Gallbladder carcinoma: clinicopathological study of 24 cases

Abstract

INTRODUCTION: Despite preoperative procedures, gallbladder carcinoma is commonly detected intraoperatively or on anatomopathologic examination after cholecystectomy. OBJECTIVE: To study the clinical-morphological aspects and evolution of patients with primary gallbladder carcinoma. METHODS: We reviewed medical records and pathologic material of all patients diagnosed with gallbladder carcinoma at our institution from 1997 to 2008. RESULTS: Twenty-four cases with primary carcinoma were studied, predominantly among female patients, mean age of 61.1 years. The most common clinical symptom was upper right hypochondriac pain. Five patients were diagnosed in early stages and 19 were in advanced stages. Only seven patients were diagnosed with carcinoma preoperatively, all of them in advanced stages. As to macroscopic examination, three early cases were identified as type IIa, two type IIb and 13 advanced cases were flat and infiltrating. Histologically, there were 23 adenocarcinomas and one adenosquamous carcinoma. Simple cholecystectomy was performed in seven patients, extended cholecystectomy in four patients, cholecystectomy and omentectomy in one patient, and tumor biopsy in only two patients. The median survival rate for patients in early stages was 59 months, and for pT2, pT3 and pT4 stages were 22 months, nine months and three days, respectively. CONCLUSION: There was a prevalence of advanced neoplasias diagnosed through anatomopathological examinations with poor prognosis. Furthermore, earlier detection contributed to higher survival rate. Investigation of anatomopathologic features, specially the macroscopic patterns of gallbladder carcinoma, is essential to improve diagnostic accuracy and to provide a definite treatment.