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Gallbladder cancer mostly grows from flat dysplasia rather than from polyps: dysplasia and carcinoma in situ sit next to four in five cancers, adenomas are rare, and the age gap between dysplasia and invasive cancer suggests about ten years of progression.
A review of the epithelial lesions involved in gallbladder carcinogenesis, dysplasia and adenomas, which represent two biologically distinct models. Dysplasia progresses to carcinoma in situ and then invasion; over 80% of invasive gallbladder cancers have areas adjacent to carcinoma in situ and epithelial dysplasia. Adenomas are uncommon (0.14% of cholecystectomies) and adenomatous remnants are found next to fewer than 3% of early carcinomas, suggesting the limited importance of that pathway.
Epithelial dysplasia unassociated with cancer is seen in about 1% of cholecystectomies for symptomatic stones. Metaplasia, dysplasia and carcinoma in situ are present in the mucosa adjacent to cancer in 66%, 81.3% and 69% of cases. The average ages of patients with isolated dysplasia (51.9 years), early carcinoma (56.8) and advanced carcinoma (62.9) form a gradient that suggests progression over roughly 10 years.
The morphological argument that gallbladder cancer is a flat-dysplasia disease, which is why it is invisible on imaging until late and why prevention rests on removing the diseased gallbladder rather than on polyp surveillance alone.
Shares Intracholecystic papillary-tubular neoplasm (ICPN), Dysplasia (pre-cancerous change), Gallbladder cancer.
Shares Metaplasia, dysplasia, carcinoma in situ: the flat route to gallbladder cancer, Dysplasia (pre-cancerous change), Gallbladder cancer.
Shares Metaplasia, dysplasia, carcinoma in situ: the flat route to gallbladder cancer, Dysplasia (pre-cancerous change), Gallbladder cancer.
Shares Intracholecystic papillary-tubular neoplasm (ICPN), Metaplasia, dysplasia, carcinoma in situ: the flat route to gallbladder cancer, Gallbladder cancer.
Shares Dysplasia (pre-cancerous change), Gallbladder cancer.
Shares Dysplasia (pre-cancerous change), Gallbladder cancer.