Diagnosis Of Gallbladder Carcinoma Research Articles

The utility of systemic immune inflammatory index in discriminating between gallbladder cancer and xanthogranulomatous cholecystitis: A single-tertiary center experience.

Xanthogranulomatous cholecystitis (XGC) and gallbladder carcinoma (GBC) are rare diseases with several similarities. This study aimed to evaluate the utility of the systemic immune inflammatory index (SII), a novel index that more accurately depicts inflammatory and immunological balance, in distinguishing between XGC and GBC. This retrospective study included 33 XGC, 22 GBC patients diagnosed according to histopathological findings and 33 age-sex-matched healthy controls at Hacettepe University Faculty of Medicine, General Surgery Department. The demographic, clinical and laboratory findings were recorded. Neutrophil to lymphocyte ratio, platelet to lymphocyte ratio, monocyte to lymphocyte ratio and SII were calculated from preoperative complete blood count parameters. The receiver operating characteristic curve was performed to evaluate the utility of SII in differentiating GBC and XGC. A P value < .05 was accepted as statistically significant. The preoperative neutrophil to lymphocyte ratio, monocyte to lymphocyte ratio, platelet to lymphocyte ratio and SII were significantly higher in patients with GBC compared to XGC patients and healthy controls (P < .001, P = .001, P = .001, P < .001, respectively). When receiver operating characteristic analysis was made, the optimal cutoff value of SII was 640 for differential diagnosis of XGC and GBC preoperatively with a sensitivity of 77.3% and a specificity of 66.7%, among which the positive likelihood ratio was 2.32, and Youden index was 0.44 (P = .006). The positive predictive value was 60.7%, the negative predictive value was 81.5%, and the diagnostic accuracy was 79.9%. SII may be a valuable, practical, and affordable method to differentiate between XGC and GBC, in addition to clinical and radiological signs, prior to surgery. When supported by prospective trials with a larger study population, distinguishing GBC from XGC using SII preoperatively may lead to a change in the management practice of GBC.

SP7.6 Do we need Routine Histopathological Examination of Gall Bladder Specimens after Cholecystectomy?

Abstract Aims Gall bladder diseases usually manifest as gall stones, inflammation of gall bladder and gall bladder cancer. There had been a constant debate over the years regarding selective vs. routine histopathological assessment of all gall bladder specimens. This study was aimed to assess the safety of adopting the policy of selective histopathological examination of those gall bladder specimens with pre-operative and/or intra-operative suspicion of malignancy without risking patient safety. Methodology A descriptive, cross-sectional study was conducted. All 1285 cases of gall bladder biopsies done after elective cholecystectomies, during a period of 2 years from 1st January, 2018 to 31st December 2019, were reviewed retrospectively. Results During the study period, a total of 1285 gall bladder specimens were submitted for histopathological analysis. Chronic cholecystitis was found in 1020 (79.3%) patients, acute cholecystitis in 198 (15.4%), gangrenous gall bladder in 19 (1.47%) patients and gall bladder carcinoma (GBC) in 26 (2.02%) patients. Pre-operative or intraoperative diagnosis of GBC was made in 22/26 patients. The remaining 4 patients had either stage Tis or T1 stage carcinoma and did not require revision surgery. Conclusion In areas with low incidence of gall bladder carcinoma, a selective approach of histopathological examination of gall bladder specimens may be considered safe. Such selective approach is more economical and reduces the work burden of pathologists without risking patient safety.

Induction chemotherapy and hepatic artery embolization followed by extended resection for locally advanced gallbladder cancer: a case report

