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https://upload.medbullets.com/topic/120447/images/intraluminal_mass.jpg
Snapshot
  • A 65-year-old woman presents with right upper quadrant pain. Her symptoms have been associated with unintentional weight loss over the course of 3 months. Physical examination is notable for right upper quadrant tenderness to palpation. She is also noted to have scleral icterus. Abdominal ultrasound demonstrates an intraluminal mass obstructive the common bile duct and infiltrating the adjacent liver.
Introduction
  • Overview
    • malignancy originating from the gallbladder
      • 2 patterns of growth
        • infiltrating
          • more common
          • can cause deep ulcerations, leading to fistula formation in towards adjacent structures (e.g., liver)
        • exophytic
          • cauliflower-appearing and can invade the gallbladder wall
      • most gallbladder cancers are adenocarcinomas
      • patients typically present when the cancer is advanced
        • due to the vagueness of symptoms
  • Epidemiology
    • incidence
      • women > men
    • risk factors
      • chronic inflammation secondary to
        • gallstones 
        • infections
      • porcelain gallbladder  
        • describes calcification of the gallbladder
        • associated with cholelithiasis
Presentation
  • Symptoms
    • asymptomatic
      • seen in early disease
    • nonspecific symptoms
      • right upper quadrant pain
      • anorexia
      • nausea or vomiting
    • symptoms resulting from compression of adjacent structures
      • obstructive jaundice
  • Physical exam
    • unintentional weight loss in severe disease
Imaging
  • Abdominal ultrasound
    • indication
      • typically the initial imaging study for patients with right upper quadrant pain
    • findings
      • mural thickening or calcification of the gallbladder wall
      • intraluminal mass 
      • direct liver infiltration
  • Cross-sectional CT or MRI/MRCP
    • indication
      • indication
        • imaging study of choice in patients with
          • ultrasound findings concerning for gallbladder cancer
          • incidentally diagnosed gallbladder cancer following cholecystectomy
Differential
  • Cholelithiasis
    • differentiating factors
      • gallstones are present within the gallbladder
Treatment
  • Treatment is geared towards gallbladder cancer staging
  • Surgical
    • gallbladder resection
      • indication
        • treatment of choice for resectable masses
Complications
  • Metastasis
  • Death

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