Gallbladder Carcinoma : Differential Diagnosis

Comments:
Differential Diagnosis: Gallbladder carcinomas can be well-differentiated and appear deceptively benign. They may be difficult to distinguish from benign processes/features such as Rokitanksy-Aschoff sinuses (shown here), metaplastic glands, peribiliary mucous glands in the neck and cystic duct region, or Luschka ducts in the subhepatic or subserosal tissues.

Rokitanksy-Aschoff sinuses do not have a lobular arrangement and may be found deep within the wall and surrounding adipose tissue. They may show no apparent connection to the surface. Given their location and the presence of fibrosis around glands in some cases, they may be mistaken for invasive adenocarcinoma.

Features favoring Rokitansky-Aschoff sinuses over invasive carcinoma: orientation perpendicular to the surface; larger, flask shaped gland with undulating contours. Cancer glands are smaller, more closely packed, with open round or angulated contours, and parallel orientation to surface.