Incidental carcinoma of gallbladder in north India: is routine histopathology of all cholecystectomy specimens justified?
DOI:
https://doi.org/10.18203/2349-2902.isj20150949Keywords:
Carcinoma, Cholecystectomy, Cholelithiasis, GallstoneAbstract
Background:Gallstones can cause varied spectrum of histopathology. Xanthogranulomatous cholecystitis and metaplasia have been shown to have association with carcinoma gallbladder. Incidental carcinoma of the gallbladder is a nightmare for the patient. Routine histopathology of all cholecystectomy specimens is an effective policy for its early diagnosis and management.
Methods: It is a retrospective study of histopathology of cholecystectomy specimens related to gallstones disease done at a rural government in north India. All patients with preoperative or intraoperative gross malignancy of gallbladder were excluded from study.
Results:In our study, females were predominating over males with a ratio of 6.07:1. The mean of all patients was 44.16±14.64 years. Chronic cholecystitis was most common (69.81%) histopathological entity. Incidental carcinoma was also revealed in 1.9 % of the cases. Metaplasia and xanthogranulomatous cholecystitis was reported in about 6% cases. Mixed stones were most common type reported in 76.79% cases. Multiple stones (72.8%) were more common than single stones. Majority (58%) of the cases in our study were operated by laparoscopic technique. Gallbladder perforation was most common complication noticed in about 4.15% cases.
Conclusions:Despite meticulous preoperative investigations and gross specimen examination, incidental carcinoma of gallbladder is a rule rather than exception in significant number of cases. A routine histopathology of specimen should be considered especially in high risk zones of carcinoma gallbladder.
References
Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: Cholelithiasis and Cancer. Gut and Liver. 2012;6(2):172-87.
Mohan H, Punia RPS, Dhawan SB, Ahal S and Sekhon MS. Morphological spectrum of gallstones disease in 1100 cholecystectomies in north India. Indian J Surg. 2005;67:140-2.
Awasthi N. A retrospective histopathological study of cholecystectomies. Int J Health Allied Sci. 2015;4:203-6.
Khuroo MS, Mahajan R, Zargar SA, Javid G and Sapru S. Prevalence of biliary tract disease in India: a sonographic study in adult population in Kashmir. Gut. 1989;30:201-5.
Mittal R, Jesudason MR, Nayak S. Selective histopathology in cholecystectomy for gallstone disease. Indian J Gastroenterol. 2010;29:32-6.
Agarwal AK, Kalayarasan R, Sakhuja P. All cholecystectomy specimens must be sent for histopathology to detect inapparent gallbladder cancer. HPB (oxford). 2012;14(4):269-73.
Targarona EM, Pons MJ, Viella P, Trias M. Unexpected carcinoma of the gallbladder, a laparoscopic dilemma. Surg Endosc. 1994;8:211-3.
Lammert F, Matern S. The genetic background of cholesterol gallstone formation: an inventory of human lithogenic genes. Curr Drug Targets Immune Endocr Metabol Disord. 2005;5:163-70.
Shaffer EA. Gallstone disease: epidemiology of gallbladder stone disease. Best Pract Res Clin Gastroenterol. 2006;20:981-96.
Everhart JE, Yeh F, Lee ET, et al. Prevalence of gallbladder disease in American Indian populations: findings from the Strong Heart Study. Hepatology. 2002;35:1507-12.
Singh V, Trikha B, Nain C, Singh K, Bose S. Epidemiology of gallstone disease in Chandigarh: a community-based study. J Gastroenterol Hepatol. 2001;16:560-3.
Einarsson K, Nilsell K, Leijd B, Angelin B. Influence of age on secretion of cholesterol and synthesis of bile acids by the liver. N Engl J Med. 1985;313:277-82.
Shaffer EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? Curr Gastroenterol Rep. 2005;7:132-40.
Coelho JC, Bonilha R, Pitaki SA, Cordeiro RM, Salvalaggio PR and Bonin EA. Incidence of gallstone in Brazilian population. Int Surg. 1999;84(1):25-8.
Bawahab MA, Maksoud WMA, Amri FSA, Ali HF, Salman ANA. Does routine histopathological examination of gallbladder after simple cholecystectomy add additional value? Bahrain Medical Bulletin. 2013;35(4):1.
