Clinicopathological features of incidental gallbladder carcinoma
HAN Yang,XU An-an,FU Xue-lian,GU Jun-yi,SONG Yan-xiang,WANG Jun-chen
(Dept.of Pathology, East Hospital, Tongji University, Shanghai 200120, China;Gallbladder Disease Center, East Hospital, Tongji University, Shanghai 200120, China;Dept.of Ultrasonography, East Hospital, Tongji University, Shanghai 200120, China)
Abstract:
ObjectiveTo analyze the clinical and pathological features in incidental gallbladder cancers. detected after laparoscopic cholecystectomy. Methods In 15042 laparoscopically resected samples, preoperatively undiagnosed gallbladder cancer was detected by pathological examination in 52 cases (0.40%). The clinical and pathological features of 52 cases of incidental gallbladder carcinoma (IGC) were retrospectively analyzed. The expressions of P53, CEA and Ki67 in tissue samples were detected by immunohistochemistry EnVison method. Results Among 52 IGC cases, the male to female ratio was 2∶3 and the mean age was 65 years (34 to 85). Macroscopically, the gallbladders were enlarged with focally thicken wall or dilated with cysts with an average thickness of 0.9cm; solitary polyp was also found; gallbladder stone was detected in 31 cases. Microscopically there were 4 cases of papillary-tubular adenoma with high grade intraepithelial neoplasm and focal invasive adenocarcinoma; 3 cases of intramucosal carcinoma and 6 cases of microinvasive adenocarcinoma with biliary intraepithelial neoplasia (BiIN) adjacent the tumor; 32 cases of invasive carcinoma including invasive adenocarcinoma, mucinous carcinoma, squamous cell carcinoma and signet ring cell carcinoma. P53 was expressed in 38.7% (12/31) invasive adenocarcinoma, while it was negative expressed in R-A glands. CEA was expressed in 61.3% (19/31) invasive adenocarcinoma, while it was negative expressed in R-A glands and the adjacent mucus. Ki67 index was higher in invasive adenocarcinoma than intramucous carcinoma and intracyctic papillary neoplasm (ICPN). Among 50 patients who were followed up for 1 to 71 months, 6 patients relapsed with liver metastasis, 14 patients died during the following up. The middle survival time was 35.6 months. TNM stage and high Ki67 index were prognostic factors. Conclusion IGC is rare, it is likely occurs in old-aged female with gallbladder stones. The lesion is often limited with thickness of the wall. Invasive adenocarcinoma is the major histology type followed by ICPN with invasive carcinoma. P53, CEA and Ki67 index are helpful in differential diagnosis in neoplastic glands and the R-A glands. Most of the IGC are in early TNM stage and the patients could receive curative treatment.