BackgroundSurgical resection plays a critical role in the curative therapy of patients with gallbladder cancer. However, extended resection for locally advanced gallbladder cancer is a controversial procedure because of the high operative morbidity, mortality, and poor prognosis after surgery, without consensus of its suitability. Several reports have described preoperative treatment modalities to reduce the risk of mortality and morbidity and improve the curability of surgery for locally advanced GBCA. However, only a few well-designed studies have verified the benefits of these preoperative strategies.Case presentationA 62-year-old male patient presented to our department with a gallbladder tumor detected on abdominal ultrasound during an annual medical checkup. Multi-phase enhanced CT revealed a gallbladder tumor with a maximum diameter of 34 mm, invading the right hepatic artery, pancreatic head, hepatic flexure of the colon, and first portion of the duodenum. We diagnosed gallbladder carcinoma as cT4 cN0 cM0 cStage IVA in the Union for International Cancer Control (UICC) classification 8th edition. After administration of 12 cycles of gemcitabine and cisplatin plus S-1 regimen, tumor shrinkage was observed on computed tomography, and elevated serum CA19-9 levels were reduced to normal limits. After preoperative hepatic artery embolization, we performed gallbladder bed resection with pancreaticoduodenectomy (minor hepatopancreatoduodenectomy) and combined resection of the right hepatic artery and hepatic flexure of the colon. Histological examination revealed no evidence of lymph node metastasis (ypT4 ypN0 ycM0 yp Stage IVA in the 8th edition of the UICC). The proximal bile duct and dissected margins were negative.ConclusionsThe combination of induction chemotherapy and preoperative hepatic artery embolization, followed by minor hepatopancreatoduodenectomy and combined resection of the involved arteries and partial colon, could be a feasible treatment strategy for patients with locally advanced gallbladder cancer invading neighboring organs.

Intelligent recognition of CTCs from gallbladder cancer by ultrasensitive electrochemical cytosensor and diagnosis of chemotherapeutic resistance

Gallbladder carcinoma (GBC) is one of most aggressive and lethal malignancies. Early diagnosis of GBC is crucial for determining appropriate treatment and improving chances of cure. Chemotherapy represents the main therapeutic regimen for unresectable GBC patients to inhibit tumor growth & metastasis. But, chemoresistance is the major cause of GBC recurrence. Thus, there is an urgent need to explore potentially non-invasive and point-of-care approaches to screen GBC and monitor their chemoresistance. Herein, we established an electrochemical cytosensor to specifically detect circulating tumor cells (CTCs) and their chemoresistance. Trilayer of CdSe/ZnS quantum dots (QDs) were cladded upon SiO2 nanoparticles (NPs), forming Tri-QDs/PEI@SiO2 electrochemical probes. Upon conjugation of anti-ENPP1, the electrochemical probes were able to specifically label captured CTCs from GBC. The detection of CTCs and chemoresistance were realized by square wave anodic stripping voltammetric (SWASV) responses to anodic stripping current of Cd 2+ ion when cadmium in electrochemical probes was dissolved and eventually electrodeposited on bismuth film-modified glassy carbon electrode (BFE). Taking use of this cytosensor, one ensured the screening of GBC and limit of detection for CTCs approaches to ～10 cells/mL. Furthermore, by monitoring phenotypic changes of CTCs after drug treatment, the diagnosis of chemoresistance was achieved by our cytosensor.

Diagnostic Accuracy of Contrast-Enhanced Computed Tomography (CECT) and Ultrasonography (USG) in Diagnosing Carcinoma Gallbladder keeping Histopathology the Gold Standard

Objective: To evaluate the comparative role of ultrasonography and contrast-enhanced computed tomographyin diagnosis of carcinoma gallbladder. Early experience at a hepatobiliary unit in a tertiary care hospitalStudy Design: Cross sectional study.Place and Duration of Study: The study was carried out at the Hepatobiliary Unit of the Pak Emirates MilitaryHospital, Rawalpindi from July 2021 to June 2022.Materials and Methods: USG and CECT scans were used to assess the diagnostic accuracy of CarcinomaGallbladder. 30 patients, with an average age of 54 years, were part of this study. Patients were included in thestudy based on radiological findings pertinent to gallbladder cancer which include gallbladder fossa massreplacing gallbladder, focal/intraluminal/polypoidal gallbladder growth and asymmetrical/diffuse thickness ofgallbladder. All resected specimens were sent for histological investigation after the operation, histopathologyserving as the Gold standard.Results: On USG and CECT examination, 13.3% of the gallbladders were contracted and reduced in size, while70% were large and distended. CECT has a sensitivity and specificity of 96% and 80%, respectively, in identifyingGB carcinoma. USG scan had a sensitivity and specificity of 92% and 60%. There was a test of agreement isexcellent (Kappa value 0.819) between the two techniques, indicating that the two diagnostic modalities arenearly equivalent in terms of diagnosing carcinoma Gallbladder.Conclusion: The study findings indicate that both USG and CECT scans are ideal, non-invasive, safe imagingmodalities for diagnosing gallbladder carcinoma. CECT scan has an additional advantage in defining theextension of the disease and involvement of surrounding structures including lymph nodes and hepatoduodenal ligament.

