Complete Clinical Remission in the Comprehensive Treatment of Advanced Gallbladder Cancer
Complete Clinical Remission in the Comprehensive Treatment of Advanced Gallbladder Cancer
Hello everyone！I am the Hepatobiliary and Pancreatic Surgery Department of Wuwei Cancer Hospital.After more than ten years of development, under the leadership of Director Liang Yuchuan’s surgical team, we have continuously innovated, forged ahead, and grown stronger.Starting today, we will share classic clinical cases with you, explore and encourage each other with fellow medical professionals, and more importantly, provide guidance and hope for patients.For diseases of the liver, gallbladder, pancreas, and spleen, we are more professional and more precise！
Case Sharing
Patient Information:
Female, 58 years old. Admitted to the outpatient department with a diagnosis of "gallbladder stones with inflammation."
Post-Admission Diagnosis (after comprehensive examinations):
- Gallbladder malignancy (malignant tumor of the gallbladder)
- Secondary malignant tumor of the liver
- Secondary malignant tumor of the abdominal cavity
- Secondary malignant tumor of the neck
- Secondary malignant tumor of the lumbar spine
TNM Staging: T3N2M1, Stage IVb (Stage Ⅵb)
Pathological Confirmation:
- Adenocarcinoma
- Metastatic adenocarcinoma in the neck
Treatment Course:
After careful and repeated planning by our department, the patient received:
- 3 cycles of systemic intravenous chemotherapy + immunotherapy→ Result: The cervical lymph node shrank from 3 cm to 0.7 cm
- Continued immunotherapy along with radiotherapy for the lumbar spine metastatic lesion→ After 7 cycles, both the cervical lymph node and mediastinal lymph nodes disappeared
Surgical Intervention (timing chosen based on optimal response):
Cholecystectomy + resection of liver segments V and IVb + lymph node dissection of the hepatoduodenal ligament + I-125 seed implantation
Postoperative Pathology:
- Gallbladder:Focal high-grade epithelial atypical hyperplasiaHemorrhage within the gallbladder wallHistocytic hyperplasia and fibrosis, with localized formation of mucin lakesNo cancer tissue found in the submitted specimens:Gallbladder duct marginGallbladder duct stumpLiver tissue adherent to the gallbladder, with no cancer tissue identifiedSome hepatocytes showed fatty degenerationLymph node (Group 8): 0/1, no cancer metastasisLymph nodes (Groups 12b and 12p): Submitted tissue was adipose tissue, with no cancer identifiedImmunohistochemistry (IHC) results:CK19, CK20, CK7 (no epithelial cells seen within the mucin lakes)
- Gallbladder stones
Final Diagnosis:
- Clinical complete remission of gallbladder malignancy after treatment
Prognosis:
The patient, diagnosed with Stage IVb (Ⅵb) gallbladder cancer, has now achieved asymptomatic survival for over 12 months.
Preoperative CT
Postoperative CT
Gallbladder Cancer Diagnosis and Treatment
The incidence of gallbladder cancer accounts for 0.4%–3.8% of biliary tract diseases during the same period, ranking as the 6th most common digestive tract tumor. The overall 5-year survival rate for gallbladder cancer patients is only 5%, and the median survival time for stage III and IV gallbladder cancer is merely 7 months. Radical resection surgery remains the only potentially curative treatment for gallbladder cancer.
Risk Factors:
1.Gallbladder stones (cholelithiasis)
2.Gallbladder polypoid lesions
3.Chronic cholecystitis (chronic inflammation of the gallbladder)
4.Post-cholecystolithotomy (gallbladder-preserving stone removal surgery), where risk factors for stone recurrence persist and gallbladder inflammation remains unresolved(Reference: 2019 Guidelines for the Diagnosis and Treatment of Gallbladder Cancer)