KEY FACTS
Imaging
- •
US for initial detection and characterization, CECT or MR for preoperative assessment and staging
- •
3 main morphological types
- ○
Large soft tissue mass infiltrating gallbladder (GB) fossa/replacing GB, ± invading liver ( most common )
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Diffuse or focal GB wall thickening: Asymmetric, irregular, extensive thickening
- ○
Polypoid intraluminal mass: > 1 cm, thickened base, irregular margins
- ○
Top Differential Diagnoses
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GB polyp
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Chronic or xanthogranulomatous cholecystitis
- •
Hyperplastic cholecystoses
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Diffuse GB thickening from portal hypertension, heart failure
Pathology
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Most are adenocarcinoma; mean 5-year survival: 5-10%
- •
Chronic irritation of GB mucosa by gallstones (GS)
- •
Malignant degeneration of adenomatous polyps less common
- •
Spreads by local invasion or hematogenous spread to liver, nodal spread to porta hepatis and paraaortic nodes
Clinical Issues
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Most common malignancy of biliary tree; prevalence: 3-7%
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F:M = 3:1; mean age: 65 years
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Risk factors: GS, chronic infection and inflammation
- •
Preoperative diagnosis occurs in < 20% of patients, found at cholecystectomy for stones/cholecystitis
- •
Right upper quadrant pain, weight loss, anorexia, fever
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Jaundice occurs when tumor invades bile ducts
Scanning Tips
- •
Look for asymmetric mass infiltrating liver
: Direct tumor infiltration to liver parenchyma 
and retrograde spread along biliary tree 
.
filled with solid tumor proven to be adenocarcinoma. Color Doppler would be useful to confirm that this is a tumor and not sludge.
surrounded by tumor 
. The interface 
between the gallbladder and the liver is indistinct, indicating local invasion.
and kidney 
in the same patient shows liver metastases 
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