Incidentally Detected Carcinoma Gallbladder in Patients Undergoing Cholecystectomy

Abstract

Gall bladder carcinoma (GBC) is most prevalent in the northern and northeastern states of India. The term ‘Incidental gall bladder carcinoma’ (IGBC) refers to the diagnosis coming as a surprise finding upon histopathological examination of the cholecystectomy specimen and its incidence varies from 0.35–2%. The conventional practice of submitting all excised gall bladder specimens for histopathological examination has also been challenged by some authors who feel that a selective approach should be adopted, in order to save costs and time. Our experience in this respect, from a tertiary level teaching hospital in southwestern India, is presented here along with a review of literature. Data in respect of all patients who underwent cholecystectomy for benign disorders from 01 Dec 2012 to 30 Nov 2014 was collected prospectively. In addition, retrospective collation of data from hospital records for the previous 2 years was undertaken. Gall bladder wall thickness ≥ 4 mm, on USG examination, was taken as abnormal. All excised gall bladder specimens were opened and examined immediately after surgery in the operation theatre and then submitted for histopathological examination. Statistical analysis was performed using SPSS 19.0. A p value of less than 0.05 was considered significant. A total of 1123 patients underwent cholecystectomy for benign gallbladder pathologies. IGBC was detected in seven (three male and four female) patients. Only one, out of these seven patients, had focal gallbladder wall thickening at the fundus while the other six cases did not have any macroscopic abnormality of the gallbladder wall or mucosa. The mean age of the patients with IGBC was 63.86 years and it was significantly higher as compared to those with benign histology (p value = 0.001). Furthermore, an age of more than 50 years was found to be significantly associated with IGBC (X ² = 9.446, p value = 0.002). In this series, IGBC was present in 0.62% of patients undergoing cholecystectomy for benign gall bladder pathologies. A patient’s age of more than 50 years was significantly associated with IGBC and we did not find any correlation between the symptomatology, ultrasound findings and macroscopic appearance of the specimen and the presence of IGBC. Hence, we feel that the practice of routine submission of all excised gall bladders for HPE should continue.