Review
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World J Clin Cases. Oct 16, 2014; 2(10): 515-521
Published online Oct 16, 2014. doi: 10.12998/wjcc.v2.i10.515
Gallbladder cancer: Clinical and pathological approach
Keita Kai, Shinichi Aishima, Kohji Miyazaki
Keita Kai, Shinichi Aishima, Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga City, Saga 849-8501, Japan
Keita Kai, Department of Pathology, Saga University Hospital, Saga City, Saga 849-8501, Japan
Kohji Miyazaki, Department of Surgery, Faculty of Medicine, Saga University, Saga City, Saga 849-8501, Japan
Author contributions: Kai K, Aishima S and Miyazaki K contributed to this paper.
Correspondence to: Dr. Keita Kai, Department of Pathology, Saga University Hospital, 5-1-1 Nabesima, Saga City, Saga 849-8501, Japan. kaikeit@cc.saga-u.ac.jp
Telephone: +81-952-342234 Fax: +81-952-342055
Received: March 22, 2014
Revised: May 15, 2014
Accepted: July 18, 2014
Published online: October 16, 2014
Processing time: 207 Days and 9.7 Hours
Abstract

Gallbladder cancer (GBC) shows a marked geographical variation in its incidence. Middle-aged and elderly women are more commonly affected. Risk factors for its development include the presence of gallstones, chronic infection and pancreaticobiliary maljunction. Controversy remains in regard to the theory of carcinogenesis from adenomyomatosis, porcelain gallbladder and adenoma of the gallbladder. The surgical strategy and prognosis after surgery for GBC differ strikingly according to T-stage. Discrimination of favorable cases, particularly T2 or T3 lesions, is useful for the selection of surgical strategies for individual patients. Although many candidate factors predicting disease progression, such as depth of subserosal invasion, horizontal tumor spread, tumor budding, dedifferentiation, Ki-67 labeling index, p53 nuclear expression, CD8+ tumor-infiltrating lymphocytes, mitotic counts, Laminin-5-gamma-2 chain, hypoxia-inducible factor-1a, cyclooxygenase-2 and the Hedgehog signaling pathway have been investigated, useful prognostic makers or factors have not been established. As GBC is often discovered incidentally after routine cholecystectomy and accurate preoperative diagnosis is difficult, close mutual cooperation between surgeons and pathologists is essential for developing a rational surgical strategy for GBC.

Keywords: Gallbladder cancer; Surgical strategy; Pathology; Prognostic factors

Core tip: This review has documented the basic knowledge and surgical strategies for gallbladder cancer (GBC) based on the clinical and pathological data from previous studies. Discrimination of favorable cases, particularly T2 or T3 lesions, is useful for the selection of surgical strategies for individual patients. As GBC is often discovered incidentally after routine cholecystectomy and accurate preoperative diagnosis is difficult, close mutual cooperation between surgeons and pathologists is essential for developing a rational surgical strategy for GBC.