Incidental Gall Bladder Adenocarcinoma in Cholecystectomy Specimens; A Single Center Experience and Review of the Literature.

BACKGROUND Gallbladder adenocarcinoma is the most common malignant tumor of the biliary tract. Most of gall bladder cancers are detected incidentally only after pathological examination of the surgical specimens. In this study we investigated the characteristics of incidental gallbladder cancers in our center and also reviewed the current literature regarding the diagnosis and treatment of such incidentally detected tumors in the gall bladder. METHODS We retrospectively reviewed all of the cholecystectomy specimens in the archives of Pathology Department in the hospitals affiliated to Shiraz University of Medical Sciences in the study period (2010-2016). Clinicopathological characteristics were extracted from the patients' clinical charts, which included symptoms, radiological findings, laboratory data, and surgical procedures as well as outcome. RESULTS During these 7 years we identified 18 cases of incidental gall bladder cancer, consisted of 13 women and 5 men with the age range of 32 to 85 (62.5 ± 14.2) years detected after pathological study of the resected gall bladders among more than 4800 resected gall bladders. During the period, only two patients were operated on with the impression of gall bladder adenocarcinoma, which was not included in the study. Ten cases were T1 and eight were T2 at the time of surgery. They have been followed up for 1-7 years, during which, six cases of T2 died. All of the T1 cases are alive and symptom free. CONCLUSION By increasing laparoscopic cholecystectomies in our center we observed 0.37% incidental cases of gall bladder adenocarcinoma. Preoperative diagnosis of this cancer in early stages is very difficult and needs high degree of suspicion. The most important predictor of prognosis is the stage of the cancer at the time of surgery. To the best of our knowledge, this is the first report of incidental gall bladder cancer from Iran.