Abstract
Aim: To evaluate the incidence of incidental gallbladder carcinoma in specimens of cholecystectomy performed for benign gallbladder diseases and to establish the utility of routine histopathological examination of all gallbladder specimens obtained following cholecystectomy done for benign diseases.Material and Methods: This was a hospital-based three years prospective and retrospective study done at a tertiary care centre in North India. Gallbladder specimens from laparoscopic and open cholecystectomies done for benign gallbladder diseases without any clinico-radiological evidence of malignancy were included in the study. Routine histopathological evaluation of 1,268 such gallbladder specimens was carried out to get the incidence of incidental gallbladder carcinoma and pathological staging of carcinoma was done according to American Joint Committee recommendations for cancer staging (AJCC). All the diagnosed cases of Incidental gallbladder carcinoma (IGBC) were analysed in terms of demographics, radiology findings, and gross and microscopic pathology findings.Results: Out of 1,268 gallbladder specimens of clinically benign diseases, 16 cases (1.26%) were diagnosed as cases of IGBC with female predominance with a male to female ratio of 1:7. Mean gallbladder thickness in these cases was 0.77±0.20 cm, and 98.30% cases of IGBC were associated with gall stone disease. However, no correlation was observed between the age, gallbladder thickness and pathological stages of these IGBC.Conclusion: IGBC is an occult disastrous malignancy of the gallbladder, which can be missed in the pre and intraoperative periods despite careful clinical and radiological evaluation and comes as a surprise for pathologists the first time. We recommend that all specimens of gallbladder obtained from its surgical resection for benign diseases should be subjected to histopathological examination.
Highlights
Gallbladder carcinoma is the most common cancer of the biliary tract and the fifth most common cancer of gastro-intestinal tract worldwide and is known for its calamitous course and poor prognosis [1]
Incidental gallbladder carcinoma (IGBC) is defined as cancer discovered at the time of histopathological examination of the specimen after cholecystectomy done for benign gallbladder disease without clinicoradiological and intraoperative suspicion of malignancy [1,5]
We performed a microscopic examination of all these cases and observed that among the all benign specimens 16 cases (1.26%) were having evidence of IGBC, which was the first time diagnosed by histopathological examination without clinico-radiological suspicion of malignancy (Table 1)
Summary
Gallbladder carcinoma is the most common cancer of the biliary tract and the fifth most common cancer of gastro-intestinal tract worldwide and is known for its calamitous course and poor prognosis [1]. Incidental gallbladder carcinoma (IGBC) is defined as cancer discovered at the time of histopathological examination of the specimen after cholecystectomy done for benign gallbladder disease without clinicoradiological and intraoperative suspicion of malignancy [1,5]. Studies have shown that the incidence of IGBC ranges from 0.2% to 3.3% in all cholecystectomies specimen of benign disease [6]. Keeping in view the incidence of IGBC, every cholecystectomy specimen should be sent for histopathological examination to increase the detection rate of occult early-stage IGBC in benign gallbladder diseases [7]. IGBC has a good prognosis, prolonged survival and potentially curable disease with an adaptation of adequate surgical strategy as compared to non-incidental or primary gallbladder carcinoma [3,5,7]. The use of routine or selective histopathological examination of gallbladder specimens is still debatable
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