• Wnt pathway
• anti‐cancer drug screen
• biliary tract cancer
• gallbladder cancer
• organoids

• Organoids/cytology
• Organoids/metabolism
• Organoids/pathology
• Humans
• Gallbladder/cytology
• Gallbladder/pathology
• Animals
• Gallbladder Neoplasms/pathology
• Bile Ducts/cytology

• Wellcome Trust
• Wellcome-DBT India Alliance
• Tata Consultancy Services Foundation

• Animal models
• Artificial intelligence
• Biopsy
• Choledochoscopy
• Elastography
• Endoscopic ultrasound
• Gallbladder carcinoma
• In vitro studies
• Non-coding RNAs
• Screening

• Diagnosis
• Drug resistance
• Gallbladder cancer
• LncRNA
• Natural products
• Prognosis

• Humans
• RNA, Long Noncoding/genetics
• RNA, Long Noncoding/metabolism
• Gallbladder Neoplasms/genetics
• Gallbladder Neoplasms/drug therapy
• Gallbladder Neoplasms/pathology
• Gallbladder Neoplasms/diagnosis
• Gallbladder Neoplasms/metabolism
• Drug Resistance, Neoplasm
• Biological Products/pharmacology
• Biological Products/therapeutic use
• Animals
• Gene Expression Regulation, Neoplastic
• Antineoplastic Agents/pharmacology
• Antineoplastic Agents/therapeutic use
• Biomarkers, Tumor/genetics
• Biomarkers, Tumor/metabolism

• carcinoma
• diagnosis
• dwi
• gallbladder
• layered pattern
• mri

• Diagnosis, Differential
• Diffusion Magnetic Resonance Imaging/methods
• Gallbladder Diseases/diagnostic imaging
• Humans
• Magnetic Resonance Imaging
• ROC Curve
• Retrospective Studies
• Sensitivity and Specificity

Adenomatous hyperplasia (AH) is an uncommon benign lesion of the gallbladder (GB), predominantly seen in men. AH is commonly confused with malignant GB neoplasms in the setting of chronic cholecystitis and gallstones. There is a scarcity of published literature on AH, suggesting its rarity and the need for this case report.

A 24-year-old woman from Western Uganda presented with signs and symptoms consistent with extrahepatic biliary obstruction. Trans-abdominal ultrasound scan revealed cholecystomegaly (13.9 cm by 4.29 cm), thickened GB wall at 5.2 mm, with a poorly defined hypoechoic polypoid solid mass involving the fundal body of the GB. Explorative laparotomy with cholecystectomy and lymph node sampling was performed. Histopathological examination was consistent with adenomatous hyperplasia of the GB. The symptoms and laboratory values improved on follow-up in the clinic after laparotomy.

Adenomatous hyperplasia may be misdiagnosed as a malignant GB neoplasm, especially in the setting of chronic cholecystitis and gallstones. If a correct histopathological diagnosis is made, no further diagnostic work-up is necessary following surgical interventions.

• Mirizzi syndrome
• adenomatous hyperplasia
• gallbladder

• EUS-guided fine-needle aspiration (EUS-FNA)
• contrast-enhanced EUS
• differential diagnosis
• endoscopic ultrasound (EUS)
• gallbladder carcinoma
• polypoid lesion
• staging of gallbladder carcinoma
• wall-thickening

Gallbladder cancer (GBC) has a poor prognosis. Although complete surgical resection is the only successful approach for improving survival, additional therapeutic modalities are required for recurrent or surgically unresectable GBCs.

To determine the expression status of HER2 and the mismatch repair (MMR) proteins MLH1, MSH2, MSH6, and PMS2, immunohistochemical staining of MMR proteins and HER2 was carried out in 216 surgically resected GBCs. HER2 labeling was scored by adopting a scoring system for gastric carcinomas. Tissues scoring 0 to 2+ were defined as HER2 negative, whereas those scoring 3+ were regarded as HER2-positive. In addition, silver in situ hybridization and microsatellite instability (MSI) analysis were conducted to confirm HER2 amplification and MSI, respectively.

Three of 216 GBCs (1.3%) showed MMR protein deficiency. All three observed MSI cases exhibited dual loss of MSH2 and MSH6 protein expression. However, no cases showed loss of either MLH1 or PMS2 expression. No association was observed between MMR protein deficiency and other clinicopathological factors. HER2 amplification was noted in 30 (13.9%) GBCs and associated with Crohn-like lymphoid reaction (P = 0.023). No survival difference was observed based on HER2 overexpression or HER2 amplification status.