Study the gallbladder carcinoma with finding under MR imaging

Aim: To study the Gallbladder carcinoma with finding under MR imaging. Methods: This prospective study was undertaken at Department of Radiodiagnosis Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow association with departments of Gastromedicine and Surgical Gastroenterology. This study was approved by the institution ethics committee, SGPGI. Study included 30 patients in our study who diagnosed as gall bladder carcinoma. The consent process included an initial examination for MRI compatibility and discussion of major safety criteria. Patients in the age range of 20-75 years with a diagnosis of gall bladder carcinoma and presenting with obstructive jaundice or abdominal mass, who were referred for MRI, were selected for the study. Results: Total 30 patients were included in our study. Pathological confirmation was done in all patients, 28 patients under gone cytopathology from GB mass and in two patients from surgical specimens. Among our 30 patients, the peak incidence age group was between 41 to 60 years. The age of patients ranged from 30 to 70 with a mean age of 51 years for female and 49 years for males with a gender distribution of 11 males (36%) and 19 females (63%).

Study the gallbladder carcinoma with finding under MR imaging

Aim: To study the Gallbladder carcinoma with finding under MR imaging. Methods: This prospective study was undertaken at Department of Radiodiagnosis Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow association with departments of Gastromedicine and Surgical Gastroenterology. This study was approved by the institution ethics committee, SGPGI. Study included 30 patients in our study who diagnosed as gall bladder carcinoma. The consent process included an initial examination for MRI compatibility and discussion of major safety criteria. Patients in the age range of 20-75 years with a diagnosis of gall bladder carcinoma and presenting with obstructive jaundice or abdominal mass, who were referred for MRI, were selected for the study. Results: Total 30 patients were included in our study. Pathological confirmation was done in all patients, 28 patients under gone cytopathology from GB mass and in two patients from surgical specimens. Among our 30 patients, the peak incidence age group was between 41 to 60 years. The age of patients ranged from 30 to 70 with a mean age of 51 years for female and 49 years for males with a gender distribution of 11 males (36%) and 19 females (63%).

Noninvasive preoperative differential diagnosis of gallbladder carcinoma and xanthogranulomatous cholecystitis: A retrospective cohort study of 240 patients

BackgroundXanthogranulomatous cholecystitis (XGC) is an extremely rare entity. Due to XGC’s clinical and radiological resemblance to gallbladder carcinoma (GBC), intraoperative frozen section during cholecystectomy is often performed to exclude the diagnosis of GBC. Our study is aiming to find a noninvasive indicator of XGC. To our knowledge, this is the largest XGC cohort ever studied.MethodsThis study retrospectively collected clinical characteristics, serological tests, and imaging features of 150 GBC patients and 90 XGC patients. The diagnosis of these 150 GBC patients and 90 XGC patients was based on intraoperative frozen section histopathology. T‐test was utilized to compare differences between XGC and GBC. Receiver operating characteristic (ROC) curve was conducted and the area under the curve (AUC) was managed to evaluate the validity.ResultsThe carcinoembryonic antigen (CEA) level in blood tests was significantly elevated in GBC patients than in XGC patients (p = 0.007). The presence of submucosal hypo‐attenuated nodules (80% in XGC, 16% in GBC, p < 0.001), low density border (60% in XGC, 21% in GBC, p = 0.001), and nodular thickening in the bottom of the gallbladder with calcification (70% in XGC, 37% in GBC, p = 0.004) is significantly associated with XGC patients, whereas massive hilar infiltration (0% in XGC, 21% in GBC, p < 0.001), multiple lymph nodes in the hilar area (10% in XGC, 72% in GBC, p = 0.001), and gallbladder mucosal line continuity (50% in XGC, 95% in GBC, p = 0.002) are highly associated with GBC patients. The ROC curve was performed and the gallbladder mucosal line continuity (AUC = 0.708) and the AUC of low density border around the occupation (AUC = 0.654) showed a good prediction of XGC.ConclusionsGallbladder mucosal line continuity and low density border around the occupation presented good indication value for the diagnosis of XGC. Our study proposed a noninvasive differential diagnosis method for XGC and GBC.

