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Retroperiton

 
Goubaa Mohamed MD Djerba Tunisia

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--- Arabic
This is an elderly female who presents with fatigue and right upper quadrant pain. There is no history of previous abdominal surgery. C'est une vieille dame qui se présente avec fatigue et douleur de l'hypochondre droit. Il n'y a aucun antécédent de chirurgie abdominale.


gallbladder_carcinoma_ultrasonography


vésicule cancer échographie.


tumor gallbladder ultrasound liver


goubaa ultrasound


cancer vesicule echographie

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A gallbladder cannot be identified. Instead, a large solid hyperechoic mass is seen in the region of the gallbladder fossa. The margins of this mass extend into the adjacent liver. The mass contains hyperechoic area with shadowing, a finding consistent with calcification or stone (Scans 1 and 3). These findings suggest a gallbladder carcinoma with hepatic invasion. La vésicule biliaire ne peut pas être identifié. A sa place, une grande masse hyperéchogène solide est visible dans la région du fossette vésiculaire. Les bord de cette masse envahissent le foie adjacent. La masse contient une zone hyperéchogène avec cône d'ombre postérieur évoquant une calcification ou une lithiase (clichés 1 et 3). Cet aspect est évocateur d'un carcinome de la vésicule biliaire avec invasion hépatique.

 

 
Gallbladder carcinoma
Cancer de la vésicule biliaire

 


Gallbladder carcinoma

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Arabic

 

Carcinoma of the gallbladder is not uncommon, it accounts for up to 3 pet cent of primary malignancies. Carcinoma of the gallbladder is the most common cancer of the biliary tract, and most tumors occur in the gallbladder fundus. Most gallbladder cancers are classified as adenocarcinoma.
The etiology is unclear; however, risk factors include gallstones : the vast majority of gallbladder cancers are associated with gallstones : It probably occurs because of chronic irritation of the gallbladder wall by stones. Other particular risk factors for gallbladder carcinoma include : porcelain gallbladder, polyps of over 1 cm in size, chronic cholecystitis, exposure to carcinogens, and occasionally, choledochal cyst due to anomalous junction of the pancreato-biliary ducts. Gallbladder carcinoma is also more common in female patients and in older persons.

CLINICAL
The clinical symptoms are nonspecific in the early stages and may mimic benign gallbladder disease. Patients may have weight loss, anorexia, right upper quadrant pain, jaundice, nausea and vomiting, and hepatomegaly. Late diagnosis is more common, which speaks to the poor prognosis of this malignant disease for which the mean survival rate is 6 months.

ULTRASONOGRAPHY
The most common sonographic appearance for gallbladder cancer is a soft tissue mass centered in the gallbladder fossa that completely or partially obliterates the lumen.
Tumor has usually invaded the gallbladder bed before the onset of symptoms. Local infiltration usually inters a poor prognosis. The carcinoma may be infiltrating causing diffuse thickening and induration of the gallbladder wall or fungating resulting in a mass which fills the gallbladder lumen and invades the wall. Gallbladder polyps over 2 cm in size have a 65 to 95 % chance of being malignant.
Identification of gallstones within the mass can help to confirm that the origin of the mass is the gallbladder rather than adjacent organs.
Sonographically, gallbladder carcinoma may have different appearances:
* 1. gallstones within a mass strongly suggest carcinoma of the gallbladder
* 2. Localized or diffuse thickening of the gallbladder wall.
* 3. Intra-luminal polypoid or fungating mass.
* 4. diffusely echogenic masse
* 5. extensive tumor spread causing obstructive jaundice
* 6. low echogenicity mass extending into the porta and liver
* 7. high velocity arterial flow signal in tumor mass on color flow Doppler.
* 8. Color Doppler imaging may be used to differentiate biliary sludge, which is avascular, from a hypoechoic mass, which would show flow.
* 9. colour flow signal in the gallbladder wall
* 10. The vast majority of patients with gallbladder carcinoma will demonstrate cholelithiasis. Other findings such as dilated bile ducts, regional adenopathy, or hepatic metastases may be seen. There is an increased incidence of gallbladder carcinoma in patients with gallbladder wall calcification (porcelain gallbladder), though most gallbladder carcinomas will not demonstrate this finding.
* 11. spread from carcinoma of the gallbladder may cause lymphadenopathy in the region of the head of the pancreas, this may obstruct the common bile duct and mimic carcinoma of the head of the pancreas.

Differential
The differential diagnosis for gallbladder masses includes tumefactive sludge (biliary sludge, which is avascular), inflammatory wall thickening, polyps, metastases, and focal adenomyomatosis.
Nonmalignant causes of gallbladder wall thickening, such as cholecystitis and hyperplastic cholecystosis, can simulate gallbladder carcinoma.
Malignant entities which may cause confusion include pancreatic carcinoma and metastasis to the gallbladder (the most common being malignant melanoma).

Prognostic
Primary gallbladder carcinoma is an uncommon but highly malignant neoplasm which quickly metastasizes to the liver and portal nodes and has a very poor prognosis. The 5-year survival rate for patients is less than 20%, although the prognosis for patients with tumor confined to the gallbladder wall is much better. Unfortunately, up to 80% of these patients have direct tumor invasion of the liver or portal node involvement at the time of diagnosis.

 

 
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