Gallbladder Adenoma Research Articles

Diagnosis of gallbladder polypoid lesions using contrast enhanced ultrasound

Purpose Effectiveness of differential diagnosis of gallbladder polypoid lesions using contrast enhanced ultrasound (CEUS) examination by perflubutane (Sonazoid®:Daiichi-Sankyo, Tokyo). Material & Methods CEUS was performed on 183 patients with gallbladder polypoid lesions.It consists of 10 adenocarcinomas, 2 adenomas, 129 benign polyps and 42 adenomyomatosis (fundal type). For benigndiseases, we examined cases where the size was 6 mm or more and could be observed for more than one year. Ultrasound was performed using TUS-A500 (Aplio 500) (Canon MedicalSystems. Tokyo) and prosound alpha10 (Hitachi Aloka Medical,Ltd.Tokyo). First, the largest cross section of a lesion was visualized using B-mode and infusion of Sonazoid. The characteristics and behavior of blood flow in the lesion in the early vascular phase were examined over approximately 30 sec. Thereafter, observation was continued accordingly for about 3 min. Sonazoid infusion using contrast harmonic imaging and real-time perfusion Imaging. Results Gallbladder carcinoma showed hypervascular staining and “eruption sign” was apparent in 60%. The “eruption sign” showed an image of a vigorously boiling water that was splashing up from the entire lesion. Blood flow imaging revealed irregular size and buckling, including tortuous vessels and erratic blood flow in 70%. Gallbladder adenoma showed “eruption sign” was apparent in 50%. The irregular size, tortuous vessels and eruption signs of blood flow imaging were 83.3% as an index of neoplastic. Gallbladder benign polyp, staining was scattered within them, and “flicker sign” was observed in 93.8%. The “flicker sign” showed an image of bubbling pre-boiled hot water. Five cases (3.9%) showed a diffused and hypervascular staining pattern. The staining time was shorter than gallbladder carcinoma. Blood flow image showed normal vessels without buckling. Linear blood flow of the stalk of gallbladder polyp was also characteristic. Gallbladder adenomyomatosis (fundal type), staining was scattered and mild flicker signs were observed in 85.7%. Blood flow at the surface of the prominence and internal Rokitansky-Aschoff sinus was observed clearity. Conclusions CEUS can clarify the hemodynamics and blood flow images and are useful for the differential diagnosis of gallbladder polypoid lesions.

Pyloric Gland Adenoma of Gallbladder: A Review of Diagnosis and Management.

Neoplastic polypoid mucosal lesions of the gallbladder are increasingly being reported in cholecystectomy specimens. However, due to the absence of unified terminology and reporting criteria, the body of scientific evidence on their classification, prognosis, and management is scarce and sometimes controversial. While they have different histomorphologic features (gastric foveolar, gastric pyloric gland, biliary, and intestinal), a significant immunohistochemical overlap exists which highlights their mixed cell lineage with a dominant cell type in each, establishing the subcategory. Because of many shared attributes, intracholecystic papillary-tubular neoplasm (ICPN) has been introduced as an umbrella terminology. ICPNs of the pyloric subtype are lesions larger than 1 cm, as most of the smaller ones are clinically insignificant and represent polypoid hyperplasia rather than a true neoplasm. In this review, we will focus on the pyloric gland adenomas as the most frequent histologic subtype of ICPNs.

Imaging diagnosis of gallbladder adenoma

Recent studies have shown that the gallbladder adenomas belong to precancerous lesions, with possible malignant transformation, and imaging examination is the first choice for the diagnosis. The study was involved in the diagnosis of gallbladder adenoma commonalities by ultrasound, CT and MRI in characterization of do retrospective analysis in order to improve the accuracy. 32 cases of hospitalized patients with the diagnosis of gallbladder adenoma were collected. The 32 patients were retrospectively analyzed by ultrasound, CT and MRI images to find its generality characteristic imaging. B ultrasonic echo showed that the diameter of the malignant papillary adenoma increased in 18 cases of cystic papillary adenoma; CT showed that adenoma internal density was uniform and CT values continue to rise; MRI in common displayed for contour shadow equally. The benign lesions were wide and the malignant lesions were narrow. Portal phase lesions around was continuous reinforced obviously and the central displayed slightly lower density area. In the 14 cases of gallbladder tubular papillary adenoma, ultrasound showed that medium echoes, and commonness CT in enhanced arterial phase, portal phase and delay lesions was progressively light-moderate strengthened. MRI was performed for single nodule “cauliflower” shaped surface and signal shadow, and high signal stove, borders, “cauliflower” shaped surface was tested on the malignant nodules. Imaging diagnostic methods can improve the detection rate of gallbladder adenoma and reduce missed diagnosis.

