Carcinoma of the gallbladder and extrahepatic bile duct in autopsy cases of the aged, with special reference to its relationship to gallstones.

To demonstrate correlation between occurrence of carcinoma and that of gallstone of the gallbladder and biliary tract, we reviewed the protocols of gallbladder and extrahepatic biliary duct carcinoma and cholelithiasis of 4,482 cases (male 2,237, female 2,245, mean age 77.7 yr) autopsied at the Department of Pathology, Tokyo Metropolitan Geriatric Hospital, during the 27 yr from 1960 to 1986. Gallbladder carcinoma was found in 94 cases, or 2.1%. The incidence was higher in the female than in the male (male 24, female 70, p less than 0.01). Gallstone of the gallbladder was found in 957 cases or 21.4%. In the male, incidences of gallbladder carcinoma and stone increased with age until the lower half of the ninety, whereas in the female, no such tendency was found after the sixties. Incidence of gallbladder carcinoma was significantly higher in the cases with cholecystolithiasis than in those without stone (p less than 0.01). Furthermore, the incidence of gallbladder stones in the cases with relatively early carcinoma was significantly higher than that of those without carcinoma (p less than 0.01). Cholesterol stones were more common than bilirubinate in the carcinoma patients. These results suggest the importance of cholecystolithiasis, especially that of the cholesterol stones, as a background factor of gallbladder carcinoma. Extrahepatic bile duct carcinomas were present in 33 cases or 0.7% (male 19, female 14, no sex preference). The incidence was significantly higher in the cases with stones than in those without stones of the extrahepatic bile ducts (p less than 0.01). However, the fact that small stones were found in the upstream portions of obstruction of biliary tracts and no stone was found at operations in the 11 operated cases suggested that stones may be secondary to the cancerous growth.