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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
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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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