A rare lesion of the gallbladder: pyloric gland adenoma

Gallbladder adenomas are rare, but well-documented benign epithelial tumors. They are usually found incidentally in cholecystectomy specimens or during preoperative imaging studies. Although they are usually asymptomatic, they may present as a result of associated symptomatic gallstones, or from cystic duct obstruction due to large adenoma. Three subtypes of adenoma are defined: tubular, papillary and tubulopapillary and they are further classified histopathologically as pyloric gland, intestinal and biliary types. Most adenomas found in the gallbladder are pyloric gland type. A 52-year-old woman suffering from aspecific upper abdominal pain was admitted in the surgery department of our hospital. Physical examination did not reveal any abnormalities nor did routine blood testing. Abdominal ultrasonography showed a polypoid lesion in the gallbladder measuring 1.5cm long. Laparoscopy was performed showing normal anatomy of the gallbladder and surroundings. The gallbladder as well as the Mascagni lymph node were removed. Macroscopic examination of the gallbladder revealed a polypoid lesion in the gallbladder body measuring 1.5cm in diameter (A). On microscopy, the polypoid lesion was almost entirely made up of tightly packed pyloric type tubular glands with little intervening stroma (B). In the background gallbladder epithelium there were no abnormalities. Recovery after surgery was uneventful and the symptoms did not recur.

KrasG12D upregulates Notch signaling to induce gallbladder tumorigenesis in mice.

BackgroundKras mutations and increased Notch activation occur frequently in gallbladder cancer. However, their roles in gallbladder carcinogenesis have not been defined. This study was aimed at determining whether expression of mutant Kras was sufficient to induce gallbladder carcinoma and whether Notch deregulation played a role in this context.MethodsWe determined Cre recombination activity of Pdx1-Cre in the gallbladder using a reporter strain and examined gallbladder tumor development in the KrasLSL- G12D/+;Pdx1-Cre mice. We analyzed expression of Notch pathway genes in the mouse gallbladder by immunohistochemistry, quantitative RT-PCR, and Western blot analysis. We also determined the effect of Jag1 deletion on Kras-induced gallbladder tumor development.ResultsPdx1-Cre exhibits robust recombination activity in the gallbladder epithelium. KrasLSL-G12D/+;Pdx1-Cre mice form early onset adenoma in the gallbladder and adjacent biliary tract with complete penetrance, albeit short of invasive adenocarcinoma. KrasG12D upregulates expressions of Notch2, Notch3, Notch4, Jag1 and downstream target genes Hes1, Hey1 and Hey2, and deletion of Jag1 partially suppresses KrasG12D-induced adenoma development.ConclusionsKrasG12D induces gallbladder adenoma and Notch plays a key role in Kras-initiated gallbladder tumorigenesis.

Non-clinical safety evaluation and risk assessment to human of aleglitazar, a dual PPAR α/γ agonist, and its major human metabolite

The non-clinical safety profile of aleglitazar, a peroxisome proliferator activated receptor alpha/gamma agonist, and its major human metabolite M6 was studied in a complete package consisting of drug metabolism and pharmacokinetics characterization, safety pharmacology, genotoxicity, repeat dose toxicity, reproductive toxicity and carcinogenicity studies. These studies identified the following main targets similar to other PPAR agonists: red blood cell parameters, liver, heart, kidney, ovaries, testes, bone marrow, adipose tissue, and fluid accumulation. Additionally, and in the 12-month monkey study only, an increased incidence of generalized hair loss/thinning was observed in all groups including controls. In the rat carcinogenicity study there was no statistically significant increase in tumors. In the mouse carcinogenicity study, there was an increased incidence of angiomatous tumors and there were three males with gallbladder adenoma. No relevant compound-related effects were observed in safety pharmacology, genotoxicity, and a 28-day immunotoxicity rat study. Effects observed in reproductive toxicity studies were similar to those known for other PPARγ agonists. Separate studies with the human metabolite M6 did not reveal findings that would prevent human dosing. Overall, the results from the non-clinical safety studies conducted with aleglitazar and the human metabolite M6 were considered to support the clinical Phase 3 program.

