Gall bladder carcinoma in patients undergoing cholecystectomy for cholelithiasis.

OBJECTIVE To determine the proportion and timing for suspecting the diagnosis of gall bladder carcinoma in patients undergoing cholecystectomy for cholelithiasis. METHODS A retrospective study conducted at the Aga Khan University Hospital, Karachi over a period of six years, included medical records of patients, with cholecystectomy for cholelithiasis and a histopathological diagnosis of gall bladder carcinoma. An extensive review was done with special reference to the features of suspected or unsuspected gall bladder carcinoma. Timing of suspicion was categorized on the basis of clinical features, investigations, operative and histopathological findings. RESULTS Out of 1396 cholecystectomies performed during the period of study, sixteen patients (1.15%) were diagnosed as gall bladder carcinoma. Only three patients had pre-operative ultrasonographic features to raise suspicion for gall bladder malignancy whereas eight patients were suspected to have a malignant lesion, on the operative findings. Five patients were missed and the diagnosis was established after histopathological examination. CONCLUSION The ultrasonography can miss a significant number of malignant lesions of the gall bladder and every cholecystectomy specimen should be examined histologically.