Primary Papillary Hyperplasia of the Gallbladder Mimicking Gallbladder Cancer

Primary papillary hyperplasia of the gallbladder (PPHG) is a rare entity. PPHG is a benign diffuse mucosal projection without any background chronic inflammation-related disease of the gallbladder or bile ducts. Reported cases of PPHG are limited in that its characteristics are not well defined. We herein report a case of PPHG mimicking gallbladder cancer in radiologic investigations and present a review of the literature. Also coincident erythroderma is discussed.Key words: Primary papillary hyperplasia, Gallbladder, Erythroderma, Carcinoembryonic antigen, Prophylactic surgeryA 63-year-old male visited our dermatology clinic, presenting with skin rash widely occupying the body (Fig. 1a). He was not allergic to anything and had no particular past history. Blood tests were carried out but detected no particular antigen related to skin rash. However, serum carcinoembryonic antigen (CEA) was above the normal limit (8.3 ng/mL) and the patient was referred to our department for further investigation of gastrointestinal malignancy. Gastroduodenoscopy and colonoscopy were performed but did not detect any malignancy. CT scan revealed a relatively small gallbladder, measuring 3 cm in maximum length, adjacent to the duodenum and its lumen, which was invisible due to the fulfilling tumor. The tumor was well enhanced by the contrast medium (Fig. 1b). Direct invasion to the nearby organs was absent and distant metastases were not detected. Magnetic resonance cholangiopancreatography showed normal biliary tree and the cystic duct was disrupted (Fig. 1c). With the diagnosis of T3N0 gallbladder cancer, we performed segmentectomy of 4a and 5 along with extrahepatic biliary duct resection, regional lymph node dissection and biliary reconstruction. Grossly, resected gallbladder was rather small measuring 2.5 × 1.5 × 1.5 cm. No calculi were found inside the lumen. Diffuse thickening of the epithelium was noted and its color was documented as light brownish. The whole gallbladder lumen was occupied by this epithelium. The thickness was limited within the gallbladder and was not seen at the continuing cystic duct (Fig. 2a). Microscopic examination revealed diffuse papillary projection of the mucosa without any structural abnormality, suggesting neoplasm (Figs. 2b, ​,2c).2c). Some tubular structure continuing from the papillary folds were found in the proper muscular layer but they were considered as results of hyperplastic change of the mucosa within the Rokitansky-Aschoff sinus. Cells composing the papillary structure are single-layered, tall columnar cells without mitosis (Fig. 2d). Fibrosis was rarely seen nor was the infiltration of inflammatory cells. The final pathologic diagnosis was primary papillary hyperplasia of the gallbladder (PPHG). The patient was discharged from the hospital on the 10th postoperative day. His CEA value did not normalize until 1 year after the operation. However, erythroderma gradually improved during the 1-year period. He is free of related disease after 5 years'' follow-up.Open in a separate windowFig. 1(A) Erythema and scaling involving more than 80% of total body surface. (B) Enhanced CT scan showing hypervascular mass full filling the lumen of the small gallbladder. The air density area beside the gallbladder is the gas within the duodenum. (C) Magnetic resonance pancreatocholangiography revealed absence of pancreaticobiliary maljunction. Note gallbladder lumen is not visualized and other bile ducts are normal.Open in a separate windowFig. 2(A) Resected specimen. Mucosal thickening of gallbladder is clearly shown. Note the thickness ends with clear margin at the neck of the gallbladder (arrow), cystic duct and common bile duct showing macroscopically normal epithelium. (B) Microscopic findings; low power view. Papillary folds and projections are dense and thick. (C) Microscopic findings; high power view. Close view of the papillary structure. Single-layer tall columnar cells and thin fibroblastic stroma are shown. (D) Immunohistochemical staining of Ki-67. Positive cells are rarely found.     

Torsion of the Gallbladder

Introduction  

A 77-year-old woman was seen with progressive abdominal pain.     

The Mucocele of the Gallbladder

Journal of Gastrointestinal Surgery - The gallbladder polyps are a common finding during ultrasonography but only in rare cases they may be a cancer. When a polyp is greater than 1 cm, the...     

Primary Carcinoma of the Gallbladder

One-hundred-and-seventeen patients with histologically proven carcinoma of the gallbladder are reviewed. The majority of the patients presented with advanced disease with extension and metastasis to the liver and to lymph nodes along the common bile duct. Four patients had localized disease recognized at the time of operation; two were treated with cholecystectomy and two with cholecystectomy and hepatic resection. There were no five-year survivals among these patients. Fourteen patients had clinically inapparent carcinoma at the time of cholecystectomy; the diagnosis being established postoperatively by histologic examination of the excised gallbladder. There were two five-year survivors in this group of patients. Both survivors had early papillary carcinoma confined to the gallbladder wall. The remaining patients with inapparent carcinoma died within three years of the time of operation with recurrent carcinoma. The present report and review of the recent literature emphasizes the poor prognosis associated with carcinoma of the gallbladder. Even with apparently localized lesions, the survival rate is extremely poor. Extended resection, while not of proven value, may improve the survival rate.     

Gallbladder volvulus

We report two new cases of gallbladder volvulus. This rare condition principally affects elderly patients but is due to a congenital malformation related to the presence of a long mesocyst. Various factors such as kyphoscoliosis, multiparity and peristalsis of neighbouring organs favorise the occurrence of volvulus, the role of lithiasis is debatable. The diagnosis may be suggested on ultrasound but is most often confirmed at laparotomy. Diagnosis should be made rapidly in order to avoid progression towards a potentially fatal secondary peritonitis. Certain clinical elements such as the presence of a "floating mass" on palpation may suggest the diagnosis.     

