Carcinoma of the Gallbladder

A 56-year-old woman presented with a several-month history of colicky right upper quadrant abdominal pain associated with fatty-food intolerance. She had no physical signs or symptoms suggestive of obstructive jaundice. Routine ultrasound examination of the biliary tract and pan­creas demonstrated a mass in the fundus of the gallbladder. A follow-up computerized tomographic (CT) scan of the abdomen was consistent with an infiltrating carcino­ma versus adenoma of the gallbladder (Fig­ure 1).

Exploration of the abdomen revealed no evidence of carcinoma involving the -liver, serosa of the gallbladder, or hepato-duodenal ligament. A routine cholecystec-tomy was performed. The postoperative course was uneventful. Pathologic exami­nation of the specimen demonstrated ade-nocarcinoma of the gallbladder with no serosal invasion. A four-year follow-up has demonstrated no recurrence.

The preoperative diagnosis of carcinoma of the gallbladder is uncommon because of its rarity and nonspecific mode of presenta­tion. Right upper quadrant abdominal pain, weight loss, anorexia, and jaundice are some of the symptoms associated with this disease. Most patients presenting with these symptoms have advanced disease. Early carcinoma of the gallbladder usually presents with symptoms of biliary disease.

The preoperative diagnosis of carcinoma of the gallbladder infrequently is made with radiographic studies. Oral cholecys-togram, ultrasonography, and HIDA scans usually are not helpful. Upper gastrointesti­nal studies may show extrinsic compres­sion of the duodenum in advanced disease. Angiography is reported to be very specif­ic, but the majority of patients diagnosed in this fashion have unresectable disease. As demonstrated in our patient, CT has been reported to be the best preoperative radio-graphic study in the diagnosis of carcinoma of the gallbladder and a helpful diagnostic tool in nearly two-thirds of all cases.

References

1. Itai Y, Araki T, et al: Computerized tomography of gallblad­der carcinoma. Radiology 137:713, 1980.
2. Nevin JE, Moran TJ, et al: Carcinoma of the gallbladder: Staging treatment and prognosis. Cancer 37:141-148,1976.
3. Piehler JM, Crichlow RW: Primary carcinoma of the gall­bladder. Surg Gynecol Obstet 147:929-942,1978.
4. Sabiston DC: Textbook of Surgery: The Biological Basis of Modern Surgical Practice, pp 1165-1169. Philadelphia, WB Saun-ders, 1986.
   

Norman Bakshandeh, M.D.
Chief Resident Dept. of Surgery Beth Israel Medical
Center New York, NY

Martin Moskovitz, M.D.
Resident Dept. of Surgery Maimonides Medical Center
Brooklyn, NY

Pauline Hecht, M.D.
Attending Surgeon Beth Israel Medical Center
New York, NY

Charles K. McSherry, M.D.
Professor of Surgery Beth Israel Medical Center
New York, NY

Received April 21, 1992; in revised form May 12, 1992; accepted for publication May 13,1992.

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