Six year disease free survival after liver transplantation in a patient with T3 gallbladder carcinoma: case presentation and review of the literature

Histopathological Features of Gallbladder Specimens Obtained From Liver Recipients

BACKGROUND

To evaluate the histopathological features of gallbladder specimens obtained from liver transplantation (LT) recipients and to find the correlation between these findings with the clinical features of patients.

METHODS

The 1985 patients who underwent LT in our institute between March 2002 and January 2021 and whose data regarding pathologic analysis of gallbladder could retrospectively be obtained were included in the study. The data of the patients including age, gender, the reason for LT (fulminant or nonfulminant), presence of ascites, macroscopic characteristics of gallbladder (the length, diameter, and wall thickness), and microscopic findings were all obtained and analyzed in the present study.

RESULTS

A total of 1985 patients (men = 1300 and women = 685) with a median age of 39.4 years were included in this study. LT was performed in 249 patients because of fulminant liver failure, and abdominal ascites were detected in 933 patients during LT. There were statistical differences in terms of age (P < .001), gallbladder length (P < .001). and width (P < .001) among the both gender, but there was no difference in terms of histopathologic characteristics and presence of gallstones. On the other hand, there were significant differences in terms of age (P < .001), gallbladder length (P < .001), width (P < .001), wall thickness (P = .021), presence of gallstones (P < .001), and histopathologic characteristics (P < .001) between the patients with fulminant and nonfulminant liver failure etiologies. Similar results were obtained when characteristics of patients with and without ascites were compared.

CONCLUSIONS

This the first study analyzing the histopathological analysis of gallbladder specimens in LT recipients. Chronic liver disease, presence of ascites and gender are the factors affecting the macroscopic and microscopic features of the gallbladder.

Role of surgery in cholangiocarcinoma: From resection to transplantation

The treatment of cholangiocarcinoma (CCA) represents a major challenge to modern medicine. Diagnostics and treatment modalities are complex and require close interdisciplinary work-up. However, surgical resection currently offers the only potentially curative treatment option. Improved peri-operative strategies as well as optimized surgical techniques have generated significantly increased survival chances for patients in recent years. Complete tumor resection is the key parameter to long-term survival. In spite of expanded surgical limits R0 resection cannot be achieved in some cases as parenchymal disease may limit the extent of resection. Although liver transplantation (LT) is not a standard therapy for CCA today, it may be an option in such selected cases. Protocols including neo-adjuvant radio-chemotherapy and staging-lymphadenectomy before LT have generated impressive results in the recent past. Since palliative options generate only short-term survival extension LT for CCA has lately been discussed more extensively after the procedure had been abandoned due to dismal survival data in the 1990-years. This review offers a comprehensive picture of the current surgical treatment option for cholangiocarcinoma.

Gallbladder polyps in primary sclerosing cholangitis: not so benign

PURPOSE OF REVIEW

The increased risk of malignancy of the biliary tract and colon observed in primary sclerosing cholangitis raises concerns as to whether standard guidelines for the practical handling of polypoid lesions of the gallbladder apply to this group of patients. The present review aims to summarize existing knowledge on this topic.

RECENT FINDINGS

Two recent studies reported adenocarcinoma in approximately 60% of the polypoid lesions of the gallbladder in patients with primary sclerosing cholangitis. One of the adenocarcinomas in the first of these studies, as well as two reported adenocarcinomas in a recent case series, occurred in lesions less than 1 cm. Cholecystectomy is normally not advocated for lesions less than 1 cm, but may be justified in patients with primary sclerosing cholangitis. In several studies, foci of dysplasia were also detected in separate adenomas and regions of the gallbladder not primarily affected by cancer. Concurrent dysplasia and malignancies of the bile ducts and colon have also been reported, and suggest that an increased awareness of malignancy is warranted in patients once gallbladder neoplasia has been detected.

SUMMARY

The increased risk of malignancy in primary sclerosing cholangitis also applies to polypoid lesions of the gallbladder. Cholecystectomy and intensified screening for dysplasia of the bile ducts and colon may be advisable in primary sclerosing cholangitis patients with neoplasia of the gallbladder.