doi:10.1111/j.1440-1746.2011.06698.

E D U C AT I O N A N D I M A G I N G

jgh_6698

1462

Gastrointestinal: Gallbladder Carcinoma and Cholelithiasis:

A RadiologicPathologic Correlation

A 82-year-old female presented with right upper quadrant pain and

fever. Anorexia and weight loss of 5Kg over six months was
reported. On MRCP, multiple round and ovoid gallbladder filling
defects were demonstrated suggestive of gallstones. An irregular
lesion attached to the slightly thickened gallbladder wall was also
demonstrated (Figure 1). Cholecystectomy was performed and
histology diagnosed a gallbladder adenocarcinoma and cholelithiasis. (Figure 2).
Primary gallbladder carcinoma (GBC) is an uncommon malignancy, three times more common in women than in men, often
presenting with vague symptoms. GBC median survival is only 6
months as anatomical factors promote early local spread. The
majority of patients present with advance disease. Cholelithiasis is
an important risk factor for the development of GBC, probably due
to chronic irritation and inflammation of the gallbladder leading to
mucosal dysplasia and then carcinoma. Other risk factors include
age, postmenopausal status and cigarette smoking. GBC is usually
unsuspected; symptoms are not specific and may include abdominal pain, fever, weight loss and jaundice. Jaundice occurs more
frequently as a result of malignant obstruction of the biliary tree
rather than hepatic metastasis or coexistent choledocholethiasis.

The cross-sectional imaging patterns of GBC consist of a mass

replacing the gallbladder (40%65% of cases) [pattern A], focal or
diffuse wall thickening (20%30%) [pattern B]. In pattern C
(15%25%)as in the present caseGBC is manifested as a
polypoid lesion (usually larger than 1 cm in diameter) with a
thickened implantation base. The differential diagnosis should
include adenomatous or cholesterol polyps, carcinoid or melanoma metastasis. It has been reported that conventional MRI with
associated Magnetic Resonance Angiography (MRA) and MRCP
can disclose the disease and simultaneously detect liver or vascular
invasion, biliary tract and/or lymph node involvement.

Figure 1 MRCP demonstrates gallbladder with multiple gallstones

and a mass lesion with irregular borders (arrow) and broad base
attached to wall.

Figure 2 Surgical specimen of the gallbladder, which contains

multiple gallstones and a polypoid mass in the wall corresponding to
adenocarcinoma.

1462

Contributed by
N Courcoutsakis*, E Astrinakis*, H Bolanaki, E Mihailidou*,
A Karayiannakis, P Prassopoulos*
*Department of Radiology and Medical Imaging and 2nd
Department of Surgery, University Hospital of
Alexandroupolis, Greece

Journal of Gastroenterology and Hepatology 26 (2011) 1462

2011 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd