Cytologic diagnosis of gallbladder lesions - A study of 150 cases

Diagnostic Utility of Ultrasound-Guided Fine-Needle Aspiration Cytology in Gall Bladder Lesions: An Experience from a Tertiary Care Cancer Center in Eastern India

Introduction

Gallbladder cancer (GBC) is the most common malignancy, representing 80-95% of biliary tract cancers. Although ultrasonography-guided fine-needle aspiration cytology (USG-FNAC) has emerged as an effective diagnostic the tool for the precise diagnosis of gallbladder lesions, data on its diagnostic utility and cytomorphological categorization of gallbladder lesions are lacking.

Aims

To study the diagnostic utility of USG-FNAC in gallbladder lesions.

Materials and Methods

This study was the conducted prospectively on patients who came with clinical and radiological evidence of gallbladder space-occupying lesion and then advised to USG-FNAC over 2 years and 6 months from January 2018 to June 2020.

Results

A total of 314 cases were included. The mean age was 56 years, with a range of 17-88 years. Women predominated over men (Male:Female = 1:2.3). Primary adenocarcinoma of the gallbladder was most common. On cyto-histological correlation, the sensitivity, specificity, and diagnostic accuracy of USG-FNAC of gallbladder lesions were found to be 98.82, 87.23, and 96.3%, respectively.

Conclusion

The USG-FNAC of gallbladder lesion was found to be an easy, quick, cost-effective, and presumptive diagnostic procedure. It should be opted as an initial preoperative diagnostic modality in high incidence areas to avoid inappropriate management with unnecessary morbidity and cost. Moreover, a close cytological examination of the architectural pattern and the cytomorphological features would help in the sub-typing and prognosticating the tumor.

Gallbladder leiomyoma treated by laparoscopic cholecystectomy in a dog

CASE DESCRIPTION

A 12-year-old spayed female Chinese Crested was referred because of a mass detected in the gallbladder during ultrasonographic evaluation of the abdomen, which had been prompted by a history of high serum liver enzyme activities.

CLINICAL FINDINGS

Serum biochemical analysis revealed mild hypoglobulinemia and high alkaline phosphatase, γ-glutamyltransferase, and alanine aminotransferase activities. Abdominal ultrasonography revealed diffuse hepatopathy and multiple pedunculated mucosal structures within the gallbladder.

TREATMENT AND OUTCOME

Following initial treatment with ursodiol (11.4 mg/kg [5.18 mg/lb], PO, q 12 h) and S-adenosylmethionine (30 mg/kg [13.6 mg/lb], PO, q 24 h) for 1 month to address possible cholestasis, no change was noted in ultrasonographic or serum biochemical findings. Consequently, laparoscopic cholecystectomy was performed concurrently with laparoscopic liver biopsy. Histologic evaluation of resected gallbladder tissue and the liver biopsy specimen revealed evidence of multifocal to coalescing leiomyomas of the gallbladder and multifocal lipogranulomas of the liver. Eleven days after the dog was discharged from the hospital, it was taken to an emergency clinic because of anorexia, vomiting, and diarrhea. Mild pancreatitis or gastroenteritis was suspected, supportive treatment was provided, and ursodiol and S-adenosylmethionine administration was reinitiated. At the time of follow-up telephone contact with the owner 234 days after surgery, the dog continued to receive ursodiol and S-adenosylmethionine and had no clinical signs associated with hepatobiliary disease.

CLINICAL RELEVANCE

Leiomyomas, although rare, can develop in dogs and should be considered as a differential diagnosis for intramural gallbladder lesions. Laparoscopic cholecystectomy served as a minimally invasive surgical treatment for this benign neoplasia.

Diagnostic role of fine needle aspiration cytology (FNAC) in the evaluation of gall bladder lesions: an institutional experience

BACKGROUND

Carcinoma of the gall bladder is the most common malignancy of the biliary tract. Ultrasonography guided Fine Needle Aspiration Cytology (FNAC) plays a crucial role in early detection of gall bladder (GB) lesions. Early diagnosis of GB lesions is a necessity in view of rising trend in GB carcinoma related mortality in India. The aim of this study is to determine the diagnostic accuracy of pre-operative ultrasonography guided FNAC in the diagnosis of GB masses.

METHODS

This was a retrospective observational study performed at a tertiary care university hospital over a period of one and a half years. A total of 47 patients with clinico-radiological suspicion of GB malignancy were subjected to USG guided FNA. 20 of these patients underwent diagnostic Trucut biopsy in addition to FNA.

RESULTS

Forty-one out of 47 patients analyzed were positive for malignancy with female preponderance; MF ratio of 0.6:1. There were 29 females (61.8%) and 18 males (38.2%) in the range of 34 to 85 years. Cytomorphology was inconclusive for malignancy in two patients and unsatisfactory in one case. Two were labeled as chronic cholecystitis and one as acute cholecystitis. Adenocarcinoma was the most common malignancy found in 36 patients (76.6%).

CONCLUSION

USG guided FNAC is a rapid, safe and successful diagnostic procedure with high sensitivity for diagnosis of GB lesions. In the present scenario of increasing incidence of GB malignancy, FNAC has proved to be a useful first choice of investigation in the detection of GB lesions.

Spectrum of gallbladder malignancies on fine-needle aspiration cytology: 5 years retrospective single institutional study with emphasis on uncommon variants

BACKGROUND

Ultrasound-guided fine-needle aspiration cytology (FNAC) is the standard modality for diagnosis of gallbladder malignant neoplasms. Adenocarcinoma is the most common malignancy; however, other types may also be encountered. The aim of this study was to perform a retrospective analysis of gallbladder malignancies diagnosed on FNAC in the last 5 years to document the cytomorphological spectrum and the variations thereof.

METHODS

The records of the Department of Cytology, PGIMER were searched from July 2010 to June 2015 and all cases of gallbladder malignancies were analyzed in detail for cytomorphological characteristics. Giemsa and Hematoxylin-Eosin stained slides were evaluated with immunocytochemistry on cell blocks wherever available.

RESULTS

A total of 791 gallbladder FNAC performed in cases of radiologically suspected gallbladder malignancies were evaluated. Gallbladder carcinoma (GBC) was more common in females with a male to female ratio of 1:2.3. Median age was 53.4 years (range 24-85 years); 81 cases (10.2%) were nondiagnostic and 31 (3.9%) were suspicious of malignancy. A total of 645 FNACs were positive for malignancy, out of which there were 619 (96%) adenocarcinoma and 26 cases with unusual malignancies. These included adenosquamous carcinoma (8, 1.2%), squamous cell carcinoma (7, 1.1%), small cell neuroendocrine carcinoma (9, 1.3%), and one case each of undifferentiated carcinoma and Non Hodgkin lymphoma respectively. The unusual malignancies were confirmed on cell block immunocytochemistry.

CONCLUSION

Adenocarcinoma is most common type of gallbladder malignancy; however, other unusual types of carcinomas occur and in such cases, FNAC supplemented by cell block immunocytochemistry is required for an accurate diagnosis. Diagn. Cytopathol. 2017;45:36-42. © 2016 Wiley Periodicals, Inc.