MMR protein deficiency and HER2 overexpression were observed in a small subset (1.3% and 13.9%, respectively) of GBCs without simultaneous occurrence of deficient MMR protein expression and HER2 overexpression. The presence of Crohn-like lymphoid reaction may help identify cases with HER2 amplification, by using hematoxylin-stained slides. Although the proportion of MMR protein-deficient- and HER2-overexpressing GBCs was small, applying immunotherapy to MMR protein-deficient GBCs and herceptin to HER2-overexpressing GBCs may provide alternative treatment options for patients with GBC.

• HER2
• cancer
• gallbladder
• microsatellite Instability
• mismatch repair proteins

Prolonged cholestasis adversely affects liver function. Hepatic functional recovery is mandatory prior to any surgical or medical intervention. Serum bilirubin levels correlate well with, and are a surrogate marker for, hepatocyte function. We aimed to ascertain factors responsible for slow decline of bilirubin and delayed recovery of liver function following percutaneous drainage in malignant biliary obstruction.

Sixty-seven patients with malignant jaundice who underwent percutaneous biliary drainage (PTBD) were followed until they achieved target bilirubin ≤ 3 mg/dl. According to duration, patients were divided into early (≤ 6 weeks, n = 43) and late (> 6 weeks, n = 24) groups. Various clinical, tumour-related and procedure-related factors were analysed for their contribution to delayed recovery with the χ² or t-test. Multi-variate logistic regression analysis was used to predict independent associations.

Gallbladder cancer presenting with type I block was the commonest pathology. Overall demographic, clinical, tumour characteristics and procedural details were comparable between groups. Duration of jaundice (p = 0.026), liver involvement (p = 0.041), baseline total (p = 0.001) and direct bilirubin levels (p < 0.001), positive bile cultures with hospital-acquired bacteria (p = 0.031) were significant factors on univariate analysis. Bacterial growth was significantly greater following repeated biliary manipulations. The commonest organisms were Pseudomonas and Citrobacter spp. Number of re-instrumentations, post-procedural biliary sepsis and native biliary organisms were non-contributory. No factor was significant on multivariate analysis.

Factors directly linked to extent and duration of disease are validated as significant contributors to functional recovery after biliary drainage. Biliary sepsis with hospital-acquired organisms, especially following re-interventions is a significant modifiable risk-factor affecting bilirubin decline.

• bile culture
• bilirubin
• infection
• nosocomial
• obstructive jaundice

• biomarkers
• diagnosis
• gallbladder cancer
• genetic susceptibility
• patient stratification
• prognosis
• treatment selection

• 825510 European Union's Horizon 2020 Research and Innovation Programme (ESCALON)
• 1170893 Fondo Nacional de Desarrollo Científico y Tecnológico (FONDECYT)

The diagnosis between benign and malignant gallbladder lesions is sometimes difficult. The objective of this study is to assess whether contrast-enhanced ultrasound (CEUS) and contrast-enhanced harmonic endoscopic ultrasound (CH-EUS) can be an accurate method for detecting gallbladder malignancy and to determine which imaging signs can be indicative of malignancy.

A study search of PubMed, Elsevier, and Sciencedirect was performed in May 2019. The pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve were used to examine the accuracy of CEUS and CH-EUS.

Twenty-one studies were included in the meta-analysis. The pooled sensitivities of CEUS and CH-EUS were 0.81 (0.75–0.86) and 0.92 (0.86–0.95); the specificities were 0.94 (0.90–0.96) and 0.89 (0.69–0. 97); the DORs were 64 (32–127) and 89 (22–354); and the area under the SROC curves were 0.90 (0.87–0.92) and 0.92 (0.90–0.94). On CEUS, the diagnostic criterion for gallbladder malignancy according to four features were analyzed. Sensitivity and specificity were 0.75 (0.65–0.83) and 0.98 (0.85–1.00) for integrity of gallbladder wall; 0.69 (0.55–0.81) and 0.89 (0.77–0.95) for heterogeneous enhancement; 0.81 (0.71–0.88) and 0.88 (0.76–0.94) for irregular vessels; and 0.81 (0.66–0.91) and 0.75 (0.59–0.86) for washout time within 28 s. On CH-EUS, heterogeneous enhancement could be indicative of malignant lesions with a sensitivity of 0.94 (0.85–0.97); and the specificity was 0.92 (0.71–0.98).

CEUS and CH-EUS are promising and reliable imaging modalities with a high sensitivity and specificity for the diagnosis of gallbladder malignancy. CH-EUS might be more sensitive than CEUS with a higher sensitivity. In addition, irregular tralesional vessels and washout time within 28 s on CEUS and heterogeneous enhancement on CH-EUS are indicative of malignancy. However, larger scale and well-designed studies are warranted to verify our results.

