Pattern of Computerized Tomographic Findings in Suspected Gallbladder Cancer in Nigeria

  • MA Olusola-Bello
  • AA Olatunji
  • OI Ajayi
  • AO Adekoya
Keywords: Cancer, Computerized Tomography, Gallbladder, Gallstones, Liver Metastasis

Abstract

Background: Gallbladder (GB) cancer is a rare malignancy with a variable incidence worldwide. Imaging detection at an early stage is elusive. Preoperative imaging for tumour recognition and non-invasive staging is essential to triage patients to appropriate care.

Objectives: To describe the CT imaging findings of GB cancer among Nigerians.

Methods: A retrospective review of the CT images of 15 patients who had gall bladder carcinoma between January 2015 and June 2017 at a private diagnostic facility in Lagos was done.

Results: The age of the patients ranged from 39 to 73 years with a mean age of 60.9 years. The male to female ratio was 1:4.3. Clinical presentations included abdominal pain (61.5%) and jaundice (38.5%). Irregular GB wall thickening (61.5%) and focal mass lesions in the GB (38.5%) were the main features on imaging while 38.5% had associated gall stones. Infiltration of the adjacent liver was found in 76.9% and 60 % of those who had local infiltration of the liver also had intrahepatic metastasis.

Conclusion: A majority of gall bladder cancer cases are still diagnosed in their late stages. CT scan readily delineates regional spread into adjacent organs which may be obscured in other imaging modalities due to adjacent bowel gas.

References

Gore RM, Yaghmani V, Newmark GM, Berlin JW, Miller FH. Imaging benign and malignant diseases of the gall bladder. Radiol Clin North Am 2002: 40: 1307-1323. https://doi.org/10.1016/s0033-8389(02)00042-8

Haaga JR, Herbener EH. The gall bladder and biliary tract. In: Haaga JR, Lanzieri CF, Gilkeson RC. (Editors). CT and MR imaging of the whole body. 4th Ed. St Louis: Mosby, 2003: p.1357-1360.

George RA, Godara SC, Dhagat P, Som PP. Computed Tomographic findings in 50 cases of Gall bladder carcinoma. Med J Armed Forces India 2007; 63: 215-219. https://doi.org/10.1016/S0377-1237(07)80137-7

Reid KM, Medina AR, Donohue JH. Diagnosis and surgical management of gall bladder cancer; a review. J Gastrointest Surg 2007; 11: 671-681. https://doi.org/10.1007/s11605-006-0075-x

Randi G, Malvezzi M, Levi F, Ferlay J, Negri E, Franceschi S, et al. Epidemiology of biliary tract cancers: An update. Ann Oncol 2009; 20: 146-159. https://doi.org/10.1093/annonc/mdn533

Afifi AH, Abougabal AM, Kasem MI. Role of Multidetector Computed Tomography (MDCT) in diagnosis and staging of gall bladder carcinoma. The Egypt J Radiol Nuclear Med 2013; 44: 1-7. https://doi.org/10.1016/j.ejrmm.2012.11.003

Sugumar K, Garg I, Nandy K. Early Diagnosis of Carcinoma Gall Bladder- A case series. IOSR J Dent Med Sci 2017; 16: 74-76. https://doi.org/10.9790/0853-1610037476

Abdulkareem FB, Faduyile FA, Daramola AO, Rotimi OA, Banjo A, Elesha S, et al. Malignant gastrointestinal tumours in south-western Nigeria: a histopathologic analysis of 713 cases. West Afr J Med 2009; 28: 173-176. https://doi.org/10.4314/wajm.v28i3.48478

Sohn TA, Lillemoe KD. Tumours of the gallbladder, bile ducts and ampulla. In: Fedelman M, Friedman LS, Sleisenger MH (Eds). Sleisenger and Fortran’s Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 7th Ed. Philadelphia: Saunders. 2003: p. 1153-1164.

Tan CH, Lim KS. MRI of gallbladder cancer. Diagn Interv Radiol 2013; 19: 312-319. https://doi.org/10.5152/dir.2013.044

Akute OO, Ayantunde AA, Obajimi MO. A review of gall bladder carcinoma in Ibadan. Niger Postgrad Med J 2003; 10: 228-230.

Alatise OI, Lawal OO, Adisa AO, Arowolo OA, Ayoola OO, Agbakwuru EA, et al. Audit of management of gall bladder cancer in a Nigerian tertiary health facility. J Gastrointest Cancer 2012; 43: 472-480. https://doi.org/10.1007/s12029-011-9335-4

Luciano L, Reale E. The human gallbladder. In: Riva A, Motta PM, Riva FT (Editors) Ultrastructure of the Extraparietal Glands of the Digestive Tract. Electron Microscopy in Biology and Medicine (Current Topics in Ultrastructural Research). 1990. Springer, Boston, MA. https://doi.org/10.1007/978-1-4613-0869-0_12

Baron RL. Computed tomography of the biliary tree. Radiol Clin North Am 1991; 29: 1235-1250.

Kim SJ, Lee JM, Lee JY, Kim SH, Han JK, Choi BI, et al. Analysis of enhancement pattern of flat gallbladder wall thickening on MDCT to differentiate gallbladder cancer from cholecystitis. Am J Roentgenol 2008; 191: 765-777. https://doi.org/10.2214/AJR.07.3331

Jung SE, Lee JM, Lee K, Rha SE, Choi BG Kim EK, et al. Gallbladder wall thickening: MR imaging and pathologic correlation with emphasis on layered pattern. Eur Radiol 2005; 15: 694-701. https://doi.org/10.1007/s00330-004-2539-2

Pilgrim CH, Groeschl RT, Pappas SG, Gamblin TC. An often overlooked diagnosis: imaging features of gallbladder cancer. J Am Coll Surgeons 2013; 216: 333-339. https://doi.org/10.1016/j.jamcollsurg.2012.09.022

Stinton LM, Shaffer EA. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver 2012; 6: 172- 187. https://dx.doi.org/10.5009%2Fgnl.2012.6.2.172

Shrikhande SV, Barreto SG, Singh S, Udwadia TE, Agarwal AK. Cholelithiasis in gallbladder cancer: coincidence, cofactor, or cause! Eur J Surg Oncol 2010; 36: 514-519. https://doi.org/10.1016/j.ejso.2010.05.002

Hundal R, Shaffer EA. Gallbladder cancer: epidemiology and outcome. Clin Epidemiol 2014; 6: 99-109. https://doi.org/10.2147/CLEP.S37357

Furlan A, Ferris JV, Hosseinzadeh K, Borhani AA. Gallbladder carcinoma update: Multimodality imaging evaluation, staging and treatment options. Am J Roentgenol 2008; 191: 1440-1447. https://doi.org/10.2214/AJR.07.3599

Published
2021-05-28
Section
Original Research

Most read articles by the same author(s)