Gallbladder neoplasms Flashcards by Rosalynn Nguyen

Q

What are the 4 types of benign gallbladder neoplasms?

A

cholesterol polyps 2. inflammatory polyps 3. adenomas 4. adenomyomatosis

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Q

Describe cholesterol polyps

A

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

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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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Q

Describe adenomas

A

0.5 to 2 cm Pedunculated 3 types associated with gallstones

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Q

What are the three types of adenomas?

A

tubular papillary mixed types

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Q

Describe adenomyomatosis

A

solitary hyperplastic mucosal lesions near the fundus rarely associated with cancer

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Q

Which benign gallbladder lesions are associated with cancer?

A

Adenomas Adenomyomatosis

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Q

Are the majority of malignant gallbladder lesions primary or metastatic?

A

primary

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Q

what is the MC histological subtype of malignant gallbladder lesion?

A

adenocarcinoma

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Q

What are the subtypes of adenocarcinoma?

A

papillary nonpapillary mucinous

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Q

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

A

squamous cell adenosquamous neuroendocrine small cell sarcomatous

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Q

what are the mc metastatic lesions to the gallbladder?

A

melanoma lymphoma RCC HCC

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Q

where do the majority of cholangiocarcinoma form?

A

perihilar region (60-70%)

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Q

What bismuth classification for cholangiocarcinoma?

A

Type I

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Q

What bismuth classification for cholangiocarcinoma?

A

Type II

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Q

What bismuth classification for cholangiocarcinoma?

A

Type IIIa

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Q

What bismuth classification for cholangiocarcinoma?

A

Type IIIb

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Q

What bismuth classification for cholangiocarcinoma?

A

Type IV

Q

Are polyps more common in males or females?

A

males

Q

Is gallbladder cancer more likely in men or women?

A

women

Q

Which ethinicities are more prone to gallbladder cancer?

A

mexican

native american

south america

southest asian

japanese

Q

What are some risk factos for gallbladder cancer?

A

obesity
large stones >3 cm
large polyps >1.0 cm
segmental mucosa calcification
PSC
anomalous pancreaticobiliary junction (choledochal cysts)

Q

What are some risk factors for cholangiocarcinoma?

A

PSC
choledochal cysts
parasitic infection
hepatolithiasis
hepatitis C

Q

What parasitic infections increase risk for cholangiocarcinoma?

A

Chlonorchisis sinesis
opisthorchis

How to cholesterol polyps look on US?

hyperechoic compared to the liver

How to adenomas look on US?

isoechoic solitary homogenous smooth

How does adenomyomatosis look on US?

focal gallbladder wall thickening with diffuse/segmental round anechoic foci

How does adenocarcinoma look on US?

homogenous/hetergenous isoechoic solitary

How do adenomas and adenocarcinoma look different on US?

adenomas are usually smooth and homogenous

What is the staging work up for gallbladder cancer?

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

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

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

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

Observe

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

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

What is the staging work up for intrahepatic cholangiocarcinoma?

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

What is the treatment for resetable intrahepatic cholangiocarcinoma?

staging laparoscopy then resection with regional lymphadenectomy

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

Get MSI/MMR, TMB testing then consider systemic therapy

What is the work up for extrahepatic cholangiocarcinoma?

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

What is the primary treatment for resectable extrahepatic cholangiocarcinoma?

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

What is the primary treatment for unresectable extrahepatic cholangiocarcinoma?

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

What layer is gallbladder cancer T1a?

limited to lamina propria

What layer is T2a in gallbladder cancer?

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).

What layer is gallbladder cancer T1b?

started to grow into the muscular layer simple cholecystectomy no longer sufficient

When is it okay to do simple cholecystectomy for polyp?

When size is 1.0 cm to 1.9 cm