Tyagi SP, Tyagi N, Maheshwari V, Ashraf SM, Sahoo P. Morphological changes in diseased gallbladder: a study of 415 cholecystectomies at Aligarh. J Indian Med Assoc. 1992;90(7):178-81.
Kafle SU, Sinha AK, Pandey SR. Histomorphology spectrum of gallbladder pathology in cholecystectomy specimens with clinical diagnosis of chronic cholecystitis. J Nepal Med Assoc. 2013;52(192):600-7.
Mathur SK, Duhan A, Singh S, Aggarwal M, Aggarwal G, Sen R, et al. Correlation of gallstone characteristics with mucosal changes in gallbladder. Trop Gastroenterol. 2012;33(1):39-44.
Memon W, Khanzada TW, Samad A, Kumar B. Histopathology spectrum of gallbladder specimens after cholecystectomy. Pak J Med Sci. 2011;27(3):533-6.
Juvonen T, Niemela O, Maketa J, Kairaluoma MI. Characteristics of symptomatic gallbladder disease in patients with either solitary or multiple cholesterol gallstones. Hepatogastroenterology. 1994;41:263-6.
Roa I, Ibacache G, Roa J, Araya J, Anetxabala XD, Munoz S. gallstones and gallbladder cancer volume and weight of gallstones are associated with gallbladder cancer: a case control study. J Surg Onco. 2006;93:624-8.
Hale MD, Roberts KJ, Toogood GJ. Xanthogranulomatous cholecystitis: a European and global perspective. HPB(oxford). 2014;16(5):448-58.
Krishnani N, Dhingra S, Kapoor S, Pandey R. Cytopathologic diagnosis of xanthogranulomatous cholecystitis and coexistent lesions. A prospective study of 31 cases. Acta Cytol. 2007;51:37-41.
Lee HS, Joo KB, Kim DH, Park NH, JOONG Yk, Suh JH, et al. A case of simultaneous xanthogranulomatous cholecystitis and carcinoma of the gallbladder. Korean J Intern Med. 2003;18:53-6.
Roa I, Araya JC, Villaseca M, Roa J, de Aretxabala X, Ibacache G. Gallbladder cancer in a high risk area: morphological features and spread patterns. Hepatogastroenterology. 1999;46:1540-6.
Shrestha R, Tiwari M, Ranabhat SK, Aryal G, Rauniyar SK, Shrestha HG. Incidental gallbladder carcinoma: value of routine histological examination of cholecystectomy specimens. Nepal Med Coll J. 2010;12:90-4.
Lohsiriwat V, Vongjirad A, Lohsiriwat D. Value of routine histopathologic examination of three common surgical specimens: appendix, gallbladder, and haemorrhoid. World J Surg. 2009;33:2189-93.
Pradhan SB, Dali S. Relation between gallbladder neoplasm and helicobacter hepaticus infection. Kathmandu Uni Med J. 2004;2(4):331-5.
Dix FP, Bruce IA, Krypcyzk A, Ravi S. A selective approach to histopathology of the gallbladder is justifiable. Surgeon. 2003;1:233-5.
Oommen CM, Prakash A, Cooper JC. Routine histology of cholecystectomy specimens is unnecessary. Ann R Coll Surg Engl. 2007;89:738.
Bazoua G, Hamza N, Lazim T. Do we need histology for a normal-looking gallbladder? J Hepatobiliary Pancreat Surg. 2007;14:564-8.
Darmas B, Mahmud S, Abbas A, Baker AL. Is there any justification for the routine histological examination of straightforward cholecystectomy specimens? Ann R Coll Surg Engl. 2007;89:238-41.
Siddiqui FG, Memon AA, Abro AH, Sasoli NA, Ahmad L. Routine histopathology of gallbladder after elective cholecystectomy for gallstones: waste of resources or a justified act? BMC Surg. 2013;13:26.
Royal College of Pathologists. Histopathology and Cytopathology of Limited or No Clinical Value. Report of Working Group of the Royal College of Pathologists. 2nd. London: Royal College of Pathologists, 2005.