Publication: Pitfalls in diagnosing Gallbladder Carcinoma – A Single Center Histopathology Study
Date
2025
Journal Title
Journal ISSN
Volume Title
Publisher
Kathmandu University
Abstract
ABSTRACT
Background
Gallbladder carcinoma is a rare cancer with incidence of less than 2 per 100,000
populations worldwide. It is the fifth most frequent gastrointestinal malignancy.
Radiological or gross examination of majority of gallbladder carcinoma detects no
mass. This may lead to under or over diagnosis of cases in histological examination.
Objective
To identify pathologic features that contribute to the difficulty in diagnosis of
gallbladder carcinoma.
Method
Between 2018 and 2023, 22 patients with gallbladder carcinoma were identified
using the histopathology registry book at the department of pathology. Blocks, slides,
reports and history of those cases were retrieved and reviewed. The slides were
analyzed by two or more pathologist noting some of the diagnostic difficulties which
could have been encountered. The number and percentage with interpretations of
the cases were noted.
Result
Nine of 22 primary gallbladder carcinoma cases had tumor masses. Nine cases
in histological examination provided diagnostic challenges. The major pitfalls
encountered while diagnosing gallbladder carcinoma was mistakenly making a
diagnosis of carcinoma when only deeply penetrating Rokitansky–aschoff sinuses
are present. Similarly, pathologists misdiagnose carcinoma with minimal disease
as benign disease, Adenomyosis as Adenocarcinoma. Under sampling of specimen,
grossly occult disease, misinterpreting extracellular mucin pools were other potential
pitfalls.
Conclusion
Deeply penetrating Rokitansky-aschoff sinus or Adenomyosis can be mistakenly
diagnosed as gallbladder carcinoma. Careful attention to any evidence of mural
thickening and close examination of deeply situated glandular structures were
crucial for proper diagnosis of gallbladder carcinoma.
KEY WORDS
Adenomysois, Gallbladder carcinoma, Histology, Necrosis, Pitfalls, Rokitansky–
Aschoff sinuses
Description
Dhakal B, Makaju R, Maharjan P, Basnet D, Shrestha B
Department of Pathology
Dhulikhel Hospital, Kathmandu University Hospital
Kathmandu University School of Medical Sciences
Dhulikhel, Kavre, Nepal
Keywords
Adenomysois, Gallbladder carcinoma, Histology, Necrosis, Pitfalls, Rokitansky– Aschoff sinuses