Bhalla Shalini, Shabbir Nida, Yadav Kusum, Kumar Manish, Gupta Nidhi, Chaudhary Sneha, Sharma Akanksha, Agarwal Preeti
Pathology, King George's Medical University, Lucknow, IND.
Pathology, Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, IND.
Cureus. 2024 Dec 22;16(12):e76217. doi: 10.7759/cureus.76217. eCollection 2024 Dec.
Background Incidental gallbladder carcinoma (IGBC) remains a significant clinical challenge, with its diagnosis often delayed due to the asymptomatic nature of the disease and its incidental discovery post-cholecystectomy. This study's aim is to calculate incidence in a high-risk, region-specific (North Indian) population and also to provide novel insights into clinical presentation as well as macroscopic and histopathological features of IGBC. Material and methods This retrospective observational study spanned four years (August 2013 to July 2016) and included a total of 3096 cases. Demographic, clinical, radiological, treatment and follow-up data were sourced from archived records. IGBC diagnoses were confirmed on formalin-fixed, paraffin-embedded tissue sections stained with hematoxylin and eosin (H&E). Results A total of 3,067 routine cholecystectomies were performed during this period, of which a total of 162 cases (18.93%) were diagnosed as gallbladder carcinoma (GBC) and 51 cases (1.74%) were identified as IGBC. The mean age was 49.8 years. Among the total IGBC cases, most patients underwent preoperative imaging of which eight cases (15.6%) showed findings on preoperative radiological evaluation suggestive of malignancy. Among these, five cases (9.8%) demonstrated subtle gallbladder wall thickening and three cases (5.8%) revealed suspicious small polypoidal lesions (less than 1 cm). Microscopy showed that majority of these tumours were well-differentiated adenocarcinomas (n=27; 52.94%), followed by moderately differentiated adenocarcinomas (n=17; 33.33%), mucinous adenocarcinomas (n=03; 5.88%), papillary adenocarcinomas (n=02; 3.92%), and neuroendocrine tumours (n=1; 1.96%). Staging revealed 26 (50.98%) cases as Stage IIA, 24 (47.0%) as Stage I, and one (1.9%) as Stage III. On follow-up, the median survival period was found to be 32 months. Conclusions Our study emphasizes the limitations of conventional imaging in detecting early-stage gallbladder cancer, and it advocated the critical importance of routine histopathological examination (HPE) of all gallbladder specimens. Additionally, our findings contribute to a growing body of evidence that suggests early-stage IGBC may offer improved survival outcomes if diagnosed timely and treated aggressively, prompting a re-evaluation of current diagnostic and management strategies.
背景 意外胆囊癌（IGBC）仍然是一项重大的临床挑战，因其疾病无症状性质以及在胆囊切除术后偶然发现，其诊断常常延迟。本研究的目的是计算高危、特定地区（北印度）人群中的发病率，并对IGBC的临床表现以及大体和组织病理学特征提供新的见解。材料与方法 这项回顾性观察性研究历时四年（2013年8月至2016年7月），共纳入3096例病例。人口统计学、临床、放射学、治疗和随访数据均来自存档记录。IGBC诊断通过苏木精和伊红（H&E）染色的福尔马林固定、石蜡包埋组织切片得以证实。结果 在此期间共进行了3067例常规胆囊切除术，其中共有162例（18.93%）被诊断为胆囊癌（GBC），51例（1.74%）被确定为IGBC。平均年龄为49.8岁。在所有IGBC病例中，大多数患者接受了术前影像学检查，其中8例（15.6%）在术前放射学评估中显示有提示恶性的表现。其中有5例（9.8%）表现为胆囊壁轻度增厚，3例（5.8%）发现可疑的小息肉样病变（小于1厘米）。显微镜检查显示，这些肿瘤大多数为高分化腺癌（n = 27；52.94%），其次是中分化腺癌（n = 17；33.33%）、黏液腺癌（n = 3；5.88%）、乳头状腺癌（n = 2；3.92%）和神经内分泌肿瘤（n = 1；1.96%）。分期显示26例（50.98%）为IIA期，24例（47.0%）为I期，1例（1.9%）为III期。随访发现，中位生存期为32个月。结论 我们的研究强调了传统影像学在检测早期胆囊癌方面的局限性，并提倡对所有胆囊标本进行常规组织病理学检查（HPE）的至关重要性。此外，我们的研究结果为越来越多的证据做出了贡献，这些证据表明，如果早期IGBC能够及时诊断并积极治疗，可能会有更好的生存结果，这促使对当前的诊断和管理策略进行重新评估。