The Value of Differentiation Diagnosis of Gallbladder Polyps Larger Than 1.0cm by CEUS: 7 Years Clinical Experiences

To assess the value of differentiation diagnosis of gallbladder polyp lesion (GPL) by contrast enhanced ultrasound (CEUS). A total of 988 consecutive cases of patients with GPL larger than 1.0cm were collected between June 2010 and May 2017 in our hospital. All patients underwent gray scale ultrasound and contrast enhanced ultrasound examinations before cholecystectomy. The patients' data and the features of GPL on gray scale ultrasound images were recorded, which include the size, color Doppler blood flow, number of GPL, echoic features of GPL and gallbladder stone. The CEUS features of GPL including enhancement intensity, enhancement homogeneous, stalk width, vascular type in arterial phase were recorded. All of the gray scale and CEUS images were analyzed by two doctors independently who have more than 10 years CEUS examinations experiences. According to the pathology findings, all the patients enrolled in this study were divided into cholesterol polyps and gallbladder adenoma groups. All the patients' data and image features between two groups were statistically compared. There were 856 cases of cholesterol polyp and 132 cases of gallbladder adenoma. There were differences in patient age, lesion size, echogenicity, gallbladder stone and vascularity of lesion between two groups (P<0.05). There were differences in stalk width, enhancement intensity and vascular types between two groups (P<0.05). Multiple logistic regression analysis proved that size of lesions, enhancement intensity, stalk of lesion, vascularity and vascular type were the independent risk factors related with GB adenoma (P<0.05). CEUS could offer useful information to distinguish adenoma from cholesterol polyp. The treatment algorithm for GPL would likely benefit from CEUS as a routine imaging investigation, especially in cases where the polyp is larger than 1cm.

Adenoma of the gallbladder in a mongoose (Mungos mungo)

ABSTRACT: Primary gallbladder neoplasms occur infrequently in domestic animals and rarely in wild animals. This article describes a case of gallbladder adenoma in a mongoose ( Mungos mungo) in captivity. Grossly, the gallbladder was moderately distended with a smooth capsular surface. Necropsy showed an irregular, soft, whitish nodule 0.8cm in diameter. Microscopic examination of the nodule showed proliferation of epithelial cells, which projected from the mucosa and formed papillary projections supported by a sparse fibrovascular stroma. Neoplastic cells were well differentiated with mild anisocytosis and anisokaryosis. Based on these histopathological findings, adenoma of the gallbladder was diagnosed.

A case of gallbladder adenoma with obstructive jaundice

A case of gallbladder adenoma with obstructive jaundice

Complex APC germline mutation associated metaplasia and intraepithelial neoplasia (CAM-IEN) of the gallbladder

Preneoplasic and neoplastic changes of the gallbladder of patients with a familial adenomatous polyposis (FAP) are rare, and very little is known about their incidence in patients with an attenuated FAP. We herein report on a unique case of a woman with an attenuated FAP who shows eight distinct, partially preneoplastic differentiation patterns within the gallbladder mucosa, which are: (1) regular gallbladder epithelium, (2) low grade biliary intraepithelial neoplasia, (3) papillary adenoma, (4) Paneth cell metaplasia, (5) goblet cell metaplasia, (6) pancreatic metaplasia, (7) pseudopyloric metaplasia, and (8) neuroendocrine differentiation. Moreover, this is the first case of a KRAS mutation in a gallbladder adenoma of a patient with an APC germline mutation, which is highly suggestive of an early event of malignant transformation. As a consequence of our findings, clinicians should draw special attention to the gallbladder of FAP patients, and a simultaneous protective cholecystectomy of FAP patients, which undergo colectomy and show conspicuous changes of the gallbladder mucosa, should be performed in these patients in order to eliminate the risk of a synchronous or metachronous gallbladder neoplasia.

