Tumours - Gallbladder and Bile Ducts

Tumours

·        Benign tumours:

o  Adenomas and papillomas: project into the lumen.  Benign overgrowths of epithelium

o  Adenomyoma: nodule at the gallbladder tip composed of smooth muscle around benign ductules

·        Malignant:

o  Carcinoma of the gallbladder:

§  Uncommon: 0.5% of cholelithiasis patients

§  Associated with gallstones and inflammation

§  Presentation: insidious until late. Abdo pain, jaundice, anorexia, weight loss, nausea. 1% 5-year survival

§  Macroscopic appearance: at fundus and neck. Either infiltrating of fungating type. At discovery usually involve liver, bile ducts and portal nodes

§  Microscopic appearance: 95% adenocarcinoma (can be poorly differentiated), 5% squamous cell carcinoma (from squamous metaplasia)

o  Carcinoma of the bile ducts and ampulla:

§  Uncommon, associated with chronic inflammation, parasites, ulcerative colitis

§  Presentation: obstructive jaundice, pale stools, nausea, ­LFTs. Differentiate from obstruction due to stones. Poor prognosis

§  Macroscopic appearance: papillary fungating mass + intraductal nodules + diffuse infiltration ® obstruction. Periampullary tumours have better prognosis

§  Microscopic appearance: adenocarcinoma, occasionally squamous cell