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Imaging features ofgallbladder carcinoma:

report of 29 cases

NEJHY W. TOUIL N. ZAMIATIA W. ADIL ACentral Department of radiology

UHC Ibn Rochd - Casablanca


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Introduction It is the most frequent malignant tumor of the bile ducts and the

fifth for all gastro-intestinal tract tumors. .

Its prognosis is generally poor and only a radical surgical

therapy allows a prolonged survival.

It is frequently diagnosed in an advanced stage because of

the non specificity of its clinical manifestations

Imaging studies play an important role for the evaluation ofthe disease.


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Purpose of the study The goal of this report is to highlight the contribution of

the imaging during primitive gallbladder carcinomasdiagnosis


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Material and methods Retrospective study about 29 cases of gallbladder

carcinoma (histologically proven) during 5 years.

An echography and an abdominal scanner havebeen realized in all the patients.

The CT imaging studies were carry out before andafter injection of a contrast enhancer, with early,portal and late phase imaging.

Anyone of our patients benefited from an MRI.


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Results

Epidemiologic data Mean age : 57 years (39-77 years)

More women involved than men (sex-ratio 0.38)

Cholelithiasis was the main risk factor (44,82 %)

Clinical data Right upper abdominal Pain (68.96%)

jaundice (39.93%)

General status worsening (37.93%)


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Imagery Rdiologic featuresNoticed by the Echography and the Scanner:

Mass replacing the gallbladder : 12 cases

Polypoid mass : 9 cases Infiltrative form : 8 cases

thickening of the wall : 11-26 mm (mean 18 mm)


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Check-up of disease spreading

20 cases

6 cases

6 cases

10 cases

6 cases

2 cases

2 cases

2 cases

2 cases

2 cases

18 cases

10 cases

9 cases

7 cases

3 cases

-

-

-

-

-

Hepatic nodules

Dilatation of the intrahepatic bile

duct

Intraperitoneal effusion

Hilar, peripancreatic and celiac

lymphadenopathy Extension of the major bile duct

Extension of the pancreas

Extension of the duodenum

Extension of the stomach

Infiltration of the transverse

colon

Infiltration of the wall abdominal

Computerized tomographyEchography

Loco-regionalspreading


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TNM CLASSIFICATION BASED ON THE

COMPUTED TOMOGRAPHY ANDTHE ECHOGRAPHY

Stage T1 : 1 case

Stage T2 : 7 cases

Stage T3 : 6 cases

Stage T4 : 15 cases


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Histologic data

Adenocarcinoma : 26 cases

Epidermoid carcinoma : 3 cases


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Transverse sonogram shows intraluminal polypoidmass with hyperechogenicity


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Transverse sonogram shows hetergeneous massefilling gallbladder with several calcifications


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Hepatic metastasis of gallbladdercarcinoma


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Contrast-enhanced CT scan revealswall thickening of gallbladder

coronal section

sagital section

axial section


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Axial unenhanced CT scan shows Irregulardiffuse wall Thickening of the gallbladder andthe lithiasis of the major bile duct


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Irregular wall Thickening of the gallbladder withmultples gallstones (arrow)

Axial unenhanced CT scan Axial Contrast-enhanced CT scan


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Axial Contrast-enhanced CT scan:hepatic metastasis


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Invasion into segments V et VI of liver

Axial unenhanced CT scan Axial Contrast-enhanced CT scan


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Axial contrast-enhanced CT scan after injection of a contrast enhancer withlate phase: Huge heterogeneous mass remplaces gallbladder and directlyinvades adjacent liver , the pancreas and the stomach withperitoneal seeding


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Infiltration of the hepatic hilum with dilatation ofthe intrahepatic bile ducts

Axial Contrast-enhanced CT scan


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Axial contrast-enhanced CT scan revealsIrregular wall Thickening of the gallbladderwith extension of the abdominal wall andthe peritoneal seeding