Contrast-enhanced ultrasound may distinguish gallbladder adenoma from cholesterol polyps: a prospective case–control study

The aim of this study was to find the independent risk factors related with gallbladder (GB) adenoma compared to cholesterol polyp by contrast-enhanced ultrasound (CEUS). Between January 2010 and September 2014, a total of 122 consecutive patients undergoing cholecystectomy for GB polypoid lesions were enrolled. Before cholecystectomy, each patient underwent conventional US and CEUS examination and all image features were documented. The patients were divided into adenoma group and cholesterol polyp group according to the pathological findings. All the image features between two groups were statistically compared. There were differences in patient age, lesion size, echogenicity, and vascularity of lesion between two groups (P<0.05). There were differences in stalk width and enhancement intensity between the two groups (P<0.05). Multiple logistic regression analysis proved that enhancement intensity, stalk of lesion, and vascularity were the independent risk factors related with GB adenoma (P<0.05). CEUS could offer useful information to distinguish adenoma from cholesterol polyp. The treatment algorithm for gallbladder polyp lesions would likely benefit from CEUS as a routine imaging investigation, especially in cases where the polyp is larger than 1cm.

Contrast-enhanced ultrasound in diagnosis of gallbladder adenoma

Gallbladder adenoma is a pre-cancerous neoplasm and needs surgical resection. It is difficult to differentiate adenoma from other gallbladder polyps using imaging examinations. The study aimed to illustrate characteristics of contrast-enhanced ultrasound (CEUS) and its diagnostic value in gallbladder adenoma. Thirty-seven patients with 39 gallbladder adenomatoid lesions (maximal diameter ≥10 mm and without metastasis) were enrolled in this study. Lesion appearances in conventional ultrasound and CEUS were documented. The imaging features were compared individually among gallbladder cholesterol polyp, gallbladder adenoma and malignant lesion. Adenoma lesions showed iso-echogenicity in ultrasound, and an eccentric enhancement pattern, "fast-in and synchronous-out" contrast enhancement pattern and homogeneous at peak-time enhancement in CEUS. The homogenicity at peak-time enhancement showed the highest diagnostic ability in differentiating gallbladder adenoma from cholesterol polyps. The sensitivity, specificity, positive predictive value, negative predictive value, accuracy and Youden index were 100%, 90.9%, 92.9%, 100%, 95.8% and 0.91, respectively. The characteristic of continuous gallbladder wall shown by CEUS had the highest diagnostic ability in differentiating adenoma from malignant lesion (100%, 86.7%, 86.7%, 100%, 92.9% and 0.87, respectively). The characteristic of the eccentric enhancement pattern had the highest diagnostic ability in differentiating adenoma from cholesterol polyp and malignant lesion, with corresponding indices of 69.2%, 88.5%, 75.0%, 85.2%, 82.1% and 0.58, respectively. CEUS is valuable in differentiating gallbladder adenoma from other gallbladder polyps (≥10 mm in diameter). Homogeneous echogenicity on peak-time enhancement, a continuous gallbladder wall, and the eccentric enhancement pattern are important indicators of gallbladder adenoma on CEUS.

ATP5b and β2-microglobulin are predictive markers for the prognosis of patients with gallbladder cancer.

