A clinicopathological analysis in unsuspected gallbladder carcinoma: A report of 23 cases

Table 1 Analysis of past history of 23 UGC cases

Indications	UGC	PDGC
Age (yr)	59.57 ± 11.49	56.21 ± 11.62
Sex	M: 5, F: 18	M: 14, F: 19
Signs and symptoms
Jaundice (n)	4	1
Stomachache (n)	20	24
Febrile (n)	1	1
Dyspepsia (n)	4	5
Body weight loss (n)	4	6
Abdominal mass (n)	0	3
Absence of symptoms (n)	1 (preoperative diagnosis is adenoma)	3
Multiple pregnancies (≥ 3 times) (n)	13	14
Family malignancy history (n)	1, his father suffered with gastric cancer	2, their fathers respectively have lung cancer and hepatoma
Past history
Gastritis (n)	4	3
Gastric ulcer (n)	3	2
Hepatitis B (n)	5	10
Contact with schistosome pestilent water (n)	9	8
Coexisted with cholecystolithiasis (n)	17	8a
Size of cholecystolithiasis (> 1 cm) (n)	7	5
Multiple (n)	17	6b
Complicated with choledoch carcinoma (n)	1	0
Biliary tract diseases found preoperatively
Polypoid lesion of gallbladder wall (n)	3	7
Multiple (n)	2	6
Size (> 1 cm) (n)	2	3
Gallbladder wall thickening (n)	12	9
Gallbladder enlargement (n)	5	6
Atrophy of gallbladder (n)	2	1
Cholestasis (n)	2	0
Congenital capsular dilation of bile duct (n)	0	1
Coexist with extra-biliary-tract diseases
Splenomegaly (n)	0	4
Kidney multiple cystis (n)	0	2
Hemangiomas of liver (n)	0	2
Heparadiposum (n)	1	5
Hepatic cirrhosis (n)	1	2
Esophageal hiatal hernia (n)	0	1
Lateral ventral hernia (n)	0	3

^aP < 0.01 (χ² = 13.53, vs UGC);

^bP < 0.01 (χ² = 17.39, vs UGC).

Table 2 Diagnosis and treatment in 23 UGC cases

Indications	UGC	PDGC
Final diagnosis during operation	60.87% (14/23)
Final diagnosis after operation	39.13% (9/23)
Open cholecystectomy	0.41% (23/5582)
Laparoscopic cholecystectomy	0% (0/3225)
Imergency operation	13.04% (3/23)
Main misdiagnosis causes (n)
Hepatoma	2
Cholecystolithiasis	14
Adenoma	3
Cholecystolithiasis coexisted with adenoma	4
Special examination methods
USG (n)	16	14
CT (n)	1	2
MRI (n)	0	1
USG + CT (n)	3	12
USG + MRI (n)	2	3
USG + CT + MRI (n)	1	1
Laboratory examinations
Carcino-embryonic antigen (n)	1/2	0/10
Alpha-fetoprotein (n)	0/1	2/10
Alkali phosphatase (n)	0/0	2/4
γ-GT (n)	2/2	2/2
Lactate dehydrogenase (n)	0/0	1/1
5-nucleophosphatase (n)	0/0	1/1
Operations
Cholecystectomy (n)	17	11
Cholecystectomy + regional lymph clearing (n)	2	4
Combined with partial hepatectomy (n)	3	10
Combined with partial excision of extrahepatic bile duct (n)	1	2
Combined with excision of outer metastasis (n)	0	5 (2 cases proved nontumorous metastasis postop)
Exploratory laparotomy (n)	0	1
Adjunctive therapy
Postoperative radiotherapy (n)	0	3
Postoperative chemotherapy (n)	4	9
Treatment with TCM (n)	1	3
TACE with recrudescent tumor (n)	0	2

Table 3 Pathological characteristics of 23 UGC cases

Indications	UGC	PDGC
Primary location of gallbladder carcinoma (n)	(with record 16 cases)	(with record 21 cases)
Cystic duct	1	1
Neck of gallbladder	8	3a
Body of gallbladder	5	6
Bottom of gallbladder	0	6b
Boundary between neck and body of gallbladder	2	0
Body and bottom of gallbladder	0	5c
Nevin staging
I	6	2d
II	5	1e
III	7	8
IV	2	6
V	3	16f
Cancerometastasis status (n)
Gallbladder lymph node	1	0
Portal lymph node	0	1
Common bile duct lymph node	1	4
Latero-hepatic artery lymph nod	0	1
Nerve boundle in gallbladder wall	0	2
Extrahepatic bile duct	0	2
Liver	3	11
Diaphragmatic muscle	0	1
Peritoneum	0	1
Omentum	0	1
Pathohistological diagnosis
Histological type (n)
Adenocarcinoma	20	27
Adenoma canceration	2	2
Squamous carcinoma	1	2
Undifferentiated carcinoma	0	2
Grade (n)
Well differentiated	14	11g
Moderately differentiated	3	4
Poorly differentiated	6	18h

^aP = 0.020, vs UGC;

^bP = 0.023, vs UGC;

^cP = 0.047, vs UGC;

^dP < 0.05 (χ² = 4.44, vs UGC);

^eP < 0.05 (χ² = 4.96, vs UGC);

^fP < 0.01 (χ² = 7.59, vs UGC);

^gP < 0.05 (χ² = 4.16, vs UGC);

^hP < 0.05 (χ² = 4.48, vs UGC).