Incidental Gall Bladder Carcinoma in Patients Undergoing Cholecystectomy: A Report of 7 Cases.

BACKGROUND: Carcinoma gall bladder accounts for 98% of all the gall bladder malignancies and is the sixth most common malignancy of the gastrointestinal tract worldwide. Incidental gall bladder carcinoma (IGBC) is an incidental finding of carcinoma diagnosed during a laparoscopic cholecystectomy or on histopathological examination of gall bladder specimen removed for benign gall bladder diseases. The incidence of IGBC is around 0.19 - 3.3% in the literature.

OBJECTIVES: The aim of the present study was to report our experience with gall bladder cancers which were incidentally diagnosed during histopathological examination of cholecystectomy specimens done for benign gall bladder disease and follow up of the cases.

MATERIAL AND METHODS: This study includes 270 cholecystectomy specimens which were removed, during June 2010 to July 2011 in a tertiary care hospital. The clinicopathological findings of cases with incidentally detected gall bladder cancers were recorded; age, sex, presenting symptoms, presence of gall stones and histologic grade and staging of tumours were included. Exclusion criteria included preoperative suspicion of malignancy before cholecystectomy. American joint committee on cancer (AJCC) staging system was used for staging incidental gall bladder carcinoma.

RESULTS: In our study laparoscopy or open cholecystectomy was attempted in 270 cases during the one year period. Incidental gall bladder carcinomas were diagnosed in 7 cases (2.59%), with mean age of 50 years. Pain, vomiting, and dysphagia were the presenting complaints. USG revealed thickened gall bladder in 6 cases, and polyp in one case. Gall stones were seen in 6 cases. Histopathology showed moderately differentiated adenocarcinoma in all the cases. AJCC staging of gall bladder carcinoma revealed 6 cases in pT2 stage and pT1 a stage in one case. On follow up at 22 months, 6 cases were alive while one expired due to tumour metastasis.

CONCLUSION: Prognosis of incidental gall bladder carcinoma is better, if diagnosed in early stages.