The differences in clinical, pathological, and biological characteristics between adenocarcinoma (AC) and squamous cell/adenosquamous carcinoma (SC/ASC) of the gallbladder have not been well documented. This study investigates the clinical and pathological associations of ATP5B and β2M with benign and malignant lesions of the gallbladder. In this study, ATP5B and β2M expression in 46 SC/ASCs and 80 ACs were examined using immunohistochemistry. The rate of ATP5B positive expression was significantly lower, while the rate of β2M expression was significantly higher, in AC and SC/ASC than in gallbladder adenomas, gallbladder polyps, or gallbladder epithelium with stone (P < 0.01). More SC/ASCs had larger tumor mass and good differentiation compared to ACs. Positive β2M and negative ATP5B expression were significantly associated with large tumor size, high TNM stage, lymph node metastasis, and invasion of SC/ASCs and ACs. Univariate Kaplan-Meier analysis showed that positive β2M (P < 0.05 or P < 0.001) expression and negative ATP5B (P < 0.001) expression were significantly associated with decreased overall survival in both SC/ASC and AC patients. Multivariate Cox regression analysis showed that negative ATP5B expression is an independent-prognostic factor for poor prognosis in both SC/ASC (P < 0.01) and AC (P < 0.001) patients. Positive β2M expression is an independent-prognostic factor for poor prognosis in AC (P < 0.05) patients. Our study suggested that positive β2M expression or loss of ATP5B expression in tumor tissues is closely related to the metastasis, invasion, and poor-prognosis of gallbladder cancer.

Management of polypoid lesions of the gallbladder: an analysis of 748 patients

Objective To investigate the risk factors of gallbladder neoplastic polyps,to determine the proper surgical indications,and to understand more about the clinical characteristics of gallbladder adenoma.Methods The clinical data of 748 patients diagnosed to have polypoid lesion of gallbladder (PLG) and underwent cholecystectomy from January 1998 to December 2012 in the Second Affiliated Hospital of Zhejiang University School of Medicine were retrospectively reviewed.Results Among 748 patients,340 had abdominal symptoms.Postoperative histopathology showed non-neoplastic polyps (n =659),gallbladder adenoma (n =68),gallbladder cancer (n =15) and no polyps (n =6).The mean diameters of the nonneoplastic lesions and the neoplastic polyps were (9.38 ± 3.44) mm and (14.55 ± 5.71) mm,respectively (P ＜ 0.01).The average age of the patients with non-neoplastic lesions was (44.14 ± 11.42) years and (47.39 ± 12.82) years in those with neoplastic polyps (P ＜ 0.05).The proportion of solitary PLG was 41.4％ (253/611) and 59.59％ (47/79) for the non-neoplastic lesions and the neoplastic polyps respec tively (P ＜ 0.01).The size of PLG (13.34 ± 4.18 mm vs.20.07 ± 8.19 mm,P ＜ 0.05) and the age of the patient (45.78 ± 11.66 years vs.54.13 ± 15.82 years,P ＜0.05) between the gallbladder adenoma and gallbladder cancer groups were significantly different.Gallbladder adenoma or dysplasia was identified in 66.7％ (10/15) of gal1bladder cancer specimens.Conclusions Patients with PLG and with abdominal symptoms,large size (≥ 10 mm),old age (≥50 y) and solitary polyp are indications for cholecystectomy.Gallbladder adenoma may develop to gallbladder cancer within 10 years. Key words: Gallbladder diseases ; Polyps ; Gallbladder neoplasms

Managing the incidentally detected gallbladder cancer: Algorithms and controversies

