2. Introduction
· Gallbladder carcinoma was first described by Maximilian Stoll in
1777
· G.B is the 5 th most common
GIT malignancy(worldwide)
· Most frequent malignant tumor of the biliary tract
· Post operatively , 90 % Adenocarcinomas.
· Squamous cell carcinoma 5%
3. Anatomy
· Gall bladder -Saccular structure located at the inferior
surface of the
liver, at the division of the right and left lobes, just
below segments IV and V
Dimensions -Approx. 7- 10 cm long and about 2.5- 3.5 cm
wide
· Parts: fundus, body, infundibulum, and
neck
· Approx. 7- 10 cm long and about 2.5- 3.5 cm wide
4. Epidemiology
· Incidence of GC 1 to 23 per 100,000 worldwide
· The highest incidence of gallbladder carcinoma is reported more
recently from the Indian -Subcontinent, including India and Pakistan
(18-23/100,000)
· Most common cause of gastrointestinal cancer-related mortality in
females in subcontinent
· Female to male ratio is 3:1
· Peak incidence is in 7th decade of life.
6. Etiology / risk factor
• Gall stone:- Gb stones are found in (65 -70%) of patient with gb cancer risk
of cancer increases in proportion to gall size ( 10 fold risk if stone size 3cm)
& longer duration of cholelithiasis
• Gallbladder polyp :- Adenomatous polyps have potential to become
malignant
single polyp > 1cm
• Typhoid carrier
• Osterogen drugs
• Anomalous pancreatico-biliary duct
• Choledochal cyst
• Primary sclerosing cholangitis
• Ulcerative colitis
• Carcinogens – nitrosamines,rubber
• Porcelain gall bladder
7.
8. Gross differentiated
histological Infiltrating pattern
more common
Poorly defined area of diffuse thickening
Mainly spreads to subserosal plane
Nodular pattern
More circumscribed mass
Less diffuse
9.
10. Presentation
· Usually asymptomatic at the time of diagnosis
Usuaslly presents as cholecystitis or biliary colic.
· Jaundice and anorexia are late features
· Palpable mass is a late sign
· Given this presentation, less than 50% of
Gallbladder cancers are diagnosed preoperatively.
Early stages are often found incidentally on pathologic
sections common sites are
• 60% - fundus
• 30% body
• 10% neck
11.
12.
13.
14. Along the peritoneal cavity
Along needle biopsy sites
Laparoscopic port sites
Direct extension to the liver and other adjacent organs
Gall bladder has a thin wall, narrow lamina propia, and single
muscle
Layer
Once penetrates the thin muscle layer, it has access to
major lymphatic
and vascular channels
• 94.4% lymphatic mets
• 64.% hematogenous dissemination
• Hematogenous form small veins extensding directly from
gall
bladder to portal venous system of GB fossa leading to
segment IV and V of liver or via larger veins to portal venous
branch of segment V and VIII
Pattern of spread
15. Relevant Anatomy
Lymphatic Drainage
· Cystic Node
· pericholedochal nodes
· regional nodal basins (superior mesenteric,
retropancreatic, retroportal, and celiac)
· aortocaval nodes*( directly or indirectly)
*exposure of this region is a necessary step in the operative staging of gallbladder
cancer
16. Ultrasonography is a very useful tool in the workup of
gallbladder cancer.
Imaging studies
• Ultrasonographic findings that indicate possible
malignancy
• A thick gallbladder wall,vascular polyp
• A mass projecting into the lumen or invading the wall,
• Multiple masses or a fixed mass in the gallbladder.
• A porcelain gallbladder and an extracholecystic mass.
• Invasionof the liver can also be seen on ultrasonograms.
CT Scan and MRCP are useful in evaluating the extent of
invasion and resectability of gall bladder tumours.
18. Partially calcified gallbladder (arrow). At
laparotomy and histology,
an infiltrating adenocarcinoma of the
gallbladder was confirmed.
CT scan showing squamous cell
carcinoma of gall bladder showing Liver
metastasis
19.
20.
21. • management
• • Stage O and
Stage I ( Tis, T1a
– Ca invades
• lamina propia but
don’t extend to
muscularis)
• • frequently
detected on
pathological
• examination
• • Imaging based
staging
• • Watch
cholecystectomy
specimen to
ensure
• negative margin
