Gallbladder Carcinoma Update: Multimodality Imaging Evaluation, Staging, and Treatment Options
Alessandro Furlan1,2,
James V. Ferris1,
Keyanoosh Hosseinzadeh1 and
Amir A. Borhani1
1 Department of Radiology, University of Pittsburgh Medical Center (Presbyterian
Campus), 200 Lothrop St., Rm. 3950 CHP MT, Pittsburgh, PA 15213.
2 Present address: Istituto di Radiologia, Azienda Ospedaliero-Universitaria
"Santa Maria della Misericordia"di Udine, 33100 Udine (UD),
Italy.
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Fig. 1A —70-year-old woman with abdominal pain and weight loss.
Sonogram shows large heterogeneous mass (arrowheads) replacing
gallbladder lumen that is consistent with biopsy-proven gallbladder
carcinoma.
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Fig. 1B —70-year-old woman with abdominal pain and weight loss.
Contrast-enhanced CT scan during hepatic arterial phase shows primary
gallbladder carcinoma as large necrotic mass (asterisk) replacing
gallbladder lumen and extending into adjacent liver parenchyma
(arrowhead). Note hypervascularity in tumor periphery
(arrow).
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Fig. 1C —70-year-old woman with abdominal pain and weight loss.
Contrast-enhanced CT scan during portal venous phase at same anatomic level
asB shows some contrast retention in periphery of primary tumor
(arrow) and liver metastasis (arrowhead).
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Fig. 2 —68-year-old woman with cirrhosis undergoing MRI for tumor
screening. Axial fast spin-echo T2-weighted MR image shows hyperintense mass
(arrow) occupying gallbladder lumen and extending into adjacent liver
parenchyma (arrowheads) with similar signal intensity. Biopsy proved
this to be gallbladder carcinoma.
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Fig. 3A —59-year-old man with fever and anorexia. Contrast-enhanced CT
scan during hepatic arterial phase shows large carcinoma replacing gallbladder
lumen (asterisk) and intense enhancement in viable periphery
(arrow) and adjacent liver metastasis (arrowhead).
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Fig. 3B —59-year-old man with fever and anorexia. Contrast-enhanced CT
scan during portal venous phase shows hypodense necrotic component
(asterisk) and contrast retention in viable portions of primary tumor
(arrow) and adjacent liver metastasis (arrowhead).
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Fig. 4A —63-year-old woman with elevated liver function test results
and remote history of breast carcinoma. Contrast-enhanced CT image shows large
gallbladder mass (arrows) and adjacent liver lesions
(arrowhead) that are more suggestive of advanced gallbladder
carcinoma than suspected breast metastases.
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Fig. 4B —63-year-old woman with elevated liver function test results
and remote history of breast carcinoma. PET/CT image at same anatomic level as
A shows intense 18F-FDG uptake in gallbladder
(arrows) and hepatic extension (arrowhead) of tumor.
Percutaneous biopsy with sonography confirmed gallbladder carcinoma.
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Fig. 5 —45-year-old man with alcoholic cirrhosis and biopsy-proven
hepatocellular carcinoma. Contrast-enhanced CT scan during portal venous phase
shows large right hepatic lobe mass (white arrow) directly invading
gallbladder (asterisk) and portal vein (black arrow), which
may mimic gallbladder carcinoma.
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Fig. 6A —57-year-old woman with abdominal pain and jaundice. Sonogram
shows heterogeneously hypoechoic, asymmetric thickening of gallbladder wall
(straight arrows) and intraluminal gallstones (arrowhead).
Hypoechoic hepatic lesion (curved arrow) further supports presumptive
diagnosis of gallbladder carcinoma.
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Fig. 6B —57-year-old woman with abdominal pain and jaundice.
Contrast-enhanced CT scan shows corresponding appearance of asymmetric
gallbladder wall thickening (arrows) and liver metastasis
(arrowhead), although gallstones were not apparent.
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Fig. 6C —57-year-old woman with abdominal pain and jaundice.
Contrast-enhanced CT scan more cephalad than B shows adenopathy
(arrowhead) and bilateral adrenal metastases (arrows),
denoting stage IV or unresectable disease.
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Fig. 6D —57-year-old woman with abdominal pain and jaundice.
Sonographically guided percutaneous 18-gauge core biopsy (arrow) of
gallbladder wall (asterisk) confirmed gallbladder carcinoma. Note
layering gallstones in gallbladder lumen (arrowhead).
