Clinicopathological Evaluation of Gall-Bladder Lesions in Cholecystectomy Specimens with Special Emphasis to Incidentally Detected Cases of Gall-Bladder Carcinoma Along with Immunohistochemical Study of Cytokeratin 7 and Cytokeratin 20

Abstract

Introduction: Cholecystectomy specimens show wide clinicopathological spectrum varying from common non neoplastic diseases to rare neoplastic lesions and histopathological examination the gold standard for final diagnosis. Gall Bladder Cancers (GBCs) are rare and account for 0.5% to 1.09% of all gall bladder lesions. It is either clinically suspected or incidentally diagnosed following cholecystectomy. Methods: It was a Hospital based cross-sectional Study. All cases diagnosed clinically & radiologically and operated as cholecystitis were included in the study. Histopathological diagnosis of gallbladder lesions, age & sex distribution in different gallbladder pathology, association with gall stones, Pathological pT staging of malignant cases and CK7 & CK20 immunohistochemical findings in malignant cases were observed in this study. Results: A total 340 cases of gallbladder specimens were examined histopathologically and 12 cases of gallbladder carcinoma were diagnosed. The most common histopathological diagnosis was chronic cholecystitis (79.4%) followed by chronic cholecystitis with cholesterolosis (7.6%) and adenocarcinoma (3.5%). The most common age group for gallbladder lesions was 4th decade (26.2%). Age varies from 09 – 85 years with a mean age of 39.4 years. Overall females (83%) are more commonly affected than males (17%) with male: female ratio is 1:4.96. Gallstones were present in 89.1% among total cases, 83.3% in malignant cases. Incidentally detected gallbladder carcinoma was 1.17% and most common histopathological type was adenocarcinoma NOS with Pathological pT staging was pT1 & pT2 only i.e. early stage. CK7 positivity was found in 91.6% cases and CK20 was positive in 16.7% cases. Both CK7 & CK20 was positive in 16.7% and both CK7 & CK20 was negative in one case (8.33%). Conclusions: Although the most common gall bladder histopathology diagnosis is chronic cholecystitis, the possibility of any incidental malignancy needs to be ruled out by mandatory routine histopathological examination of all cholecystectomy specimens.