Gallbladder Volvulus

A case of torsion of the gallbladder is presented. This is a rare condition that occurs more frequently in elderly females, it is associated with anatomical variants related to abnormal fixation of the gallbladder to the liver bed. It is usually diagnosed at laparotomy and treatment consists of cholecystectomy. This condition should be suspected in elderly females with acute cholecystitis or acute abdominal pain of unknown origin.     

Gallbladder injury

The Authors report on a rare case of blunt traumatic injury of the gallbladder. A careful clinical examination, an abdominal ultrasonography and a contrast material-enhanced computed tomography have a primary importance for a correct diagnosis. Laparoscopic surgery has an important diagnostic and, in selected cases, therapeutic role. In all traumatic gallbladder ruptures, after an accurate search of eventual associated injuries of other abdominal organs, cholecystectomy is considered the treatment of choice.     

Gallbladder cancer

BACKGROUND: Gallbladder cancer (GC) is a relatively rare but highly lethal neoplasm. We review the epidemiology, etiology, pathology, symptoms, diagnosis, staging, treatment, and prognosis of GC. METHOD: A Pubmed database search between 1971 and February 2007 was performed. All abstracts were reviewed and articles with GC obtained; further references were extracted by hand-searching the bibliography. The database search was done in the English language. RESULTS: The accurate etiology of GC remains unclear, while the symptoms associated with primary GC are not specific. Treatment with radical cholecystectomy is curative but possible in only 10% to 30% of patients. For patients whose cancer is an incidental finding on pathologic review, re-resection is indicated, where feasible, for all disease except T1a. Patients with advanced disease should receive palliative treatment. Laparoscopic cholecystectomy is contraindicated in the presence of GC. CONCLUSION: Prognosis generally is extremely poor. Improvements in the outcome of surgical resection have caused this approach to be re-evaluated, while the role of chemotherapy and radiotherapy remains controversial.     

Gallbladder volvulus

Gallbladder volvulus is a rare condition caused by torsion of the cholecystic pedicle and is favored by a long or nonexistent cholecystic mesentery. Gallbladder torsion presents clinically as gangrenous cholecystitis. Emergency cholecystectomy is the standard treatment. Lack of awareness of this condition can result in delayed diagnosis and worsen the prognosis of elderly patients.     

Gallbladder Bilharziasis

A 30 years old man presented with symptoms of Bilharziasis. Ultrasound showed gallstones in the gallbladder which was removed laproscopically, heavy bilharzial infection was detected in the gallbladder tissue. The first case in Saudi Arabia is reported. A Review of the world literatures since 1966 about the subject is presented and different aspects of the gallbladder schistosomiasis are discussed.     

胆囊息肉

胆囊息肉并非是一种单一的疾病 ,而是一类表现为胆囊粘膜向腔内呈局限性息肉样突起病变的总称。常为Ｂ超 (Ｂ ＵＳ)发现 ,影像学称为胆囊息肉样病变 (ｐｏｌｙｐｏｉｄｌｅｓｉｏｎｏｆｇａｌｌ ｂｌａｄｄｅｒ ,ＰＬＧ) ,这一诊断包含良、恶性病变 2 0余种。近年因Ｂ ＵＳ的普及和设备的更新 ,使ＰＬＧ的检出率日益增多 ,已成为胆道疾病的一个新的分支。1　ＰＬＧ流行病学及其自然史文献报道的ＰＬＧ流行率差别很大 ,1 5 %～ 9 5 % ,但国内外大多数大宗资料统计的人群流行率为 5 %以上 ,且男性居多。Ｏｋａｍｏｔｏ[1] 用Ｂ ＵＳ作 19476 7…     

Gallbladder cancer

Gallbladder cancer is the fifth most common cancer involving gastrointestinal tract, but it is the most common malignancy of the biliary tract, accounting for 80-95% of biliary tract cancers. This tumor is a highly lethal disease with an overall 5-year survival of less than 5% and mean survival mere than 6 months. An early diagnosis is essential as this malignancy progresses silently with a late diagnosis. The percentage of patients diagnosed to have gallbladder cancer after simple cholecystectomy for presumed gallbladder stone disease is 0.5-1.5%. Patients with preoperative suspicion of gallbladder cancer should not be treated by laparoscopy. Epidemiological studies have identified striking geographic and ethnic disparities—inordinately high occurrence in American Indians, elevated in Southeast Asia, yet quite low elsewhere in the Americas and the world. Environmental triggers play a critical role in eliciting cancer developing in the gallbladder, best exemplified by cholelithiasis and chronic inflammation from biliary tract and parasitic infections. Improved imaging modalities and improved radical aggressive surgical approach in the last decade has improved outcomes and helped prolong survival in patients with gallbladder cancer. The overall 5-year survival for patients with gallbladder cancer who underwent R0 curative resection was from 21% to 69%. In the future, the development of potential diagnostic markers for disease will yield screening opportunities for those at risk either with ethnic susceptibility or known anatomic anomalies of the biliary tract.     

Duplicated Gallbladder

Duplication of the gallbladder is a rare congenital anomaly of the biliary system with the incidence of 1 in 3800. A 38-year-old woman visited our patient clinic for evaluation of wall thickening of the gallbladder, detected by abdominal ultrasonography during a regular medical checkup. Drip infusion cholecystocholangiography–computed tomography revealed Y-shaped duplicated gallbladders.Key words: Duplicated gallbladder, Drip infusion cholecystocholangiography, Computed tomographyDuplicated gallbladder is a rare congenital anomaly, important in clinical practice as it may cause some clinical, surgical, and diagnostic problems.¹ We herein report a successfully diagnosed case of duplicated gallbladder using drip infusion cholecystocholangiography–computed tomography (DIC-CT).