ABSTRACT
The diagnosis of early gallbladder carcinoma is almost impossible before surgery; in many cases the tumors are grossly inapparent. The usefulness of imprint cytology in detecting early carcinoma of the gallbladder mucosa was assessed. Eight macroscopically inapparent carcinomas were diagnosed, and nine grossly evident carcinomas were confirmed by imprint cytology in 120 cholecystectomies. The sensitivity of cytologic diagnosis of macroscopically inapparent carcinoma was 80%, specificity and predictive value were 100%, and efficiency was 97.7%. If overt carcinomas are included, both the sensitivity and efficiency increase, to 89.6% and 98%, respectively. For the diagnosis of dysplasia the sensitivity and predictive value was 84%, specificity 97.6% and efficiency 95.8%. Because of the simplicity and rapidity of imprint cytology of gallbladder mucosa, coupled with its high sensitivity and reliability, it is recommended for the detection of inapparent carcinoma during cholecystectomy in patients at high risk of cancer.
Subject(s)
Gallbladder Neoplasms/pathology , Gallbladder/pathology , Acute Disease , Aged , Carcinoma in Situ/complications , Carcinoma in Situ/diagnosis , Carcinoma in Situ/pathology , Cholecystectomy , Cholecystitis/complications , Cholecystitis/surgery , Cholelithiasis/complications , Cholelithiasis/surgery , Cholestasis, Extrahepatic/complications , Cholestasis, Extrahepatic/surgery , Female , Gallbladder Neoplasms/complications , Gallbladder Neoplasms/diagnosis , Humans , Male , Middle Aged , Mucous Membrane/pathology , Predictive Value of Tests , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
Papillary hyperplasia of the gallbladder was found in 376 patients (28.4%) and cholesterolosis in 206 (15.6%) of 1323 cholecystectomies. An association between these pathological alterations was found (p < 0.001). Papillary hyperplasia was interpreted as a morphological adaptation of the mucosa to permit a greater absorption of cholesterol from the gallbladder lumen to the blood capillaries. By means of this peculiar hyperplasia the surface of interchange increases and, therefore, absorption would be facilitated. It is suggested that papillary hyperplasia could be induced by the increase of bile pressure in the extrahepatic bile ducts and/or by the concentration of bile cholesterol.
Subject(s)
Bile/metabolism , Cholesterol/metabolism , Gallbladder/pathology , Aged , Case-Control Studies , Female , Gallbladder/metabolism , Humans , Hyperplasia , MaleABSTRACT
Papillary hyperplasia of the gallbladder was found in 376 patients (28.4
) and cholesterolosis in 206 (15.6
) of 1323 cholecystectomies. An association between these pathological alterations was found (p < 0.001). Papillary hyperplasia was interpreted as a morphological adaptation of the mucosa to permit a greater absorption of cholesterol from the gallbladder lumen to the blood capillaries. By means of this peculiar hyperplasia the surface of interchange increases and, therefore, absorption would be facilitated. It is suggested that papillary hyperplasia could be induced by the increase of bile pressure in the extrahepatic bile ducts and/or by the concentration of bile cholesterol.
