title: Gallbladder cancer: Clinical and pathological approach.
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.
authors.affiliation: Keita Kai, Shinichi Aishima, Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga City, Saga 849-8501, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Kai
authors.affiliation: Keita Kai, Shinichi Aishima, Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga City, Saga 849-8501, Japan.
authors.forename: Shinichi
authors.initials: S
authors.lastname: Aishima
authors.affiliation: Keita Kai, Shinichi Aishima, Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga City, Saga 849-8501, Japan.
authors.forename: Kohji
authors.initials: K
authors.lastname: Miyazaki
keywords: Gallbladder cancer; Pathology; Prognostic factors; Surgical strategy