Biliary Tract and Gallbladder Neoplasia Flashcards
What are the locations of cholangiocarcinoma?
What are their relative incidences?
Intrahepatic (5%)
Perihilar (65%)
Extrahepatic (30%)
What is the epidemiology of cholangiocarcinoma?
(Relative incidence of malignancy, age)
3% of GI malignancies
Typically age of dx: 50-70
PSCs and biliary cysts results in younger age of dx
What are risk factors for cholangiocarcinoma?
PSCs (30% of cases)
Biliary cysts
Biliary parasitosis
Thorotrast - Contrast agent
Cirrhosis/liver damage not at all required
What types of biliary cysts are there?
Which one predispose to cholangiocarcinoma?
Classification (Stated we just have to understand they can occur in different spots):
Type I: Extrahepatic only
Type IV: Multiple cysts, extrahepatic
Type V: Intrahepatic only, Caroli’s disease
I, II, IV predispose to cholangiocarcinoma
What biliary parasites are there? Where are they located?
Clonorchis sinensis (Chinese liver fluke)
Far east and Russia
Asymptomatic, cholangitis
Growth cycle
Sheep/dogs natural host
Snail takes up egg and then deposits intermediate parasite in water
Transferred via water consumption
Opisthorchiasis (liver fluke of cats, dogs, and fish-eating mammals)
Southeast Asia and in Central and Eastern Europe
Similar to Clonorchis sinensis
What does cholangiocarcinoma lead to?
How does it manifest?
Leads to obstruction or severe narrowing
Extrahepatic: symptomatic from biliary obstruction
Jaundice, abdominal pain, pruritus, weight loss, fever
Intrahepatic: Less likely to be jaundiced, abdominal pain and weight loss
Half of draining still works
What lab tests are involved for cholangiocarcinoma?
What imaging/diagnostic studies?
Reduction of alk phos
Jaundice
Increased direct bilirubin
Carbonic Anhydrase (CA) 19-9 of limited value due to false positives and negatives
CT, MRI, ERCP (Necessary to confirm)
What is the histiological types of cholangiocarcinoma?
>90% adenocarcinoma
Squamous cell carcinoma and others exist
What is the treatment for cholangiocarcinoma?
What is the prognosis if not treated?
Curative Surgery
Distal: Whipple procedure
Resect piece of bile duct and pancreatic head
Reinsert bile duct and pancreas to small intestine
Perihilar: Bile duct resection, hepatic lobectomy
Intrahepatic: Hepatic resection
Liver transplant for hilar cholangiocarcinoma
Palliative care
5-10%, 5-year survival
What is the epidemiology of gallbladder cancer?
(Histiology, relative incidence, fatality, sex)
Adenocarcinoma; 75% of cases
Uncommon, highly fatal
Women have 2-6x risk than men
What are the risk factors?
Porcelain gallbladder
Gallbladder polyps
Cholelithiasis
What is a porcelain gallbladder?
What mechanisms result in its formation?
Epidemiology?
What elevates the risk?
Chronic cholecystitis with intramural calcification of gallbladder wall
Possible mechanisms:
Gallbladder wall injury from irritation of gallstones
Bile stagnation and mucosal precipitation of calcium carbonate salts
Deposition of lime salts from chronic inflammation
Uncommon but 5:1 in females
Incomplete calcification appears worse risk
What are the different causes and types of gallbladder polyps?
What likely determines the transformation potential?
Cholesterol: abnormal deposition of TGs, cholesterol precursors and esters into gallbladder mucosa
Inflammatory: Granulation and fibrous tissue with plasma cells and lymphocytes
Adenomas: Benign glandular tumors with potential for malignancy
Likelihood of transformation related to size (none less than 12 mm in series)
What percent of people have cholelithiasis?
What percent of gallbladder cancer patients have cholelithiasis?
What attribute fof cholelithiasis might indicated cancer?
0.5-3% incidence
70-90% of patients with gallbladder cancer have cholelithiasis
Size possibly indicative
What are the four typical presentations of gallbladder cancer?
Incidental on imaging (Best case)
Found intraoperatively during cholecystectomy for presumed benign disease
Found incidentally on pathologic examination: Most common
Symptomatic: Pain, anorexia, nausea, vomiting, jaundice; Very poor prognosis
