Table of Contents
1
UI - 11444747
AU - Yeh CN; Jan YY; Chao TC; Chen MF
TI -
Laparoscopic cholecystectomy for polypoid lesions of the gallbladder: a
clinicopathologic study.
SO - Surg Laparosc Endosc Percutan Tech 2001 Jun;11(3):176-81
AD - Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
The size and number of gallbladder polyps are used to differentiate
between benign and malignant lesions before surgery and to determine
whether surgery is necessary for the lesion. Since 1987, laparoscopic
cholecystectomy has been widely used as the management method of choice
for gallbladder lesions. The results of a clinicopathologic study of
polypoid lesions of the gallbladder, based completely on
laparoscopically resected gallbladder tissue, have not yet been
evaluated fully. Data from 123 patients with polypoid lesions of the
gallbladder treated by laparoscopic cholecystectomy were reviewed
retrospectively. The gallbladders were classified into four histologic
groups. Clinical features, maximal diameter, and the number of lesions
were compared among the groups. The mean age of patients with adenoma
and cancer was significantly greater than that of patients with
cholesterol polyps and other lesions. More women than men had a neoplasm
(adenoma and cancer). Patients in the neoplasm group tended to have a
single lesion. The mean maximal diameter of neoplasms was significantly
larger than that of lesions in the nonneoplasm group. All seven
malignant lesions that were detected measured at least 1.5 cm.
Univariate analysis showed that polypoid lesions of the gallbladder with
neoplastic lesions correlated significantly with age, sex, size, and
number of the lesions. Univariate analysis also showed that malignancy
in polypoid lesions of the gallbladder correlated significantly with
age, size, and number of the lesions. Multivariate logistic regression
analysis showed that the age of the patient and the size of the lesion
(> or = 1.0 cm) are two independent factors in predicting neoplastic
lesions in polypoid lesions of the gallbladder. The size of the lesion
(> or = 1.5 cm) is the only independent factor in predicting malignancy
in the polypoid lesions of the gallbladder as shown by multivariate
logistic regression analysis. Laparoscopic cholecystectomy is a safe and
feasible method for gallbladder polypoid lesions. Neoplastic change in
polypoid lesions of the gallbladder should be considered when a patient
older than 50 years of age has a polypoid lesion larger than 1.0 cm.
Cancer should be suspected when a polypoid lesion of the gallbladder is
larger than 1.5 cm, and an aggressive surgical approach is warranted so
that early gallbladder cancer can be detected and patients can have an
increased chance of cure.
2
UI - 11473335
AU - Ohtsuka T; Inoue K; Ohuchida J; Nabae T; Takahata S; Niiyama H; Yokohata
TI -
K; Ogawa Y; Yamaguchi K; Chijiiwa K; Tanaka M
Carcinoma arising in choledochocele.
SO - Endoscopy 2001 Jul;33(7):614-9
AD - Dept. of Surgery and Oncology, Graduate School of Medical Sciences,
Kyushu University, Fukuoka, Japan.
BACKGROUND AND STUDY AIMS: Choledochocele has a potential for
carcinogenesis, but no report has described malignant changes of the
choledochocele in relation to pancreaticobiliary reflux because its
anatomic form does not fit the criteria of pancreaticobiliary malunion
(PBM). The aims of this study were to analyze the amylase level in bile
in patients with choledochocele and to clarify whether the presence of a
choledochocele predisposed to carcinoma. PATIENTS AND METHODS: Records
of 2826 patients who had undergone endoscopic retrograde
cholangiopancreatography between 1995 and 1999 were reviewed for the
presence of choledochocele and/or periampullary carcinoma. As an
evidence of pancreaticobiliary reflux, amylase activity was examined in
common duct bile obtained at surgery or by endoscopy. The prevalence of
periampullary carcinoma was compared between patients with and without
choledochocele. RESULTS: A total of 11 patients were diagnosed as having
a choledochocele. The amylase level in bile was higher in patients with
choledochocele (120,922 +/- 62,269 IU/l; n = 4) than in previously
examined patients with functioning gallbladders (15 +/- 24 IU/l; n = 10,
P = 0.005). The prevalence of periampullary carcinoma in patients with
choledochocele (27%, 3/11) was significantly higher than that in those
without choledochocele (0.9%, 26/2815; P<0.0002). CONCLUSION: The bile
analysis of the present study presents one possible explanation for the
predisposition to carcinoma in choledochocele as bile containing amylase
may stagnate in the choledochocele and then carcinoma may develop in the
inner epithelium of the choledochocele by the same mechanism as that
leading to carcinogenesis in patients with PBM.
