Gallbladder polyps: correlation and agreement between ultrasonographic and histopathological findings in a population with high incidence of gallbladder cancer / Pólipos da vesícula biliar: correlação e concordância entre achados ultrassonográficos e histopatológicos em uma população com alta incidência de câncer de vesícula biliar

ABSTRACT BACKGROUND: Gallbladder polyps are becoming a common finding in ultrasound. The management has to consider the potential risk of malignant lesions. AIMS: The aim of this study was to analyze the ultrasound findings in patients undergoing cholecystectomy due to gallbladder polyps and compare them for histopathological findings (HPs). METHODS: Patients with an ultrasonographic diagnosis of gallbladder polyp and who underwent cholecystectomy from 2007 to 2020 were included in the study. RESULTS: A total of 447 patients were included, of whom 58% were women. The mean age was 45±12 years. The mean size of polyps in US was 7.9±3.6 mm. Notably, 9% of polyps were greater than 10 mm, and single polyps were significantly larger than the multiple ones (p=0.003). Histopathological findings confirmed the presence of polyps in 88.4%, with a mean size of 4.8±3.4 mm. In all, 16 cases were neoplastic polyps (4.1%), 4 of them being malignancies, and all were single and larger than 10 mm. We found a significant correlation between ultrasound and histopathological findings polyp size determination (r=0.44; p<0.001). The Bland-Altman analysis obtained an overestimation of the US size of 3.26 mm. The receiver operating characteristic (ROC) curve analysis between both measures obtained an area under the receiver operating characteristic curve (AUC) of 0.77 (95%CI 0.74-0.81). Ultrasound polyps size larger than 10 mm had an odds ratio (OR) of 8.147 (95%CI 2.56-23.40) for the presence of adenoma and malignancy, with a likelihood ratio of 2.78. CONCLUSIONS: There is a positive correlation and appropriate diagnostic accuracy between ultrasound size of gallbladder polyps compared to histopathological records, with a trend to overestimate the size by about 3 mm. Neoplastic polyps are uncommon, and it correlates with size. Polyps larger than 10 mm were associated with adenoma and malignancy.

RESUMO RACIONAL: Os pólipos da vesícula biliar estão se tornando um achado comum na ultrassonografia (US). O manejo deve levar em consideração o risco de lesões malignas. OBJETIVOS: Analisar os achados da ultrassonografia em pacientes submetidos à colecistectomia por pólipos vesicais e compará-los com os achados histopatológicos. MÉTODOS: Foram revisados os prontuários médicos dos pacientes com diagnóstico ultrassonográfico de pólipo vesicular e submetidos à colecistectomia no período de 2007 a 2020. RESULTADOS: Foram incluídos no estudo 447 pacientes. A média de idade foi 45±12anos, sendo 58% mulheres. O tamanho médio dos pólipos na US foide 7,9±3,6mm. Nove por cento foram maiores que 10 mm, e os pólipos únicos encontrados foram maiores do que os múltiplos (p=0,003). A HP confirmou a presença de pólipos em 88,4%, tamanho médio 4,8±3,4mm. Dezesseis eram pólipos neoplásicos (4,1%) e quatro deles malignos, únicos e maiores que 10 mm. Foi encontrado correlação significativa entre a determinação do tamanho do pólipo ao ultrassonografia e histopatológicos (r=0,44; p<0,001). A análise de Bland-Altman obteve uma superestimação do tamanho do pólipo ao US em 3,26 mm. A análise da curva da característica de operação do receptor entre as duas medidas obteve uma área sob a curva curva da característica de operação do receptor (AUC) de 0,77 (IC95% 0,74-0,81). Pólipos ao ultrassonografia maiores que 10 mm apresentaram razão de chance (OR) de 8,147 (IC95% 2,56-23,40) para presença de adenoma e malignidade, com razão de verossimilhança de 2,78. CONCLUSÕES: Há uma correlação positiva e acurácia diagnóstica apropriada entre o tamanho dos pólipos da vesícula biliar por ultrassonografia em comparação com os achados histopatológicos, com uma tendência de superestimar o tamanho em cerca de 3 mm. Pólipos maiores que 10 mm foram associados a adenoma e malignidade.

Cholangiohydatidosis: an Infrequent Cause of Obstructive Jaundice and Acute Cholangitis

ABSTRACT Background. One of the evolutionary complications of hepatic echinococcosis (HE) is cholangiohydatidosis, a rare cause of obstructive jaundice and cholangitis. The aim of this study was to describe the results of surgical treatment on a group of patients with cholangiohydatidosis and secondary cholangitis in terms of post-operative morbidity (POM). Material and method. Case series of patients operated on for cholangiohydatidosis and cholangitis in the Department at Surgery of the Universidad de La Frontera and the Clínica Mayor in Temuco, Chile between 2004 and 2014. The minimum follow-up time was six months. The principal outcome variable was the development of POM. Other variables of interest were age, sex, cyst diameter, hematocrit, leukocytes, total bilirubin, alkaline phosphatase and transaminases, type of surgery, existence of concomitant evolutionary complications in the cyst, length of hospital stay, need for surgical re-intervention and mortality. Descriptive statistics were calculated. Results. A total of 20 patients were studied characterized by a median age of 53 years, 50.0% female and 20.0% having two or more cysts with a mean diameter of 13.3 ± 6.3 cm. A median hospital stay of six days and follow-up of 34 months was recorded. POM was 30.0%, re-intervention rate was 10.0% and mortality rate was 5.0%. Conclusion. Cholangiohydatidosis is a rare cause of obstructive jaundice and cholangitis associated with significant rates of POM and mortality.(AU)

Benign nodules mimicking hepatocellular carcinoma on gadoxetic acid-enhanced liver MRI

No abstract available.

