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Gallbladder carcinoma

  • Lesion

Gallbladder cancer grows in a gallbladder inflamed by stones for many years; it is often found late, sometimes by chance after surgery.

Updated

What it is

Carcinoma of the gallbladder is the most common malignancy of the extrahepatic biliary tract. It is more frequent in women and in some populations of Latin America (Chile, Bolivia and other Andean areas) and South Asia. Gallstones are present in most cases, and chronic inflammation drives a dysplasia-carcinoma sequence. Most tumours are adenocarcinomas that infiltrate the wall and liver early, so prognosis is poor unless found incidentally at an early stage.

Structure

  • Gross: diffuse grey-white thickening of the wall or a papillary mass, usually with stones; may invade the liver.
  • Micro: glands of malignant columnar cells in desmoplastic stroma; perineural and lymphatic invasion.

Step by step

  1. Stones and chronic inflammation injure the mucosa for years.
  2. Repeated regeneration favours metaplasia (pyloric or intestinal) and mutations (TP53, KRAS, ERBB2).
  3. Low-grade dysplasia progresses to high-grade dysplasia and carcinoma in situ.
  4. Invasive adenocarcinoma infiltrates the thin wall, which has no submucosa.
  5. The tumour invades the liver bed and spreads to lymph nodes and peritoneum.

Markers

  • Keratin 7
  • CEA
  • CA 19-9 (serum)
  • HER2 (ERBB2) in some

Clinical notes

  • Symptoms resemble gallstone disease: pain, then jaundice, weight loss and a mass when advanced.
  • Pathologists examine every cholecystectomy specimen because early carcinomas are often unsuspected.

Test yourself

Think of the answer, then tap the question to see it.

What is the main risk factor for gallbladder carcinoma?

Long-standing gallstones with chronic cholecystitis.

Why does gallbladder carcinoma invade the liver early?

The gallbladder wall is thin, lacks a submucosa and lies directly on the liver bed.

In which regions is gallbladder cancer especially common?

Andean South America (such as Chile and Bolivia) and parts of South Asia, with high rates in women.

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: Gallbladder Carcinoma (StatPearls (NCBI Bookshelf), 2024).

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