3
UI - 11527262
AU - Nikfarjam M; Muralidharan V; McLean C; Christophi C
TI -
Local resection of ampullary adenocarcinomas of the duodenum.
SO - ANZ J Surg 2001 Sep;71(9):529-33
AD - Department of Surgery, Alfred Hospital Melbourne, Victoria, Australia.
mnikfarjam@optusnet.com.au
BACKGROUND: Pancreaticoduodenectomy (PD) is considered to be the optimal
treatment for ampullary adenocarcinomas. Local resection (LR) is a less
invasive and potentially equally effective alternative for cancers with
favourable prognostic features. Identification of these prognostic
parameters may allow selection of patients suitable for LR. METHODS:
Twenty-five patients were treated for a primary Vater's ampulla
adenocarcinoma at the Alfred Hospital, Melbourne, Australia, between
evaluated and the specific role of LR was defined. RESULTS: Fourteen
patients had PD, five had LR and six had bypass procedures (five biliary
stents; one operative bypass). Presenting symptoms included jaundice
(64%), abdominal pain (54%) and weight loss (32%). Adenocarcinomas that
were resected had a median diameter of 2.5 cm, and were limited to the
ampulla in 26% (T1), invaded the duodenal wall in 42% (T2) and
infiltrated 2 cm or less into the pancreas in 32% (T1) of cases. Locally
resected cancers were confined to the ampulla or invaded the duodenum
and recurred in one patient following excision. Six recurrences occurred
in total, influenced significantly by T staging (P = 0.009). Patient
age, preoperative symptoms, laboratory tests, tumour size,
differentiation, ulceration, lymphovascular spread and perineural
invasion had no effect on recurrence. Patients undergoing LR had lower
morbidity and mortality, reduced blood transfusion requirements and
shorter hospital stay than those treated by PD. CONCLUSIONS: T staging
predicts the risk of tumour recurrence and can be determined using
endoscopic ultrasound. Local resection is a suitable alternative to
pancreaticoduodenal resection in patients with T1 and T2 adenocarcinomas
with a maximum diameter of 3 cm or less.
4
UI - 11574081
AU - Bachellier P; Nakano H; Oussoultzoglou PD; Weber JC; Boudjema K; Wolf
TI -
PD; Jaeck D
Is pancreaticoduodenectomy with mesentericoportal venous resection safe
and worthwhile?
SO - Am J Surg 2001 Aug;182(2):120-9
AD - Centre de Chirurgie Viscerale et de Transplantation, Hopital
Universitaire de Hautepierre, Avenue Moliere, 67098 Cedex, Strasbourg,
France.
BACKGROUND: Whether or not superior mesentericoportal venous resection
(SM-PVR) associated with pancreaticoduodenectomy (PD) is safe and
worthwhile has not been fully confirmed. The aim of the present study
was to investigate results of this surgical procedure performed for
pancreatic head and periampullary neoplasms. METHODS: As a first
analysis, postoperative morbidity and mortality after PD with (n = 31)
or without SM-PVR (n = 119) were investigated in 150 patients with
pancreatic head and periampullary neoplasms. As a second analysis, rates
of margin-negative resection and survival after SM-PVR (n = 21) and
without SM-PVR (n = 66) were compared in 87 patients with pancreatic
ductal adenocarcinoma of the pancreatic head. In these patients
undergoing SM-PVR (n = 21), survival rate was investigated in patients
who did (n = 13) and did not (n = 8) undergo a margin-negative
resection. RESULTS: In the first analysis, duration of surgery and
volume of blood transfused perioperatively were higher in patients
undergoing SM-PVR. However, mortality, morbidity rates, and mean
hospital stay did not differ between patients who did undergo SM-PVR (31
patients, 3.2%, 48.4%, and 22.2 days, respectively) and who did not (119
patients, 2.5%, 47.1%, 25.9 days, respectively). No postoperative death
occurred in the recent part of the present study, since 1994, in
patients undergoing SM-PVR. In the second analysis of pancreatic ductal
adenocarcinoma, rates of margin-negative resection and 2-year survival
did not significantly differ between patients who did and did not
undergo SM-PVR (62% and 22%, respectively, versus 73% and 24%). In
patients undergoing SM-PVR, survival rate was significantly higher for
patients undergoing a margin-negative resection (n = 13) than for
patients undergoing a macroscopic or microscopic margin-positive
resection (n = 8, 2-year survival = 57.1% versus 0%, P <0.05).