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Fig. 7 —78-year-old man undergoing further evaluation of gallbladder
lesion reported on sonography performed at outside institution.
Gadolinium-enhanced coronal T1-weighted MR image during equilibrium phase
shows gallbladder partially filled with sludge (arrowhead),
asymmetric irregular wall thickening, and delayed enhancement
(arrow).
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Fig. 8A —Common benign causes of gallbladder wall thickening.
40-year-old woman with chronic cholecystitis that was histologically proven
after surgical resection. Axial T2-weighted MR image shows hyperintense and
symmetric gallbladder wall thickening (arrow).
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Fig. 8B —Common benign causes of gallbladder wall thickening.
49-year-old man with xanthogranulomatous cholecystitis proven at
cholecystectomy. Color Doppler sonogram (B) shows gallbladder lumen
with diffuse wall thickening (arrowheads, B) and intramural
hyperechoic nodule (arrow, B) with acoustic shadowing
corresponded at pathology to xanthogranuloma. Coronal T2-weighted MR image
(C) shows xanthogranulomas as multiple intramural nodules
(arrows, C). Note presence of sludge in gallbladder lumen
(asterisk).
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Fig. 8C —Common benign causes of gallbladder wall thickening.
49-year-old man with xanthogranulomatous cholecystitis proven at
cholecystectomy. Color Doppler sonogram (B) shows gallbladder lumen
with diffuse wall thickening (arrowheads, B) and intramural
hyperechoic nodule (arrow, B) with acoustic shadowing
corresponded at pathology to xanthogranuloma. Coronal T2-weighted MR image
(C) shows xanthogranulomas as multiple intramural nodules
(arrows, C). Note presence of sludge in gallbladder lumen
(asterisk).
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Fig. 8D —Common benign causes of gallbladder wall thickening.
49-year-old woman with right upper quadrant pain. Contrast-enhanced CT scan
shows focal gallbladder wall thickening with intramural diverticulum
(arrow). Subsequent cholecystectomy for cholelithiasis confirmed
adenomyoma.
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Fig. 9 —51-year-old woman with primary sclerosing cholangitis
undergoing evaluation for liver transplantation. Contrast-enhanced CT scan
during portal venous phase shows focal nodular thickening (arrow) and
diffuse gallbladder wall thickening, proven at cholecystectomy to be T2
carcinoma and background chronic cholecystitis, respectively. Note cirrhosis
and varices (asterisk).
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Fig. 10A —81-year-old woman with weight loss. Sonogram shows
hyperechoic shadowing portions of gallbladder wall (arrowheads)
consistent with porcelain gallbladder and hypoechoic, polypoid, nondependent
mass (arrow) suggestive of malignant degeneration into gallbladder
carcinoma.
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Fig. 11 —70-year-old man undergoing CT for suspected abdominal aortic
aneurysm. Contrast-enhanced CT scan during portal venous phase shows enhancing
3-cm polypoid gallbladder mass (arrow) that was proven at
cholecystectomy to be gallbladder carcinoma.
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Fig. 12B —42-year-old man with malignant melanoma. PET/CT image
corresponding to A shows intense 18F-FDG uptake in proven
melanoma metastases to gallbladder (arrow) and lymph nodes
(asterisk), which mimic primary gallbladder carcinoma with nodal
metastasis.
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Fig. 13 —80-year-old woman referred for surgical consideration after
sonography performed at outside institution suggested gallbladder carcinoma
(not shown). Contrast-enhanced CT scan shows large gallbladder mass
(asterisk) directly invading liver (arrow), duodenum (D),
omentum (O), and colon (C), denoting stage IV (unresectable) disease.
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Fig. 14 —76-year-old man with suspected gallbladder carcinoma
undergoing staging CT. Contrast-enhanced CT scan shows hypodense polypoid
gallbladder mass (black arrow) extending to surrounding liver (T3)
(arrowhead) and adenopathy (white arrows).
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Fig. 15A —61-year-old woman with primary sclerosing cholangitis,
abdominal pain, and weight loss. Contrast-enhanced CT image shows superior
aspect of primary gallbladder carcinoma (arrowheads) with intraductal
growth via cystic duct to common duct (arrow).
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Fig. 15B —61-year-old woman with primary sclerosing cholangitis,
abdominal pain, and weight loss. Contrast-enhanced CT image shows enhancing
mixed cystic and solid bilateral ovarian masses (arrows) that were
confirmed at biopsy via transvaginal sonography to be metastases from
gallbladder carcinoma.
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Copyright © 2008 by the American Roentgen Ray Society.
