Dwivedi M, Misra S P, Misra V
Department of Gastroenterology and Pathology, MLN Medical College, Allahabad.
J Assoc Physicians India. 2000 Feb;48(2):192-5.
To determine the clinical and ultrasound appearances of carcinoma gallbladder in Indian patients.
The study included all patients suspected to have gallbladder malignancy, attending the gastroenterology department from January 1989 to February 1997. These patients underwent ultrasonographic examination with a grey scale sector scanner (Aloka SSD-630) with a 3.5 MHz transducer after an overnight fast. Histological confirmation was done at surgery, by US guided fine needle aspiration cytology or by direct biopsy/aspiration of the palpable mass.
There were a total of 92 cases of cytologically and histologically proven carcinoma of gallbladder. A distinct female preponderance was seen with a male:female ratio of 1:3.6. The mean +/- SD age was 47.9 +/- 19.6 years (range 25-75 years). The histological confirmation was done at surgery in 10% of patients, by US guided fine needle aspiration cytology in 50 cases (54%) or by direct biopsy/aspiration of the palpable mass in 33 (36%) of cases. Pain in the right hypochondrium was the commonest presenting symptom (91%) followed by anorexia (88%) and weight loss (67%). Surgical obstructive jaundice was observed in 54% cases while 10.9% presented with biliary sepsis. A mass of mixed echogenicity protruding in the lumen of the gallbladder was seen in the majority of cases (52.8%). Less commonly infiltration of the gallbladder wall (33.7%) or a mass replacing the gallbladder (14.1%) was encountered. Gallstones were associated in 57% of patients with gallbladder malignancy. The elevated stone sign and peripancreatic nodal spread were important clues for gallbladder malignancy.
A high index of suspicion of gallbladder malignancy in elderly Indian female patients presenting with features of choletithiasis, and awareness of the ultrasound findings may lead to early diagnosis and radical resection of this highly lethal malignancy.