Clinicopathological Features of Gallbladder Carcinoma Managed in a Tertiary Level Hospital of Nepal

Introduction: Gallbladder carcinoma is a relatively rare disease in some parts of the world but is common in countries like Chile, Japan, India, and Nepal. Nepal stands as one of the five countries with the highest mortality. However, there are only a few studies published on this matter from Nepal. This study aims to study the demographic and clinicopathological features of gallbladder carcinoma managed in a tertiary level teaching hospital in Nepal. Methods: A retrospective analysis of all the patients with the diagnosis of gall bladder carcinoma in Tribhuvan University Teaching Hospital from 2018 to 2020 was done. Patient demographics, clinical characteristics, and laboratory parameters including tumor markers were analyzed. Results: Of the 59 patients, there were 33 (56%) females. The median age at diagnosis was 56 years. Among all, the most common presenting symptom was abdominal pain. Curative resection was done in 18 (30%) of the cases. Metastasis was present in 30% of the cases of which the liver was the most frequently involved organ. The mean carcinoembryonic antigen (CEA) level in unresectable cases was 18.65±22.53 nanograms per milliliter (ng/mL) which was higher than in resectable cases being 6.78±12.75 ng/mL. Similarly, the mean carbohydrate antigen 19-9 (CA 19-9) level in unresectable cases was 604.55±671.28 units/milliliter (U/ml), which was higher than the value in the resectable cases 89.44±273.67 U/ml. Conclusion: In this study, gall bladder carcinoma was more common in females below 60 years with vague abdominal pain as the most frequent presenting symptom. One-third of the evaluated cases were resectable. Unresectable cases were associated with high CEA and CA 19-9 levels.

Xanthogranulomatous cholecystitis: Diagnosis and management

Xanthogranulomatous cholecystitis(XGC) is a rare form of cholecystitis, characterized by the presence of xanthogranuloma, prominent yellow structures within the gallbladder wall that is very often lithiasic. When XGC presents in its pseudo-tumoral form with occasional adjacent organ involvement, it can mimic gallbladder carcinoma (GBC). The etiopathogenesis of XGC is inflammatory destruction of Rokitansky-Aschoff sinuses containing biliary and cholesterol pigments within the gallbladder wall; this leads to a florid granulomatous histiocytic inflammatory reaction. The prevalence ranges from 1.3% to 8.8% of all cholecystectomies and varies from country to country; XGC occurs predominantly in patients over 50 years of age, and is equally distributed between males and females. Its association with GBC remains a topic of debate in the literature (between 0 and 20%). Symptoms are non-specific and generally similar to those of acute or chronic cholecystitis. XGC, when associated with altered health status, leads to the suspicion of GBC. XGC can also come to light due to an acute complication of cholecystolithiasis, in particular, gallstone migration. Imaging by sonography and CT scan is suggestive, but magnetic resonance imaging is more specific. In difficult cases, biopsy may be necessary to eliminate the diagnosis of tumor. In case of pre- or intra-operative diagnostic doubt, the opinion of a hepatobiliary specialty center can be of help. When diagnosis of GBC has been eliminated, laparoscopic cholecystectomy is recommended, although with a high risk of conversion to laparotomy and complications.

