNAC for salivary gland lesions. Methods The study involved 187 cases of parotid and submandibular swellings of patients who underwent FNAC at our institution. Thirty one (31) patients with a FNAC diagnosis of neoplastic lesion subsequently underwent excision biopsies. The results of FNAC and final histology were compared and accuracy of FNAC was determined. Results Mean age of patients was 42 (±21) years and male to female ratio was 1:1. Chronic sialadenitis was the most common non-neoplastic lesion (33.8%) followed by acute and chronic sialadenitis (29.7%) and chronic granulomatous inflammation (27.0%). Pleomorphic adenoma was the most common benign neoplasm and non-Hodgkin’s lymphoma was the most common malignant lesion (38.9%) followed by acinic cell (27.8%) and adenoid cystic carcinoma (16.7%). Total 31 patients subsequently underwent surgical excision, out of which 21 were benign and 9 were malignant, 20 cases (64.5%) were of pleomorphic adenoma, 3 cases (9.6%) of acinic cell carcinoma, 2 cases (6.4%) each of warthin tumor, adenoid cystic carcinoma and non-hodgkin lymphoma and 1 case (3.2%) each of mucoepidermoid carcinoma and mucinous adenocarcinoma. The overall accuracy of FNAC in our study was found to be 83.8% with 77.7% sensitivity and 86.3%, specificity. The revised sensitivity and specificity after adjusting verification bias were 68.5% and 91% respectively. False negative diagnosis was rendered in mucoepidermoid carcinoma and acinic cell carcinoma whereas false positive diagnosis was given in cases of pleomorphic adenoma. Conclusion We found a good concordance between FNAC and histology, however pleomorphic adenoma may impart a diagnostic challenge when inadequately aspirated and therefore we advice either immunohistochemical studies (if cell block material is available) or repeat aspiration in difficult cases.
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Affiliation(s)
- Samreen Naz
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan.
| | - Atif Ali Hashmi
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan.
| | - Amna Khurshid
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan.
| | - Naveen Faridi
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan.
| | | | - Anwar Kamal
- Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan.
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Yadav R, Jain D, Mathur SR, Iyer VK. Cytomorphology of neuroendocrine tumours of the gallbladder. Cytopathology 2015; 27:97-102. [PMID: 25689921 DOI: 10.1111/cyt.12239] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Gallbladder neuroendocrine tumours (GB-NETs) are rare and account for 0.5% of all NETs. GB-NETs have an aggressive behaviour, which depends on the tumour grade. The cytomorphological spectrum of these tumours has never been described in detail. The present study evaluates the cytological features of GB-NETs and grades them according to the World Health Organization (WHO) classification. Furthermore, the expression of thyroid transcription factor-1 (TTF-1) has not been investigated previously in GB-NETs, although found in a subset of extrapulmonary NETs. METHODS Twenty cases of GB-NET among 875 gallbladder carcinomas diagnosed by ultrasound-guided fine needle aspiration cytology (FNAC) over a period of nearly 4 years were studied. The following parameters were evaluated: architectural pattern, nuclear chromatin, nucleoli, mitoses, necrosis, moulding, apoptosis and smudge cells. Cases were categorized into well-differentiated (grades 1 and 2), small cell carcinoma (SCC) (grade 3) and mixed adenoneuroendocrine carcinoma. Nuclear positivity for TTF-1 was considered as positive. RESULTS Morphologically, tumour cells were mainly arranged in rosettes in the well-differentiated category; sudden anisonucleosis and rare nuclear moulding with or without mitotic figures were other features. Eleven cases of SCC showed prominent nuclear moulding with frequent smudge cells, mitoses, apoptosis and necrosis. Three mixed adenoneuroendocrine carcinomas showed papillary fragments and an acinar arrangement of tumour cells. Four of the nine SCCs in which TTF-1 was evaluated on de-stained smears showed nuclear positivity. Histopathology was available in two SCCs and showed morphology similar to FNAC. CONCLUSION Cytology plays an important role in the diagnosis of GB-NETs for appropriate subtype characterization, which is necessary for the prognostication of these tumours. TTF-1 may not be used for the differentiation of gallbladder SCCs from pulmonary SCCs.
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Affiliation(s)
- R Yadav
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - D Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - S R Mathur
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - V K Iyer
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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Shidham VB, DeMay RM. Thank you CytoJournal reviewers for your 2012 and 2013 services! Cytojournal 2014. [PMCID: PMC4007383 DOI: 10.4103/1742-6413.129186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Vinod B. Shidham
- Address: Department of Pathology, Wayne State University School of Medicine, Karmanos Cancer Center and Detroit Medical Center, Detroit, MI 48201, USA
| | - Richard M. DeMay
- Department of Pathology, University of Chicago, Chicago, IL, USA
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