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WHO Classification of Tumours
Adenocarcinoma, NOS
Gallbladder and extrahepatic biliary tract


Definition

A common, malignat tumour characterized by the presence of malignant glandular cells. Morphologically, adenocarcinomas are classified according to the growth pattern (e.g., papillary, alveolar) or according to the secreted product (e.g., mucinous, serous). Representative examples of adenocarcinoma are ductal and lobular breast carcinoma, lung adenocarcinoma, renal cell adenocarcinoma, hepatocellular carcinoma, colon adenocarcinoma, and prostate adenocarcinoma.

I - Carcinoma of the gallbladder
This is a malignant epithelial neoplasm, usually with biliary, intestinal, foveolar or squamous differentiation, arising in the gallbladder. Most patients with carcinoma of the gallbladder are in the sixth or seventh decade of life. The incidence of this cancer tend to decrease

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Horner MJ, Ries LAG, Krapcho M, Neyman N, Aminou R, Howlader N et al (eds.)
SEER Cancer Statistics Review
http://seer.cancer.gov/csr/1975_2006/
National Cancer Institute: Bethesda 2009



and varies geographically and also in different ethnic groups within the same country. In the USA, it is more common in American Indians and Hispanic Americans than in whites or African Americans
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Albores-Saavedra J, Henson DE, and Klimstra DS eds.
Tumors of the Gallbladder, Extrahepatic Bile Ducts, and Ampulla of Vater
Armed Forces Institute of Pathology: Washington, DC 2000




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Devor EJ, Buechley RW
Gallbladder cancer in Hispanic New Mexicans II Familial occurrence in two northern New Mexico Kindreds
Can J Genet Cytol 1: 139-145.
1979




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Shaffer EA (2006)
Gallstone disease: Epidemiology of gallbladder stone disease.
Best Pract Res Clin Gastroenterol 20: 981-96



. The most important risk factors for carcinoma of the gallbladder are genetic background, gallstones and an abnormal choledochopancreatic junction. The prognosis for patients with carcinoma of the gallbladder depends primarily on the extent of disease and histological type
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Albores-Saavedra J, Murakata L, Krueger JE, Henson DE (2000)
Noninvasive and minimally invasive papillary carcinomas of the extrahepatic bile ducts.
Cancer 89: 508-15




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Albores-Saavedra J, Vardaman CJ, Vuitch F (1993)
Non-neoplastic polypoid lesions and adenomas of the gallbladder.
Pathol Annu 28 Pt 1: 145-77




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Bosman FT, Carneiro F, Hruban RH, Theise ND (Eds.)
WHO Classification of Tumours of the Digestive System.
4th Edition
International Agency for Research on Cancer: Lyon 2010



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> Histological subtypes
Adenocarcinomas
Adenocarcinoma, biliary type
Adenocarcinoma, intestinal type
Adenocarcinoma, gastric foveolar type
Clear cell adenocarcinoma
Mucinous adenocarcinoma
Hepatoid adenocarcinoma
Signet ring cell carcinoma

Carcinomas other than adenocarcinomas
Adenosquamous carcinoma
Cribriform carcinoma
Intraductal papillary neoplasm with an associated invasive carcinoma
Mucinous cystic neoplasm with an associated invasive carcinoma
Squamous cell carcinoma
Carcinosarcoma
Poorly differentiated carcinoma

II - Carcinoma of the extrahepatic bile ducts
This is also a malignant epithelial neoplasm, usually with biliary, intestinal, foveolar or squamous differentiation, arising in the extrahepatic bile ducts. Most patients with carcinoma of the extrahepatic bile ducts are also in the sixth or seventh decade of life. Except for the Republic of Korea, where incidence is somewhat higher, there is no geographical variation in the incidence of extrahepatic bile-duct carcinoma. Unlike in the gallbladder, choledocholithiasis does not play a role in the pathogenesis of carcinomas of the extrahepatic bile ducts. Risk factors for carcinoma of the extrahepatic bile ducts include primary sclerosing cholangitis, ulcerative colitis, abnormal choldedochopancreatic junction and, in south-east Asia, infestation with Clonorchis sinensis or Opisthorcis viverrini

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Choi D, Lim JH, Lee KT, Lee JK, Choi SH, Heo JS, Jang KT, Lee NY, Kim S, Hong ST (2006)
Cholangiocarcinoma and Clonorchis sinensis infection: a case-control study in Korea.
J Hepatol 44: 1066-73




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Curado. M. P., Edwards, B., Shin. H.R., Storm. H., Ferlay. J., Heanue. M. and Boyle. P. (Eds.)
Cancer Incidence in Five Continents
Vol. IX
IARC: Lyon 2007




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Lim MK, Ju YH, Franceschi S, Oh JK, Kong HJ, Hwang SS, Park SK, Cho SI, Sohn WM, Kim DI, Yoo KY, Hong ST, Shin HR (2006)
Clonorchis sinensis infection and increasing risk of cholangiocarcinoma in the Republic of Korea.
Am J Trop Med Hyg 75: 93-6




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Trajber HJ, Szego T, de Camargo HS, Mester M, Marujo WC, Roll S (1982)
Adenocarcinoma of the gallbladder in two siblings.
Cancer 50: 1200-3




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Watanapa P, Watanapa WB (2002)
Liver fluke-associated cholangiocarcinoma.
Br J Surg 89: 962-70



. As for gallbladder carcinomas, the prognosis for patients with neoplasms of the extrahepatic biliary tract depends primarily on the extent of disease and histological type
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Henson DE, Albores-Saavedra J, Corle D (1992)
Carcinoma of the extrahepatic bile ducts. Histologic types, stage of disease, grade, and survival rates.
Cancer 70: 1498-501




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Henson DE, Albores-Saavedra J, Corle D (1992)
Carcinoma of the gallbladder. Histologic types, stage of disease, grade, and survival rates.
Cancer 70: 1493-7




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Ohtani T, Shirai Y, Tsukada K, Hatakeyama K, Muto T (1994)
The association between extrahepatic biliary carcinoma and the junction of the cystic duct and the biliary tree.
Eur J Surg 160: 37-40




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Todoroki T, Okamura T, Fukao K, Nishimura A, Otsu H, Sato H, Iwasaki Y (1980)
Gross appearance of carcinoma of the main hepatic duct and its prognosis.
Surg Gynecol Obstet 150: 33-40



.

> Histological subtypes
Adenocarcinoma, biliary type
Adenocarcinoma, gastric foveolar type
Intestinal-type adenocarcinoma
Squamous cell carcinoma
Clear cell adenocarcinoma
Adenosquamous carcinoma
Carcinosarcoma
Mucinous adenocarcinoma
Poorly differentiated carcinoma