Gallbladder carcinoma is the most common biliary malignancy causing secondary liver invasion. Most commonly presents as a mass centered at the gallbladder fossa with direct invasion of segments IVb/V. Gallstones are the most important risk factor (>80% association). 2-3 times more common in women. Advanced disease shows biliary obstruction, hepatoduodenal ligament lymphadenopathy and peritoneal spread. Prognosis is poor as it is usually diagnosed at advanced stage.
Age Range
50-80
Peak Age
65
Gender
Female predominant
Prevalence
Uncommon
Over 90% of gallbladder carcinomas are adenocarcinomas. Chronic inflammation (gallstones → chronic cholecystitis) triggers the dysplasia-carcinoma sequence. Since the muscularis layer of the gallbladder wall is thin, tumor rapidly spreads to serosa and surrounding structures. Liver invasion occurs through direct contiguous spread — the gallbladder bed is not covered by peritoneum and is in direct contact with Glisson's capsule. Venous drainage into portal vein branches allows early hematogenous spread.
Infiltrative mass at gallbladder fossa replacing or indistinguishable from gallbladder wall, with direct invasion of liver segments IVb/V. Associated gallstones support diagnosis. This pattern is pathognomonic for gallbladder carcinoma and distinguishes it from other liver masses — mass center is at gallbladder fossa, not within parenchyma.
Heterogeneously enhancing mass at gallbladder fossa on portal venous phase. Gallbladder wall cannot be identified separately; mass has replaced the gallbladder and invaded the liver. Best evaluated on portal venous phase as contrast difference between liver parenchyma and tumor is maximal.
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Heterogeneously enhancing mass at gallbladder fossa with liver invasion is identified.
Heterogeneous enhancement in arterial phase. In mass-type lesions, peripheral enhancement may be more prominent. In wall thickening type, diffuse or focal increased enhancement is seen.
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Mass at gallbladder fossa demonstrating heterogeneous enhancement in arterial phase.
Mildly to moderately hyperintense mass at gallbladder fossa on T2-weighted images. Hyperintense relative to invaded liver parenchyma. Necrotic areas within the mass may show higher T2 signal. Gallstones typically appear as signal voids on T2.
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Moderately hyperintense mass at gallbladder fossa with associated gallstones on T2-weighted images.
Marked diffusion restriction on DWI — mass shows hyperintensity. Low signal on ADC map. Diffusion restriction in gallbladder carcinoma aids differentiation from benign wall thickening (chronic cholecystitis, xanthogranulomatous cholecystitis).
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Diffusion restriction within the mass at gallbladder fossa, consistent with malignancy.
Heterogeneous echogenic mass at gallbladder fossa on US. Gallbladder wall cannot be distinguished. Associated gallstones appear as echogenic foci with acoustic shadow. Liver invasion appears as hypoechoic/heterogeneous area. Biliary dilatation may accompany.
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Heterogeneous echogenic mass at gallbladder fossa with associated gallstones, suggesting liver invasion.
Progressive or persistent heterogeneous enhancement on delayed phase. Areas with desmoplastic stroma show late enhancement increase. Infiltrative borders may become more conspicuous on delayed phase.
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Persistent heterogeneous enhancement on delayed phase, suggesting desmoplastic stromal component.
Criteria
Most common presentation type (40-65%). Mass filling or replacing the gallbladder fossa. Associated with advanced disease — liver invasion usually accompanies.
Distinct Features
Large heterogeneous mass at gallbladder fossa, gallbladder not separately identifiable, prominent liver invasion
Criteria
Focal or diffuse wall thickening (>3 mm). Associated with earlier stage disease. May mimic chronic cholecystitis — irregular/asymmetric thickening and enhancement favor malignancy.
Distinct Features
Focal asymmetric thickening, irregular enhancement, DWI restriction — chronic cholecystitis shows diffuse, uniform thickening without DWI restriction
Criteria
Polypoid mass protruding into gallbladder lumen. Type with earliest diagnostic chance. Polyp >10 mm, broad base, increased vascularity favor malignancy. Associated wall thickening and liver invasion indicate advanced stage.
Distinct Features
>10 mm, broad-based, sessile polyp, enhancing lesion without acoustic shadow
Distinguishing Feature
ICC is peripherally located within liver parenchyma, independent of gallbladder fossa. Capsular retraction and peripheral biliary dilatation are more typical of ICC. Gallbladder carcinoma is centered at gallbladder fossa with direct invasion.
Distinguishing Feature
Hepatic adenoma is well-defined, encapsulated, homogeneously enhancing lesion. No gallstone association or infiltrative borders. Associated with young women and OCP use. Infiltrative border and gallstone association distinguish gallbladder carcinoma.
Distinguishing Feature
Colorectal metastasis is typically multiple and scattered within liver parenchyma. Shows rim enhancement and HBP target sign. Gallbladder carcinoma presents as single large mass at gallbladder fossa with gallstone association.
Urgency
urgentManagement
surgicalBiopsy
NeededFollow-up
3-monthGallbladder carcinoma is usually diagnosed at advanced stage. In early stage (T1a), simple cholecystectomy is sufficient; T1b and above require extended cholecystectomy + segment IVb/V resection + portocaval lymph node dissection. Unresectable cases receive palliative chemotherapy (gemcitabine + cisplatin). 5-year survival is 50-80% for stage I, <5% for stage IV. Surgical margin positivity and lymph node involvement are the most important prognostic factors.
Gallbladder carcinoma is usually diagnosed at an advanced stage. Surgery is curative in early-stage (T1-T2) cases. Cases with liver invasion require extended cholecystectomy and hepatectomy. Five-year survival is below 5% in advanced stages.