Hamartoma de glándula peribiliar: reporte de dos casos / Peribiliar gland hamartoma: report of two cases

El hamartoma peribiliar (HPB) o adenoma de conductos biliares corresponde a un tumor hepático benigno, que representa tan solo el 1,3 por ciento de todos los tumores primarios del hígado. Macroscópicamente corresponde a una lesión redondeada bien delimitada, subcapsular, siendo habitualmente diagnosticado como un hallazgo intra-operatorio o de autopsia. Se presentan dos pacientes con diagnóstico incidental de HPB realizado en la Unidad de Anatomía Patológica del Hospital Hernán Henríquez de Temuco.

Peribiliary gland hamartoma (PGH) or bile duct adenoma corresponds to a benign liver tumor, which represents only 1.3 percent of all primary liver tumors. Corresponds to a macroscopically well-defined round lesion, subcapsular, and is usually diagnosed as an intra-operative findings or autopsy. We report two patients with incidental diagnosis of PGH conducted in the Pathology Unit of the Hospital Hernán Henríquez in Temuco.

Cytological diagnosis of cholangiocarcinoma with rib metastasis in a young female--a case report.

Intrahepatic cholangiocarcinomas are second most common primary tumors of the liver. They are usually seen in 6th to 7th decades of life and at an advanced stage leading to poor prognosis. Their occurrence in the young age group is rare. Histopathological features of this tumor are well documented but literature regarding cytomorphological features on FNA is limited. We describe the cytological features of this tumor in a young woman presenting primarily with a rib metastasis. FNA smears from hard lump in the right chest wall and liver mass showed small round tumor cells arranged in the form of sheets, clusters and occasional tubules. The cells showed mild pleomorphism and bland nuclear morphology. Intimately admixed with tumor cells were spindle shaped fibroblastic cells. Serum alpha-fetoprotein level was within normal limit. Special stain for bile and immunocytochemical staining for NSE, chromogranin and CALLA were all negative. Cholangiocarcinoma was diagnosed based on cytological findings and special stains and this diagnosis was histologically confirmed on biopsy.

Intrahepatic cholangiocarcinoma: report of a surgically resected case.

We report a middle aged female with intrahepatic cholangiocarcinoma which was resected successfully. Because of an unusual histology, a microscopic diagnosis could not be established pre-operatively. The tumor recurred locally 21 months after surgery. The case is reported mainly for the diagnostic problems it created.

Establishment and characterization of a cholangiocarcinoma cell line from a Thai patient with intrahepatic bile duct cancer.

A new human cholangiocarcinoma cell line (HuCCA-1) was established from cholangiocarcinoma (CCA) tissue fragments surgically removed from a Thai patient with intrahepatic bile duct cancer. The growth medium used for the primary cell culture was Ham's F12 supplemented with 10% fetal bovine serum (FBS) and 10 ng/ml epithelial growth factor (EGF). Approximately one month later, the cells were subcultured in Ham's F12 supplemented with only 10% FBS. The population doubling time was approximately 55 hr. Staining of the cells for cytokeratin and mucin confirmed that the cells were mucin-secreting tumor of epithelial cell origin. The supernatant fluid secreted a number of non-specific tumor markers including CA125 and traces of MCA and AFP. The ability of the HuCCA-1 cell line to synthesize specific marker that may have potential in the diagnosis of cholangiocarcinoma is now being investigated.

A histopathologic study of 61 cases of peripheral intrahepatic cholangiocarcinoma.

The histopathological study of 61 cases of peripheral intrahepatic cholangiocarcinoma was reported. Of the 5 autopsied livers and 13 surgically resected livers, 89 per cent showed massive gross appearance, 94 per cent contained Opisthorchis viverrini or showed evidence of previous opisthorchiasis. Gall stones were found in 7 cases (11.5%), common bile duct stones were found in one case. The tumors were classified into well differentiated, less differentiated and uncommon types (adenosquamous, anaplastic and mucinous) which were found in 14.66, 70 and 13.66 per cent respectively. Of the 61 liver specimens, 92 per cent produced mucin and 53 per cent had more than one histological types. The important routes of intrahepatic spreadings were lymphatic involvement (90%) and permeation into the portal connective tissue (80%). One case of combined hepato-cholangiocarcinoma was observed in a cirrhotic liver containing Opisthorchis viverrini and positive HBsAg.

Intracranial metastasis of hepatic carcinomas: a study of 9 cases within 28 years.

A study was made on nine hepatic carcinomas with intracranial metastases. These cases brought a total number of reported intracranial metametastatic hepatic carcinomas to 32 instances. The secondary intracranial hepatic carcinomas formed a proportion of 1.3 to 2.9 per cent among intracranial metastatic tumors. Nine patients in this series were young with an average age of 37 years. There were five hepatocellular carcinomas and four cholangiocarcinomas. An intracranial secondary hepatocellular carcinoma in a 37-year-old man produced massive intracerebral hemorrhage. Only four cases including the current one have been described as massive intracerebral hemorrhage because of secondary hepatocellular carcinoma. Our case, moreover, had a high level of hematocrits representing a paraneoplastic syndrome.