Accuracy of Preoperative T-Staging of Gallbladder Carcinoma Using MDCT
Soo Jin Kim1,
Jeong Min Lee1,
Jae Young Lee1,
Jin Young Choi1,2,
Se Hyung Kim1,
Joon Koo Han1 and
Byung Ihn Choi1
1 Department of Radiology and Institute of Radiation Medicine, Seoul National
University Hospital, 28, Yeongeon-dong, Jongno-gu, Seoul 110-744, Korea.
2 Present address: Department of Diagnostic Radiology, Research Institute of
Radiological Science, Yonsei University College of Medicine, Seoul,
Korea.
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Fig. 1A —51-year-old woman with stage pT1a lesion of gallbladder, which was
diagnosed on CT as stage T1. Axial CT scan shows well-enhancing nodular lesion
(arrow). There is no wall thickening around nodular lesion in
gallbladder.
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Fig. 1B —51-year-old woman with stage pT1a lesion of gallbladder, which was
diagnosed on CT as stage T1. Photomicrograph of histopathologic specimen
reveals tumor to be confined to mucosal layer (pT1a). (H and E)
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Fig. 2A —55-year-old woman with stage pT1b lesion of gallbladder, which was
diagnosed on CT as stage T1. Axial CT scan shows nodular lesion with smooth
thickening and enhancement of gallbladder wall (arrows).
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Fig. 2B —55-year-old woman with stage pT1b lesion of gallbladder, which was
diagnosed on CT as stage T1. Photomicrograph of histopathologic specimen shows
tumor to be confined to muscular layer (pT1b) (arrowheads). (H and E,
x40)
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Fig. 3A —72-year-old man with stage pT1 gallbladder cancer, which was
overstaged as T2. Axial CT scan shows focal wall thickening and nodular lesion
(black arrow) in body of gallbladder. Tumor was overstaged as T2 by
observers because enhancement of thickened gallbladder wall was considered to
represent tumor involvement of whole layer of gallbladder wall (white
arrow).
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Fig. 3B —72-year-old man with stage pT1 gallbladder cancer, which was
overstaged as T2. Endoscopic sonogram definitely shows preserved hypoechoic
muscle layer (arrowheads) that suggests T1 lesion.
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Fig. 3C —72-year-old man with stage pT1 gallbladder cancer, which was
overstaged as T2. Photomicrograph of histopathologic specimen reveals tumoral
extension (arrowheads) through Rokitansky-Aschoff sinuses
(asterisk). Involvement of Rokitansky-Aschoff sinuses indicates T1
lesion. However, tumor involvement of Rokitansky-Aschoff sinuses, which is
invaginated into muscular layer, may mimic T2 lesion. (H and E, x40)
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Fig. 4A —57-year-old man with stage pT3 gallbladder cancer that was
understaged as T2 on axial CT images. Axial CT scan shows nodular lesion
(arrow) in body of gallbladder and subtle hyperattenuation of
adjacent pericholecystic fat (arrowheads). Observers considered
lesion to be cholecystitis accompanying cancer because of weak enhancement of
pericholecystic fat.
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Fig. 4B —57-year-old man with stage pT3 gallbladder cancer that was
understaged as T2 on axial CT images. Oblique coronal CT scan shows
pericholecystic fat infiltration and pericholecystic vessel involvement
(arrowheads).
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Fig. 4C —57-year-old man with stage pT3 gallbladder cancer that was
understaged as T2 on axial CT images. Cut surface of gross specimen of
gallbladder reveals pericholecystic fat invasion (arrowheads).
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Fig. 5A —54-year-old woman with stage pT3 gallbladder cancer. These images
show value of multiplanar reformation (MPR) images in evaluation of T-staging.
Axial CT scan shows eccentric wall thickening (arrow) and papillary
lesion (asterisk) in fundus of gallbladder. Fat plane between liver
and gallbladder seems to be preserved on this axial plane
(arrowheads). This lesion was interpreted as T2 on axial CT
image.
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Fig. 5B —54-year-old woman with stage pT3 gallbladder cancer. These images
show value of multiplanar reformation (MPR) images in evaluation of T-staging.
However, oblique coronal MPR image shows focal liver invasion of gallbladder
cancer into adjacent liver (arrowheads). Asterisk indicates papillary
lesion.
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Fig. 5C —54-year-old woman with stage pT3 gallbladder cancer. These images
show value of multiplanar reformation (MPR) images in evaluation of T-staging.
Cut surface of gross specimen reveals pT3 lesion (arrowheads).
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