Ann Hepatobiliary Pancreat Surg.  2019 Nov;23(4):334-338. 10.14701/ahbps.2019.23.4.334.

Differentiation of gallbladder adenomyomatosis from early-stage gallbladder cancer before surgery

• Moon J
• Shin YC
• Heo TG
• Choi PW
• Kim JI
• Jung SW
• Jun H
• Jung SM
• Um E

• KMID: 2464321
• DOI: http://doi.org/10.14701/ahbps.2019.23.4.334

Abstract

BACKGROUNDS/AIMS
This study aimed to compare the perioperative and clinical outcomes in patients undergoing laparoscopic cholecystectomy for gallbladder adenomyomatosis (GBA) or early-stage gallbladder cancer (GBC).
METHODS
The perioperative and clinical outcomes of 194 patients diagnosed with GBA and 30 patients diagnosed with GBC who underwent laparoscopic cholecystectomy in our institution from January 2011 to December 2017 were retrospectively compared.
RESULTS
There were no significant differences between the GBA and GBC groups in sex (male:female ratio 1.0:0.8 vs. 1.0:0.7, p=0.734), BMI (23.9±3.4 vs. 24.0±3.8 kg/m², p=0.916), or preoperative liver function tests. Patients in the GBC group were significantly older (50.5±14.1 vs. 65.9±10.6 years, p<0.001) and had a higher ASA grade (40.3 vs. 63.4% grade II or III, p=0.043) than patients in the GBA group. Although there was no significant difference in preoperative diagnostic methods (p=0.442), the GBC group showed a significantly higher rate of misdiagnosis on preoperative imaging compared with postoperative histopathologic findings (30.9% vs. 53.3%, p=0.011). There were significantly more patients with gallstones in the GBA group than in the GBC group (68.6% vs. 40.0%, p=0.004).
CONCLUSIONS
In older patients hospitalized for biliary colic without gallstones but with a thickened gallbladder wall with inflammation on preoperative diagnostic exam, the possibility of early-stage GBC should be considered.

Keyword

Gallbladder adenomyomatosis; Gallbladder cancer; Differential diagnosis

MeSH Terms

Cholecystectomy, Laparoscopic
Colic
Diagnosis, Differential
Diagnostic Errors
Gallbladder Neoplasms*
Gallbladder*
Gallstones
Humans
Inflammation
Liver Function Tests
Retrospective Studies

Figure

• 

  Fig. 1 Preoperative diagnostic images of gallbladder diseases. (A) Ultrasonographic finding of a patient with gallbladder cancer, considered as chronic calculous cholecystitis preoperatively. (B) Computed tomographic scan of a patient with gallbladder cancer, considered as gallbladder adenomyomatosis preoperatively. (C) Computed tomographic scan of a patient with gallbladder adenomyomatosis, considered as gallbladder cancer preoperatively.

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