Gallbladder carcinoma manifesting as acute cholecystitis: Clinical and computed tomographic features

Liang, Jiun-Lung; Chen, Min-Chi; Huang, Hsuan-Ying; Ng, Shu-Hang; Sheen-Chen, Shyr-Ming; Liu, Po-Ping; Kung, Chia-Te; Ko, Sheung-Fat

doi:10.1016/j.surg.2009.04.037

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Volume 146, Issue 5 , Pages 861-868, November 2009

Gallbladder carcinoma manifesting as acute cholecystitis: Clinical and computed tomographic features

Jiun-Lung Liang, MD
- Department of Radiology, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan
Min-Chi Chen, PhD
- Department of Public Health and Biostatistics Consulting Center, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan
Hsuan-Ying Huang, MD
- Department of Pathology, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan
Shu-Hang Ng, MD
- Department of Radiology, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan
Shyr-Ming Sheen-Chen, MD
- Department of Surgery, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan
- Department of Surgery, Xiamen Chang Gung Hospital, Xiamen, China
Po-Ping Liu, MD
- Department of Surgery, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan
Chia-Te Kung, MD
- Department of Emergency Medicine, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan
Sheung-Fat Ko, MD
- Department of Radiology, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan
- Reprint requests: Sheung-Fat Ko, MD, Department of Radiology, Chang Gung University, College of Medicine, Chang Gung Memorial Hospital, Kaohsiung Medical Center, 123 Ta-Pei Road, Niao-Sung Hsiang, Kaohsiung Hsien, 833 Taiwan.

Accepted 17 April 2009. published online 30 July 2009.

Background

Gallbladder carcinoma is uncommon and may manifest as acute cholecystitis. An accurate diagnosis is helpful for operative planning and this study attempted to explore the distinctive clinical and computed tomographic (CT) features for differentiating acute cholecystitis alone from that with contemporaneous gallbladder carcinoma.

Methods

This 20-year, retrospective study evaluated the CT features of 26 patients with surgically proven gallbladder carcinoma with clinical presentations of acute cholecystitis (carcinoma group). Thirty elderly patients with surgically proven simple acute cholecystitis were enrolled as age-matched controls (cholecystitis group). The clinical, laboratory, and CT findings were compared between the 2 groups.

Results

The carcinoma and cholecystitis groups showed no significant differences with respect to clinical symptoms (abdominal pain, fever, and jaundice), serum total bilirubin level, leukocyte count, percentage of segmented leukocytes, presence of gallstones, and CT features of pericholecystic stranding/fluid and focally increased enhancement of adjacent liver. Fifteen of the 26 (57.6%) patients in the carcinoma group exhibited diffuse gallbladder wall thickening on CT and the other 11 exhibited focal thickening or intraluminal masses. Beside female predominance, the patients in the carcinoma group had significantly higher serum aspartate/alanine aminotransferase and alkaline phosphatase levels, a thicker gallbladder wall, smaller volume, lower frequency of triple-layer gallbladder wall enhancement pattern, and a higher frequency of enlarged regional lymph nodes than those in the cholecystitis group.

Conclusion

For elderly patients, especially women, presenting with acute cholecystitis and abnormal liver function, CT demonstration of focal gallbladder wall thickening, intraluminal masses, small gallbladder with diffuse wall thickening, and enlarged regional lymph nodes are suggestive of concurrent gallbladder carcinoma. Triple-layer gallbladder wall enhancement is suggestive of simple acute cholecystitis.