title: Gallbladder cancer in a high risk area: morphological features and spread patterns.
abstract: OBJECTIVE
  Gallbladder carcinoma is one of the most frequent malignant tumors in Chile. The aim of this paper is to show our experiences in gallbladder carcinoma.
  
  
  METHODS
  Six-hundred-sixty-nine cases of gallbladder carcinoma were included in this prospective study; 557 females (83.5%) and 112 males (16.5%). In 466 cases (70%), diagnosis was carried out in the cholecystectomy sample, 45 cases were partial cholecystectomies and 158 cases were metastases of gallbladder carcinoma.
  
  
  RESULTS
  Ninety-eight per cent of the cases were adenocarcinomas, and in 85% of the cases gallstones were observed. Thirty-seven per cent of the primary tumors were macroscopically inapparent. One-hundred-thirty-one cases (29%) were early carcinomas and 323 cases (71%) were advanced carcinomas. A relationship between differentiation grade and infiltration level (p=0.0001) was observed. Lymph-node metastasis was found in 18.5%, 4.5% and 3.3% in the first, second and third lymph-node barriers respectively. Muscular tumors presented no lymph-node metastasis, while in serosal tumors lymph node metastasis reached 62% (p=0.04). Hepatic tumor infiltration was observed in 11%, 19% and 38% of muscular, subserosal and serosal tumors.
  
  
  CONCLUSIONS
  The high frequency of inapparent carcinomas, gallstones and inflammatory changes of the vesicular wall are elements that make the pre-operative diagnosis of gallbladder carcinoma difficult. Differentiation grade and infiltration level are the most reliable prognostic factors in gallbladder carcinoma. Lymph-node metastasis or liver tumor infiltration are infrequent in early gallbladder carcinoma.
authors.affiliation: Department of Pathology and Cytopathology, Temuco Hospital, Faculty of Medicine, Universidad de la Frontera, Chile.
authors.forename: I
authors.initials: I
authors.lastname: Roa
authors.forename: J C
authors.initials: JC
authors.lastname: Araya
authors.forename: M
authors.initials: M
authors.lastname: Villaseca
authors.forename: J
authors.initials: J
authors.lastname: Roa
authors.forename: X
authors.initials: X
authors.lastname: de Aretxabala
authors.forename: G
authors.initials: G
authors.lastname: Ibacache
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002763:Cholecystectomy; D002769:Cholelithiasis / Q000401:mortality / Q000473:pathology / Q000601:surgery; D005260:Female; D005704:Gallbladder / Q000473:pathology; D005706:Gallbladder Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate