Gallbladder Carcinoma

We'll discuss a case of gallbladder carcinoma, including imaging findings, clinical features, and differential diagnoses.

Imaging Findings

CT Imaging

1. Axial Sections:

• Initial views show the liver and spleen, followed by the liver in its entirety during the portal venous phase.
• An ill-defined, isodense mass replaces the gallbladder, with central necrotic areas visible on contrast-enhanced CT.
• The liver interface with the mass is poorly defined, suggesting liver involvement.
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2. Common Bile Duct (CBD):

   • The cystic duct is not separately visualized; the mass abuts the CBD, which shows dilation along its entire course.
   • Upstream, there is intrapatic biliary radical dilation (IHBRD), more pronounced centrally.
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3. Coronal Sections:

   • The ill-defined mass in the gallbladder fossa is confirmed with necrotic areas and dilated CBD.
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Clinical Features and Epidemiology

• Demographics: More common in women, particularly in regions like New Mexico, Bolivia, and Israel.

• Risk Factors:

  • Female gender and postmenopausal age.
  • Chronic infections (e.g., Salmonella typhi), smoking, and industrial exposures.
  • Cholelithiasis and congenital conditions (e.g., choledochal cyst, primary sclerosing cholangitis).

• Symptoms: Often present with advanced disease. Early symptoms are rare but may include:

  • Chronic abdominal pain
  • Anorexia and weight loss
  • Jaundice and a palpable mass
  • Incidental detection on imaging; elevated serum alpha-fetoprotein and CA levels may occur.

Radiological Features

• X-ray: First-line imaging, although not definitive.
  • Can show porcelain gallbladder or calcified gallstones.
  • Abnormal contour may indicate fistula formation.

Types of Gallbladder Carcinoma

1. Mass Replacing the Gallbladder: Most common presentation.
2. Focal or Diffuse Wall Thickening: May mimic benign processes.
3. Intra-luminal Polypoid Mass: Polyp >1 cm is a risk for malignancy.

Ultrasound Findings

• Polypoid Mass: Shows internal vascularity.
• Ill-defined Mass: Indicates invasion into liver tissue.

Cross-Sectional Imaging

• Contrast-Enhanced CT: Critical for assessing mass replacement, wall thickening, and potential metastases.

• MRI: Useful for differentiating gallbladder carcinoma from benign conditions like adenomyomatosis.

Differential Diagnosis

1. Wall Thickening Causes:

   • Inflammatory: Acute and chronic cholecystitis, abscess.
   • Non-inflammatory: Heart failure, cirrhosis, renal failure leading to ascites.

2. Xanthogranulomatous Cholecystitis: Radiologically similar to carcinoma, often with fat stranding.

3. Adenomyomatosis: Characterized by focal wall thickening with ring down artifacts.

Conclusion

Gallbladder carcinoma is a challenging diagnosis often identified at advanced stages. Imaging plays a vital role in detection and differentiation from other conditions.

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