English

BACKGROUND Gallbladder cancer is recognised as an irreversible malignancy with a high fatality rate. The highest incidence of gall bladder carcinoma is seen in India and Chile, and relatively low level in many Western countries. Gall bladder carcinoma has an extremely poor prognosis, increasing incidence, and diagnosed at an advanced stage despite recent advances in diagnostic modalities. Considering the high rate of mortality attributable mainly to late detection of disease at an advanced stage, early diagnosis remains to be one of the most important determinants of the outcome. This study was conducted to assess the role of tumour markers, namely carbohydrate antigen (CA 19-9), carcinoembryonic antigen (CEA) and alpha fetoprotein (AFP) in the diagnosis of gall bladder carcinoma. We wanted to assess the diagnostic role of tumour markers in carcinoma gall bladder. METHODS Patients with radiologically and histopathologically confirmed diagnosis of carcinoma gall bladder were invited to participate in the study. A thorough history was taken, and relevant examination done as per protocol. All necessary laboratory and radiologic investigations were done according to study design. Assessment of the tumour markers CA19-9, CEA and AFP was done, and values compared with carcinoma gall bladder patients. RESULTS The diagnostic value of tumour markers has been studied in context with histopathological grade as all the cases were histopathologically proven cases of carcinoma gall bladder (Ca GB). CONCLUSIONS The present study showed that CA 19-9 was most effective with regard to its ability to differentiate between different grades of gall bladder carcinoma. KEY WORDS CA 19-9, CEA, AFP, Carcinoma Gallbladder

Novel cholangioscopy-guided targeted biopsy for diagnosing gallbladder carcinoma.

Watch a video of this article.

Circular RNA circ-MTO1 serves as a novel potential diagnostic and prognostic biomarker for gallbladder cancer.

Primary gallbladder carcinoma (GBC) is one of the most common biliary malignancies in the gastrointestinal tract. In this work, we examined the roles of circular-mitochondrial translation optimization 1 (circ-MTO1) in GBC tissues and patient plasma. Circ-MTO1 expression in GBC tissues and patient plasma was evaluated by quantitative Real Time-PCR (qRT-PCR). The relationships between circ-MTO1 expression and the pathological characteristics of GBC were analyzed. Kaplan-Meier survival curve was applied to calculate overall survival (OS) and progression-free survival (PFS) in GBC patients with different circ-MTO1 expression. The univariate COX regression curve analysis method was employed to analyze the potential relationships between high circ-MTO1 expression and OS and PFS. At last, we assessed the diagnostic value of the circ-MTO1 level in GBC patient plasma. Circ-MTO1 expression was significantly upregulated in tumor tissues and plasma in GBC patients. In addition, circ-MTO1 expression was associated with clinical-pathological characteristics in GBC. High circ-MTO1 expression served as an independent prognostic factor for poor OS and PFS in GBC patients. Moreover, upregulated plasma circ-MTO1 level was significantly associated with tumor development. Circ-MTO1 is a potential early diagnostic and prognostic biomarker for patients with gallbladder cancer. Thus, our present work might provide a new understanding of the diagnosis and treatment of GBC.

Surgical Management of Gallbladder Carcinoma

Gallbladder carcinoma is the commonest malignancy of the hepatobiliary system. It is plagued by the dismal outcome in terms of 5-year survival and high recurrence rate. The varying presentation from an incidental surprise during routine laparoscopic cholecystectomy for gallstone disease to presentation in advance stage. Surgical resection remains the only curative alternative; however, it is only possible in few patients at the time of diagnosis. Although, radical cholecystectomy is said to be the standard of surgical care, yet the extent of liver resection, lymphadenectomy, bile duct resection, adjacent organ resection, and palliative surgical treatment needs to be elaborately discussed. The resection of tumor with R0 margin with appropriate lymphadenectomy is the only hope for long-term survival. Revision surgery should be considered in patients who underwent simple cholecystectomy with incidentally diagnosed gallbladder carcinoma that invaded muscularis propria or beyond. The advance lesions are treated non-operatively with palliative intension. This review discusses the current surgical treatment options in patients with gallbladder cancer depending on the stage of disease.

