Carcinoma involving the gallbladder: a retrospective review of 23 cases - pitfalls in diagnosis of gallbladder carcinoma

<p>Abstract</p> <p>Background</p> <p>Carcinoma of the gallbladder (GBC) clinically mimics benign gallbladder diseases and often escapes detection until advanced stage. Despite the frequency of cholecystectomy, diagnosis of GBC remains problematic in many situations. We sought to identify pathologic features that contribute to the difficulty in recognition of GBC.</p> <p>Methods</p> <p>We identified 23 patients (ranged from 45 to 86 years, male to female ratio 1:4.5) with carcinoma involving the gallbladder referred to an academic medical center over a period of 10 years for study. This includes 10 cases of primary GBC, 6 cases of metastatic tumor to gallbladder, 6 cases of directly invasive adenocarcinoma arising elsewhere in the biliary tree, and one case of unidentified origin adenocarcinoma. Primary tumors include adenocarcinoma not otherwise specified (NOS) in 6 cases, papillary adenocarcinoma in 2 cases, and single cases of undifferentiated carcinoma and combined adenocarcinoma and neuroendocrine carcinoma (NEC). Metastatic tumors to gallbladder were from a wide range of primary sites, predominantly the gastrointestinal tract.</p> <p>Results</p> <p>These cases illustrate seven potential pitfalls which can be encountered. These include: 1) mistakenly making a diagnosis of adenocarcinoma of gallbladder when only benign lesions such as deeply penetrating Rokitansky-Aschoff sinuses are present (overdiagnosis), 2) misdiagnosing well-differentiated invasive carcinoma with minimal disease as benign disease (underdiagnosis), 3) differentiating between primary NEC of gallbladder and metastasis, 4) confusing primary mucinous adenocarcinoma of gallbladder with pseudomyxoma peritonei from a low grade appendiceal neoplasm disseminated to gallbladder, 5) confusing gangrenous necrosis related to cholecystitis with geographic tumoral necrosis, 6) undersampling early, grossly occult disease, and 7) misinterpreting extracellular mucin pools.</p> <p>Conclusions</p> <p>Clinical history and a high index of suspicion are prerequisite to detecting GBC. Detection of GBC at an early stage is difficult because the symptoms mimic benign gallbladder diseases. Misinterpretation of subtle microscopic abnormalities contributes diagnostic failures in early cases. Careful attention to any evidence of mural thickening, thorough sampling, particularly in older patients, and close examination of any deeply situated glandular structures are critical. Correlations with radiographic and clinical findings are important helps to avoid misdiagnosis in this commonly resected organ.</p

Working with farmers : The key to achieving adoption of more sustainable cassava production practices on sloping land in Asia

Farmers in Asia like to grow cassava because the crop will tolerate long dry periods and poor soils, and will produce reasonable yields with little inputs. Most farmers realize, however, that cassava production on slopes can cause severe erosion, while production without fertilizer inputs may lead to a decline in soil productivity. Research has shown that cassava yields can be maintained for many years with adequate application of fertilizers, and that there are various ways to reduce erosion. Adoption of erosion control practices, however, has been minimal as farmers generally see little short-term benefits of these practices. To enhance the adoption of soil conserving practices and improve the sustainability of cassava production, a farmer participatory research (FPR) approach was used to develop not only the best soil conservation practices, but also to test new varieties, fertilization and cropping systems that tend to produce greater short-term benefits. Th

Improving the sustainability of cassava-based cropping systems in Asia: a farmer participatory approach to technology development and dissemination

Cassava (Manihot esculenta Crantz) is the third most important food crop in southeast Asia; the crop is usually grown by smallholders in marginal areas of sloping or undulating land. Farmers grow cassava because the crop will tolerate long dry periods and poor soils, and will produce reasonable yields with minimum inputs. Most farmers realize, however, that cassava production on slopes can cause severe erosion, while production without fertilizer or manure inputs will lead to a gradual decline in soil productivity. Current production practices may thus not be sustainable. Research has shown that cassava yields can be maintained for many years with adequate application of fertilizers or manures, and that there are various ways to reduce erosion. Adoption of erosion control practices, however, has been minimal as farmers generally see little short-term benefits, while initial costs of establishing these practices may be substantial. In order to enhance the adoption of soil conserving practices and improve the sustainability of cassava production under a wide range of socio-economic and bio-physical conditions, a farmer participatory research (FPR) approach was used to develop not only the best soil conservation practices, but also to test new cassava varieties, fertilization practices and cropping systems that tend to produce greater short-term benefits. The FPR methodology was initially developed in 2-3 sites each i

Potentials for different models for freshwater aquaculture development in the Red River Delta (Vietnam) using GIS analysis

This study was an attempt to apply land-based GIS analysis for freshwater aquaculture planning in the Red River Delta of Vietnam. It was based on diverse data sources in order to help decision makers at the site and also to contribute to the modelling of selection processes for aquaculture development planning in the region

Potentials for different models for freshwater aquaculture development in the Red River Delta (Vietnam) using GIS analysis

Aquaculture development, Freshwater aquaculture, Geographical information systems, Red River Delta, Vietnam,