Introduction: Gallbladder cancer (GBC) is the fifth most common neoplasm of the gastrointestinal tract and the most common cancer of the biliary tract. GBC is suspected preoperatively in only 30–40% of patients. The other 60–70% are discovered incidentally (IGBC) by the pathologist on a gallbladder specimen following cholecystectomy for benign diseases such as polyps, gallstones, and cholecystitis. Materials and methods: Between 1995 and 2011, 30 cases of GBC, who underwent resection with curative intent in our institutions, were retrospectively reviewed. They were analyzed for demographic data, and type of operation, surgical morbidity and mortality, histopathological classification, and survival. Incidental GBC was compared with suspected or preoperatively diagnosed GBC. Overall survival, disease-free survival (DFS) and the difference in DFS between patients previously treated with laparoscopic cholecystectomy and those who had oncological resection as first intervention were analyzed. The authors also present a systematic review to evaluate the role of extended surgery in the treatment of the incidental GBC. Results: GBC was diagnosed in 30 patients, 16 women and 14 men. The M/F ratio was 1:1.14 and the mean age was 69.4 years (range 45–83 years). A preoperative diagnosis was possible only in 14 cases; fourteen of the incidental cases were diagnosed postoperatively after the pathological examination; two were suspected intraoperatively at the opening of the surgical specimen and then confirmed by frozen sections. The ratio between incidental and nonincidental cases was 1, 14/1, with twelve cases discovered after laparoscopic cholecystectomy. Eighty-one per cent of the incidental cases were discovered at an early stage (≤II). The preoperative diagnosis of the 30 patients with GBC was: GBC with liver invasion diagnosed by preoperative CT (nine cases); gallbladder abscess perforated into hepatic parenchyma and involving the transversal mesocolon and hepatic hilum (one case); porcelain gallbladder (three cases); gallbladder adenoma (four cases); and chronic cholecystolithiasis (thirteen cases). Every case, except one, with a T1b or more advanced invasion underwent IVb + V wedge liver resection and pericholedochic/hepatoduodenal lymphoadenectomy. One patient refused further surgery. Cases with Tis and T1a involvement were treated with cholecystectomy alone. Nine of the sixteen patients with incidental diagnosis reached 5-year DFS (56.25%) and eight of them are recurrence free. Surprisingly, one patient reached 38 mo survival despite a port-site recurrence (the only one in our experience) 2 years after the original surgery requiring further resection. Cases with non incidental diagnosis were more locally advanced and only two patients experienced 5 years DFS (Tables 2 and 3). Conclusion: Laparoscopic cholecystectomy does not affect survival if implemented properly. Reoperation should have two objectives: R0 resection and clearance of the lymph nodes.

Increased rate of cholecystectomies performed with doubtful or no indications after laparoscopy introduction: a single center experience

BackgroundDuring recent years laparoscopic cholecystectomy has dramatically increased, sometimes resulting in overtreatment. Aim of this work was to retrospectively analyze all laparoscopic cholecystectomies performed in a single center in order to find the percentage of patients whose surgical treatment may be explained with this general trend, and to speculate about the possible causes.Methods831 patients who underwent a laparoscopic cholecystectomy from 1999 to 2008 were retrospectively analyzed.ResultsAt discharge, 43.08% of patients were operated on because of at least one previous episode of biliary colic before the one at admission; 14.08% of patients presented with acute lithiasic cholecystitis; 14.68% were operated on because of an increase in bilirubin level; 1.56% were operated on because of a previous episode of jaundice with normal bilirubin at admission; 0.72% had gallbladder adenomas, 0.72% had cholangitis, 0.36% had biliodigestive fistula and one patient (0.12%) had acalculous cholecystitis. By excluding all these patients, 21.18% were operated on without indications.ConclusionsThe broadening of indications for laparoscopic cholecystectomy is undisputed and can be considered a consequence of new technologies that have been introduced, increased demand from patients, and the need for practice by inexperienced surgeons. If not prevented, this trend could continue indefinitely.

Unicryptal gallbladder adenomas in a patient with Gardner's syndrome

Gardner's syndrome occurs when mutation of the adenomatous polyposis coli gene is associated with extra-intestinal manifestations in addition to colorectal adenomas. Only eleven cases of gallbladder adenoma in Gardner's syndrome have been previously reported in the literature. We report a case of Gardner's syndrome in which multiple adenomas are associated with unicryptal adenomas.The lesion showed cytoplasmic and nuclear expression of β-catenin. The identification of multiple fully formed and unicryptal adenomas in the gallbladder are suggestive of Gardner's syndrome, and these patients require further investigation and follow up.

The role of contrast-enhanced ultrasound in the differentiation between gallbladder adenoma and carcinoma developing from gallbladder adenoma