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DISCUSSION


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Epidemiology and clinic

The most common malignancy of the biliary system

Adult about 60 years

Woman/man : 3/1

Association to a vesicular lithiasis : 70% of the

cases++

Its symptoms and signs are non specific thatare frequently diagnosed in an advanced stage


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Imaging EchographyThe echography shows :

the different features of primitive gallbladder cancer: Mass replacing the galbladder (The absence of

visualization of normal gallbladder and the possible

presence of calcification must lead to the suggestion ofthe diagnosis)

Polypoid mass within the gallbladder lumen

Diffuse wall thickening of the gallbladder The gallstones are generally visible Hilar or pedicular extension

Hepatic metastasis, lymphadenopathy or ascitis


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Imaging Computed tomography It reveals the different features of gallbladder carcinoma

It is a sensitive technique for detection of direct tumor extensioninto:- Adjacent liver: segments IV and V- Common bile ducts

- Lymph nodes- Duodenum and head of the pancreas- Colon and wall abdominal- Intraperitoneal seeding

It help to determine the resecability of gallbladder carcinoma andprovides a vascular road map for radical cholecystectomy It permits to postoperative follow-up


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Imaging MRI It is a sensitive modality for detection and evaluation

of the tumor and its extent

The primary tumor is, to varing degrees, hypointenseon T1and hyperintense on T2

It remains the more sensitive technique for detectionof intra and extrahepatic bilary dilatation


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TNM ClassificationStage T1 : polypoid lesions without wall thickening

Stage T2 : Nodular or sessile lesion with wall thickening andpresence of a greasy plan that separates the tumorfrom the adjacent organs

Stage T3 : lesion that doesnt respect the greasy plan thatseparates the tumor from a adjacent organ (lessthan 2cm at the level of the liver)

Stage T4 : lesion invading two adjacent organ or more

and invading the liver of more than 2 cm.


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Conclusion Primitive gallbladder cancers are frequently diagnosed

in an advanced stage. As result, its prognosis remainsgenerally poor. Echography : high sensitivity for depicting the tumor

Computed tomography permits to : Confirm the echographic diagnosis investigating dissemination

Specify the stage of the gallbladder carcinoma Postoperative follow-up Prophylactic cholecystectomy+++++


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1- Gore RM, Shetland RP. Biliary tract neoplasms: diagnosis and staging. CancerImaging. 2007 Oct 1;7 Spec No A:S15-23. Review. PMID: 17921093.

2- Huang CP, Chiou YY, Chou YH, Chiang JH, Chang CY. Imaging findings inmucin-producing carcinoma of the gallbladder. J Formos Med Assoc. 2006May;105(5):427-30.

3- Kalra N, Suri S, Gupta R, Natarajan SK, Khandelwal N, Wig JD, Joshi K. MDCT inthe staging of gallbladder carcinoma. AJR Am J Roentgenol. 2006Mar;186(3):758-62.

4- Kim BS, Ha HK, Lee IJ, et al. Accuracy of CT in local staging of gallbladdercarcinoma. Acta Radiol 2002;43:71-6.5- Kim YH. Carcinoma of the gallbladder associated with clonorchiasis:

clinicopathologic and CT evaluation. Abdom Imaging 2003;28:83-6.6- Miller G, Schwartz LH, D'Angelica M. The use of imaging in the diagnosis and

staging of hepatobiliary malignancies. Surg Oncol Clin N Am. 2007Apr;16(2):343-68. Review. PMID: 17560517.

7- Reid KM, Ramos-De la Medina A, Donohue JH. Diagnosis and surgicalmanagement of gallbladder cancer: a review. J Gastrointest Surg. 2007May;11(5):671-81. Review. PMID: 17468929.

8- Yoshimitsu K, Honda H, Shinozaki K, et al. Helical CT of the local spread of

carcinoma of the gallbladder: evaluation according to the TNM system inpatients who underwent surgical resection. AJR 2002;179:423-8.

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