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Rosalynn's ABSITE > Gallbladder neoplasms > Flashcards

Gallbladder neoplasms Flashcards

1
Q

What are the 4 types of benign gallbladder neoplasms?

A
  1. cholesterol polyps 2. inflammatory polyps 3. adenomas 4. adenomyomatosis
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2
Q

Describe cholesterol polyps

A

smaller than 1 cm multiple associated with vesicular cholesterolosis no risk of cancer

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3
Q

Describe inflammatory polyps

A

smaller than 1 cm made of inflammatory cells secondary to chronic inflammation and cholestasis no risk of cancer

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4
Q

Describe adenomas

A

0.5 to 2 cm Pedunculated 3 types associated with gallstones

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5
Q

What are the three types of adenomas?

A

tubular papillary mixed types

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6
Q

Describe adenomyomatosis

A

solitary hyperplastic mucosal lesions near the fundus rarely associated with cancer

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7
Q

Which benign gallbladder lesions are associated with cancer?

A

Adenomas Adenomyomatosis

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8
Q

Are the majority of malignant gallbladder lesions primary or metastatic?

A

primary

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9
Q

what is the MC histological subtype of malignant gallbladder lesion?

A

adenocarcinoma

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10
Q

What are the subtypes of adenocarcinoma?

A

papillary nonpapillary mucinous

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11
Q

What other primary malignant lesions can be found in the gallbladder?

A

squamous cell adenosquamous neuroendocrine small cell sarcomatous

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12
Q

what are the mc metastatic lesions to the gallbladder?

A

melanoma lymphoma RCC HCC

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13
Q

where do the majority of cholangiocarcinoma form?

A

perihilar region (60-70%)

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14
Q

What bismuth classification for cholangiocarcinoma?

A

Type I

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15
Q

What bismuth classification for cholangiocarcinoma?

A

Type II

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16
Q

What bismuth classification for cholangiocarcinoma?

A

Type IIIa

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17
Q

What bismuth classification for cholangiocarcinoma?

A

Type IIIb

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18
Q

What bismuth classification for cholangiocarcinoma?

A

Type IV

19
Q

Are polyps more common in males or females?

A

males

20
Q

Is gallbladder cancer more likely in men or women?

A

women

21
Q

Which ethinicities are more prone to gallbladder cancer?

A

mexican

native american

south america

southest asian

japanese

22
Q

What are some risk factos for gallbladder cancer?

A
  1. obesity
  2. large stones >3 cm
  3. large polyps >1.0 cm
  4. segmental mucosa calcification
  5. PSC
  6. anomalous pancreaticobiliary junction (choledochal cysts)
23
Q

What are some risk factors for cholangiocarcinoma?

A
  1. PSC
  2. choledochal cysts
  3. parasitic infection
  4. hepatolithiasis
  5. hepatitis C
24
Q

What parasitic infections increase risk for cholangiocarcinoma?

A
  1. Chlonorchisis sinesis
  2. opisthorchis
25
Q

How to cholesterol polyps look on US?

A

hyperechoic compared to the liver

26
Q

How to adenomas look on US?

A

isoechoic

solitary

homogenous

smooth

27
Q

How does adenomyomatosis look on US?

A

focal gallbladder wall thickening with diffuse/segmental round anechoic foci

28
Q

How does adenocarcinoma look on US?

A

homogenous/hetergenous

isoechoic

solitary

29
Q

How do adenomas and adenocarcinoma look different on US?

A

adenomas are usually smooth and homogenous

30
Q

What is the staging work up for gallbladder cancer?

A
  1. Liver protocol CT or MRI if contraindicated
  2. CT chest and pelvis
  3. endoscopic U/S if CT equivocal
  4. Don’t need routine PET
  5. Elevated CA 19-9 and CEA may be suggestive of GB cancer but not diagnostic
31
Q

What is the staging work up for gallbladder cancer found incidentally during surgery?

A
  1. Frozen section plus any suspicious lymph nodes
  2. CT liver protocol + CT chest, MRI if CI
  3. If resectable: radical cholecystectomy with resection of segments IVB and V, lymphadenectomy, and hepatic/biliary resection as needed
  4. If unresectable: get microsatellite/mismatch repair testing and tumor mutational burden testing
32
Q

What is the staging work up for gallbladder cancer found incidentally on pathology that is T1a?

A

Observe

33
Q

What is the staging work up for gallbladder cancer found incidentally on pathology that is T1b or greater?

A
  1. Liver protocol CT, CT chest
  2. Consider staging laparoscopy
  3. if resectable do radical cholecystectomy with hepatic resection + lymphadenectomy +/- bild duct excision for malignant involvement
  4. if unresectable get MSI/MMR and TMB testing
34
Q

What is the staging work up for intrahepatic cholangiocarcinoma?

A
  1. Liver protocol CT, CT chest
  2. Consider CEA and CA 19-9, AFP
  3. LFT
  4. consider viral hepatitis serologies
  5. EGD and colonoscopy
  6. Biopsy
35
Q

What is the treatment for resetable intrahepatic cholangiocarcinoma?

A

staging laparoscopy then resection with regional lymphadenectomy

36
Q

What is the treatment for unresectable intrahepatic cholangiocarcinoma or metastatic disease?

A

Get MSI/MMR, TMB testing then consider systemic therapy

37
Q

What is the work up for extrahepatic cholangiocarcinoma?

A
  1. Liver protocol CT and CT chest
  2. cholangiography
  3. LFT
  4. consider CEA, CA 19-9
  5. consider EUS after surgical consultation
  6. consider serum IgG4 to rule out autoimmune cholangitis
38
Q

What is the primary treatment for resectable extrahepatic cholangiocarcinoma?

A
  1. surgical exploration/staging laparoscopy
  2. consider preop drainage
  3. multidisciplinary review
  4. resection
  5. Adjuvant therapy with capacitabine
39
Q

What is the primary treatment for unresectable extrahepatic cholangiocarcinoma?

A
  1. Biliary drainage if indicated
  2. biopsy (only after determining transplant status)
  3. get MSI/MMR/TMB testing
  4. Systemic treatment with Capecitabine
40
Q

What layer is gallbladder cancer T1a?

A

limited to lamina propria

41
Q

What layer is T2a in gallbladder cancer?

A

The cancer has grown through the muscle layer into the fibrous tissue on the side of the peritoneum (the lining of the abdominal cavity) (T2a).

42
Q

What layer is gallbladder cancer T1b?

A

started to grow into the muscular layer

simple cholecystectomy no longer sufficient

43
Q

When is it okay to do simple cholecystectomy for polyp?

A

When size is 1.0 cm to 1.9 cm

44
Q
A

Rosalynn's ABSITE (33 decks)

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