Usefulness of Ultrasound in Differentiating Xanthogranulomatous Cholecystitis from Gallbladder Carcinoma

Our study was aimed at finding the ultrasound (US) features of xanthogranulomatous cholecystitis (XGC) and evaluating the usefulness of US in differentiating XGC from gallbladder carcinoma (GBC). Through use of an electronic medical record system and the picture archiving and communication system, 31 cases of XGC and 52 cases of GBC with both sonograms and pathologic results were identified. Sonographic features of the abnormal gallbladder were evaluated. The smooth and intact interface between gallbladder lumen and mucosa was observed in most XGC cases (23/31, 74.2%) but in no GBC cases. XGC featured hyper-echoic foci, small hypo-echoic nodules and a layered appearance in the lesion, which were more frequently seen in the XGC group than in the GBC group. In conclusion, US may prove useful in the differential diagnosis of XGC and GBC, but more studies are required.

Bilateral breasts metastases from gall bladder adenocarcinoma: a rare presentation

Bilateral breasts metastasis from gallbladder adenocarcinoma is very rare and has never been reported. Overall incidence of breast metastasis from other primaries as reported in literature is 0.5-3%. A 38 year female presented with progressive abdominal distension followed by lumps in the left and right breasts consecutively. Abdominal examination revealed a huge right upper quadrant lump, hard in consistency and moving with respiration. CT abdomen suggested gallbladder lump infiltrating liver, colon, duodenum and pylorus. HRUSG of breasts revealed malignant lumps. Histopathology and immuno-histochemistry of breast biopsy confirmed it to be metastatic and not the primary (mammaglobin-, GATA 3 -, CK 19+, GCDFP-). Gallbladder biopsy showed adenocarcinoma with similar marker pattern. A diagnosis of gallbladder carcinoma with secondaries in bilateral breasts was made. Patient received one cycle of platinum based palliative chemotherapy and thereafter was lost to follow up. A proper clinical, radiological and histopathological examination is essential to distinguish primary and metastatic breast lesion due to the difference in the management of both. Overall prognosis is very poor and treatment should be directed towards palliative therapy of primary malignancy.

Earlier mean age of diagnosis of Gallbladder Carcinoma observed in Eastern India: A cross-sectional study reveals in a Tertiary Care Hospital of West Bengal

Earlier mean age of diagnosis of Gallbladder Carcinoma observed in Eastern India: A cross-sectional study reveals in a Tertiary Care Hospital of West Bengal

Role of Ultrasound in the Diagnosis and Management of Gall Bladder Diseases

Background &amp; objective: The majority of published data on the sensitivity and specificity of ultrasound (US) in the diagnosis of gallbladder pathology was conducted over 30 years ago. Since then the quality and resolution of ultrasonography has improved significantly. It is, therefore, essential to asses afresh whether the progression in technology has translated into improved diagnostic accuracy. The present study was undertaken to find the usefulness of US in diagnosing gallbladder diseases with particular reference to cholecystitis and gall bladder carcinoma.&#x0D; Methods: This cross-sectional observational study was conducted at the Department of Radiology and Imaging, Rajshahi Medical College, Rajshahi in collaboration with the Departments of General Surgery and Histopathology of the same Medical College between July 2016 to June 2018. A total of 128 patients were initially included on the basis of signs and symptoms of gallbladder diseases. All these patients were subjected to abdominal US to achieve a ultrasonic diagnosis of gall bladder disease followed by histopathological examination of biopsy material taken from the gall bladder or specimen of the operated gall bladder. The accuracy of ultrasound in the diagnosis of gall bladder diseases was determined by comparing the ultrasound sound diagnosis with that of histopathological diagnosis. In particular, the role of ultrasound was evaluated in the differentiation of benign gall bladder diseases from those of malignant ones.&#x0D; Result: Age distribution of the patients shows that over one-third (35.9%) was ≥50 years old followed by 24.9% 40-50 years, 21.9% 30 - 40 years and 16.4% 20 – 30 years old with mean age of the patients being 43.8(range: 18-80) years. Females outnumbered males by roughly 11:9. In terms of BMI, 6.2% were underweight, 16.4% overweight, and 4.7% obese. The predominant complaints reported by the patients were pain in the right upper abdomen (95.3%), epigastric pain (94.7%), abdominal discomfort (96.9%) followed by nausea (75%), low-grade fever (37.5%), jaundice (26.6%) and vomiting (26.6%). Approximately 44% of the patients exhibited anaemia. Nearly half (46.1%) of the patients exhibited sonographic Murphy’s sign. Hyperechoic echo character was invariably obtained with 12.5% cases having hypoechoeic character as well. Over 90% of the patients had gall-stones, 62.5% cholecystitis (thickened gall-bladder wall). Ultrasound comment on the type of diseases revealed that 112(87.5%) were benign diseases and 16(12.5%) malignant cases. Approximately 55% of the gall bladder diseases diagnosed by histopathology were cholecystitis. Histopathological comment shows that about 90% of the diseases were benign and the rest (10.2%) were malignant. The sensitivity of ultrasound in diagnosing cholecystitis was 85.9%, while the specificity of the test was 60.9% with overall diagnostic accuracy of the test being 73.4%. The US had a optimum sensitivity (84.6%) and high specificity (95.6%) in diagnosing gall-bladder carcinoma.&#x0D; Conclusion: The study concluded that US could be considered as the preferred initial imaging technique for patients who are clinically suspected of having acute calculous cholecystitis. It is also a useful imaging modality for diagnosing gall-bladder malignancy. Thus, US can be dependably used in the primary evaluation of heptobilliary pathology.&#x0D; Ibrahim Card Med J 2017; 7 (1&amp;2): 70-75