• Contrast-enhanced ultrasound
• Diagnosis
• Endoscopic ultrasonography
• Gallbladder
• Malignant lesions
• Meta-analysis

• Cancer
• Gallbladder
• Prognosis
• Stage
• Survival

• Adult
• Aged
• Aged, 80 and over
• Female
• Follow-Up Studies
• Gallbladder Neoplasms/surgery
• Humans
• Lymph Nodes/surgery
• Male
• Middle Aged
• Neoplasm Staging
• Prognosis
• United States

• Bile duct diseases
• Chemoprotection
• Cholangiocarcinoma
• Colorectal cancer
• Gallbladder carcinoma
• Hepatocellular carcinoma
• Inflammatory bowel disease

• Biliary Tract Neoplasms/epidemiology
• Biliary Tract Neoplasms/etiology
• Biliary Tract Neoplasms/prevention & control
• Carcinoma/epidemiology
• Carcinoma/etiology
• Carcinoma/prevention & control
• Carcinoma, Hepatocellular/epidemiology
• Carcinoma, Hepatocellular/etiology
• Carcinoma, Hepatocellular/prevention & control
• Cholangiocarcinoma/epidemiology
• Cholangiocarcinoma/etiology
• Cholangiocarcinoma/prevention & control
• Cholangitis, Sclerosing/complications
• Colorectal Neoplasms/epidemiology
• Colorectal Neoplasms/etiology
• Colorectal Neoplasms/prevention & control
• Early Detection of Cancer/methods
• Humans
• Inflammatory Bowel Diseases/complications
• Liver Neoplasms/epidemiology
• Liver Neoplasms/etiology
• Liver Neoplasms/prevention & control
• Population Surveillance
• Risk Factors

• Diagnosis
• Gallbladder polyps
• Pathology
• Treatment
• Ultrasonography.

The prevalence of gallbladder cancer (GBC) varies between different parts of the world. This study is a review of literature and an update of a previously published study conducted in our university and aims to reassess the incidence of GBC over the past 2 decades.

We conducted a retrospective study between 2002 and 2016. Data regarding demographics, clinical presentation, risk factors, histopathology, investigations, and treatments were obtained. A diagnosis of GBC established during surgery or primarily detected in the surgical specimen was classified as incidental.

Of 11 391 cholecystectomies performed, 31 cases (0.27%) of GBC were found. The mean age of patients with GBC was 68 years (43-103 years), 74% were women. The annual incidence of GBC was 0.2/100 000 (men: 0.1/100 000; women: 0.3/100 000). Biliary colic and acute cholecystitis were the main presentations. Diagnosis of GBC was “incidental” in 67% of cases. About 75% of patients with GBC had gallstones, 13% had polyps, and 3% had porcelain gallbladder. Adenocarcinoma was the dominant (87%) histologic type.

The GBC rate in our region, similar to others parts of the world, is still low and has not changed over the past 2 decades. This study consolidates the previously published recommendations regarding the high index of suspicion of GBC in elderly with cholelithiasis.

• Gallbladder cancer
• Jordan
• jaundice

Endoscopic ultrasonography (EUS) is considered a superior investigation when compared to conventional ultrasonography for imaging gall bladder (GB) lesions as it can provide high-resolution images of small lesions with higher ultrasound frequencies. Examination of GB is frequently the primary indication of EUS imaging. Imaging during EUS may not remain restricted to one station and multi-station imaging may provide useful information. This review describes the techniques of imaging of GB by linear EUS from three different stations. The basic difference of imaging between the three stations is that effective imaging from station 1 is done above the neck of GB, from station 2 at the level of the neck of GB and from station 3 below the level of the neck of GB.

• Gallbladder
• Gallbladder cancer
• Gallstones
• Biliary sludge
• Antrum
• Duodenal bulb
• Endoscopic ultrasound

• chemosensitizer
• cisplatin
• diagnosis
• miR-1207-5p
• peripheral blood
• primary gallbladder carcinoma

Gallbladder cancer (GBC) is an uncommon disease in the majority of the world despite being the most common and aggressive malignancy of the biliary tree. Early diagnosis is essential for improved prognosis; however, indolent and nonspecific clinical presentations with a paucity of pathognomonic/predictive radiological features often preclude accurate identification of GBC at an early stage. As such, GBC remains a highly lethal disease, with only 10% of all patients presenting at a stage amenable to surgical resection. Among this select population, continued improvements in survival during the 21st century are attributable to aggressive radical surgery with improved surgical techniques. This paper reviews the current available literature of the 21st century on PubMed and Medline to provide a detailed summary of the epidemiology and risk factors, pathogenesis, clinical presentation, radiology, pathology, management, and prognosis of GBC.

• Unexpected gallbladder carcinoma
• clinical characteristics
• diagnosis
• pathological characteristics
• ultrasound