Objectives To investigate the role of contrast-enhanced ultrasound in the differentiation between gallbladder adenoma and carcinoma developing from gallbladder adenoma.Methods The data from 28 patients who received contrast-enhanced ultrasound (19 patients with gallbladder adenoma and 9 patients with gallbladder carcinoma developing from gallbladder adenoma) were retrospectively analyzed.We analyzed the contrast enhancement characteristics of the initial enhancement time,the enhancement level,enhanced morphology and the integrity of gallbladder wall adjacent to the lesions.All the lesions were confirmed by histopathology.Results The time to initial enhancement and the time to peak enhancement were significantly shorter in patients with gallbladder adenoma than in patients with gallbladder carcinoma developing from gallbladder adenoma [(13.11 + 3.63)s vs.(18.11-±-3.26)s,(17.36+3.95)s vs.(24.56-±-4.36)s,all P＜0.01].The time to iso-enhancement,however,showed no significant differences.The time to hypo-enhancement and enhancement time of the liver were significantly shorter in patients with gallbladder carcinoma developing from gallbladder adenoma than in patients with gallbladder adenoma [(55.56 ± 15.4) s vs.(91.00 ± 34.25) s,P＜0.01,(16.63+4.66)svs.(22.78+5.29)s,P＜0.05].Using ROC curve,the time to peak enhancement value greater than 20 s had a sensitivity of 89 ％ and a specificity of 85 ％ for detecting gallbladder carcinoma developing from gallbladder adenoma.The enhancement level showed no significant difference between the two groups.Inhomogeneous enhancement was found in 3 (33 ％) gallbladder cancer developing from gallbladder adenoma and none (0/19) in gallbladder adenoma (P＜0.01).Destruction of the integrity of gallbladder wall was found in 6 (66.7％) gallbladder carcinoma developing from gallbladder adenoma and none (0/19) in gallbladder adenoma (P＜0.01).Conclusions Contrast-enhanced ultrasound is useful in the identification of patients with gallbladder adenoma and gallbladder carcinoma developing from gallbladder adenoma.The time to peak enhancement,the enhancement morphology and the integrity of gallbladder wall adjacent to the lesions significantly improved the ability to differentiate between gallbladder adenoma and gallbladder carcinoma developing from gallbladder adenoma. Key words: Gallbladder neoplasms; Ultrasonography

Differential diagnosis between gallbladder adenomas and cholesterol polyps on contrast-enhanced harmonic endoscopic ultrasonography

Differential diagnosis between gallbladder (GB) adenomas and cholesterol polyps based on ultrasonography or endoscopic ultrasonography (EUS) is challenging because they have similar echogenicity and morphology. We evaluated the usefulness of contrast-enhanced harmonic EUS (CEH-EUS) for differentiating between GB adenomas and cholesterol polyps. Between June 2010 and December 2011, a total of 87 patients with GB polyps who underwent a CEH-EUS were reviewed retrospectively. Of the 87 patients, 57 had a cholecystectomy. Of these, 34 patients were diagnosed with adenoma, cholesterol polyp, adenocarcinoma, or adenomyomatosis pathology. The remaining 23 patients were not diagnosed with GB polyps because their lesions separated from the GB mucosal layer during pathological sampling. On CEH-EUS, homogeneous and heterogeneous enhancement was shown in 6 and 2 patients with adenoma and in 4 and 8 patients with cholesterol polyps, respectively. Sensitivity and specificity of CEH-EUS for differential diagnosis of GB adenomas from cholesterol polyps based on the enhancement pattern were 75.0 and 66.6 %, respectively. CEH-EUS might be useful for distinguishing GB adenomas and cholesterol polyps based on enhancement patterns. However, an additional technique such as quantitative perfusion analysis is necessary because visual assessment of CEH-EUS images is subjective.

Large villous adenoma of gallbladder: A case report

INTRODUCTIONAdenomas of the biliary tract are uncommon. Gallbladder adenomas are generally smaller than 20mm in size and can be classified histologically as tubular, papillary, or tubulopapillary. Villous adenoma of gallbladder is extremely rare and is considered as a premalignant condition that eventually progresses to adenocarcinoma via the adenoma–carcinoma sequence. PRESENTATION OF CASEThe clinical data including images, surgical specimen and pathological results of this gallbladder adenoma larger than 50mm were analyzed. This huge gallbladder adenoma had unique imaging appearance, and the pathological examination revealed the lesion to be villous adenoma with mild to moderate dysplasia. DISCUSSIONThis rare huge villous adenoma of gallbladder had unique images and pathological appearance different from that of huge tubular adenoma of gallbladder and that of adenocarcinoma. CONCLUSIONLarge villous adenoma of gallbladder is a rare disease with unique imaging appearance and pathological characteristics.