Prospective observational study on cholelithiasis in patients with carcinoma gall bladder in a tertiary referral hospital of Eastern India.

Gallbladder carcinoma (GBCA) is the fifth most common types of gastrointestinal malignancy and is the most common malignancy of the biliary tract. Cholelithiasis, gallbladder polyps, porcelain gall, and choledochal cysts are common known associations with GBCA. Because of the better understanding of the etiopathogenesis, the traditional nihilistic attitude toward the prognosis has, over the years, given way to greater interest and hope for treating the disease. Long-term survival has been reported in patients with resectable lesions in the hands of expert hepatobiliary surgeons. This prospective observational study was conducted at a tertiary referral hospital of Eastern India on patients with the diagnosis of GBCA. The main objective was to assess the incidence of gallstones in patients with GBCA, and the relationship, if any, between the size and number of stones and GBCA in our patient cohort. This prospective observational study was conducted, over a period of 2 years, at a tertiary referral hospital of Eastern India which caters to patients from all the neighboring districts. A total of 54 patients with the diagnosis of GBCA were included in the study. Data on their demographic and clinical profile, the incidence of associated gallstones, their size (<3 or ≥3cm), and number (solitary or multiple) were collected. Known predisposing factors of GBCA, if any, in those presenting without stones were noted. GBCA was found to afflict females 2.4 times as frequently as males. Patients, irrespective of their sex, were mostly in their sixth decade. Approximately three-fourth of the cases had associated cholelithiasis. The number of stones had no correlation with the disease. However, contrary to available published data, stones <3 cm were significantly more common in our study cohort. The results of this study reaffirm that cholelithiasis is a strong predisposing factor for GBCA and females with gallstones in their sixth decade, are more at risk. Although number of stones was not found to be an independent risk factor, patients with stones <3 cm (mostly multiple) were found to be more at risk in our study.

The Multiple Molecular Signatures in Gallbladder Carcinoma: from Basic Studies to Clinical Application

Gallbladder carcinoma (GBC) is a malignant tumor in gastrointestinal system. In this review, we mainly focus on three molecular levels to illuminate the potential molecular mechanisms in gallbladder carcinoma. First, we review genes with mutation and methylation associated with occurrence and development of GBC. Second, we review non-coding RNA and key differential genes at the transcript level, especially for their interactions. Third, we review crucial proteins in GBC. Moreover, we also discuss the challenges of these molecular signatures in clinical applications. Finally, we discuss potential application of these crucial genes in prevention, diagnosis and treatment of GBC.