Differential diagnosis and indications of gallbladder cancer

Differential diagnosis and indications of gallbladder cancer? Gallbladder cancer (also known as gallbladder cell carcinoma, English: carcinoma of gallbladder) refers to malignant tumors originating from the gallbladder. From the perspective of histological classification, adenocarcinoma accounts for the highest proportion (greater than 80%), followed by squamous cell carcinoma, mixed carcinoma and undifferentiated carcinoma. Due to its high malignancy, easy early metastasis, difficulty in early detection, and insensitivity to chemotherapy drugs, gallbladder cancer ranks first among malignant tumors of the gallbladder. Others include sarcoma, carcinoid, primary malignant melanoma, giant cell adenocarcinoma, etc. Primary gallbladder cancer is relatively rare in clinical practice.

The differential diagnosis of gallbladder cancer presents different requirements depending on the course of the tumor.

1. Gallbladder polypoid lesions: Early gallbladder cancer is mainly differentiated from gallbladder polypoid lesions. The diameter of gallbladder cancer is greater than 1.2 cm, the pedicle is wide, and the gallbladder wall is thickened. It is very difficult to differentiate between malignant transformation of gallbladder adenomatous polyps and benign adenomas. Because gallbladder adenomas are precancerous lesions, they should be surgically removed once diagnosed, so it does not affect surgical treatment decisions.

2. Gallstones: About 57% of domestic patients with gallbladder cancer have concurrent gallstones. Patients often have symptoms of biliary diseases for a long time. Such patients are most likely to be ignored, or the symptoms caused by gallbladder cancer are explained by gallstones. In differential diagnosis, the possibility of gallbladder cancer should be considered mainly for the elderly, women, long-term gallstones, gallbladder atrophy or filling stones, and when abdominal pain symptoms worsen and become persistent, and in-depth examinations should be done.

3. Primary liver cancer invading the gallbladder: Advanced gallbladder cancer also needs to be differentiated from primary liver cancer invading the gallbladder, forming a mass in the gallbladder and obstruction of the gallbladder outlet. Hepatocellular carcinoma invading the gallbladder may cause large lymph node metastases in the hilar region and hepatoduodenal ligament, similar to the lymph node metastasis in advanced gallbladder cancer. Gallbladder neck cancer may directly invade or cause high-level bile duct obstruction through lymph node metastasis, with clinical manifestations similar to hilar cholangiocarcinoma. Sometimes the original cancerous gallbladder has been surgically removed, but a pathological diagnosis could not be obtained for various reasons. Postoperative local recurrence of the tumor and hilar bile duct obstruction may make differential diagnosis difficult.