CONCLUSION: PD combined with SM-PVR can be performed safely. This
surgical procedure is followed by a promising survival rate and can be
recommended in order to obtain a margin-negative resection; however,
candidates for SM-PVR should be carefully selected.
5
UI - 11587685
AU - Schwarz M; Pauls S; Sokiranski R; Brambs HJ; Glasbrenner B; Adler G;
TI -
Diederichs CG; Reske SN; Moller P; Beger HG
Is a preoperative multidiagnostic approach to predict surgical
resectability of periampullary tumors still effective?
SO - Am J Surg 2001 Sep;182(3):243-9
AD - Department of General Surgery, University of Ulm, Ulm, Germany.
BACKGROUND: Multimodality staging is recommended in patients with
periampullary tumors to optimize preoperative determination of
resectability. We investigated the potency of currently used diagnostic
procedures in order to determine resectability. METHODS: Ninety-five
consecutive patients with periampullary tumors prehospitally staged
resectable underwent preoperative diagnostic tests: helical-computed
tomography (CT) with maximum intensity projection of arterial vessels
(MIP), magnetic resonance imaging (MRI), magnetic resonance
cholangiopancreaticography (MRCP), endoscopic ultrasonography (EUS),
endoscopic retrograde cholangiopancreaticography (ERCP), digital
subtraction angiography (DSA), and positron emission tomography (PET).
Diagnoses were verified by surgery and histopathology. RESULTS: In 45
patients with benign and 50 patients with malignant periampullary tumors
sensitivity for tumor diagnosis was 89% to 96% in CT, MRI, EUS, and PET.
Small tumors were best diagnosed by EUS (100%). Diagnosis of malignancy
was made with 85% (EUS), 83% (CT), 82% (PET), and 72% (MRI) accuracy.
Arterial vessel infiltration was best predicted by CT/MIP with an
accuracy of 85%. For venous vessel infiltration MRI reached 85%
accuracy. Accuracy rates for local nonresectability were 93% (EUS), 92%
(MRI), and 90% (CT). Two and 4 of 8 patients with distant metastases
were identified by CT and PET, respectively. The correct diagnosis of
malignancy and determination of resectability was made by CT in 71% and
by MRI in 70%. Biliary stenting reduced accuracy of CT diagnosis of
malignancy from 88% to 73%. CONCLUSIONS: CT obtained before stenting was
the single most useful test, providing correct diagnosis in 88% and
resectability in 71% of patients. If no tumor is depicted in CT, EUS
should be added. Uncertain venous vessel infiltration can be verified by
MRI or EUS. Angiography should no longer be a routine diagnostic
procedure. Equivocal tumors or possible metastasis may be further
examined with PET.
6
UI - 11602888
AU - Johnson SR; Kelly BS; Pennington LJ; Hanto DW
TI -
A single center experience with extrahepatic cholangiocarcinomas.
SO - Surgery 2001 Oct;130(4):584-90; discussion 590-2
AD - Department of Surgery, Division of Transplantation, University of
Cincinnati College of Medicine, Cincinnati, Ohio 45267-0558, USA.
BACKGROUND: Few large Western series on cholangiocarcinoma have been
reported in the literature. We reviewed 40 consecutive cases of
extrahepatic cholangiocarcinomas referred to a single center. METHODS:
From 1992 until 2000, 40 patients with extrahepatic cholangiocarcinomas
were evaluated. The charts of all patients were reviewed to evaluate
predictors of survival. Survival was calculated with the Kaplan-Meier
method. RESULTS: Forty patients were referred for management of
extrahepatic cholangiocarcinomas. Tumors were located in the distal
common duct in 3 (7.5%), mid duct in 5 (12.5%), and at the bifurcation
in 32 (80%). Surgical resection was attempted in 32 (80%) patients and
was curative in 9 (22.5%), palliative in 11 (27.5%), and diagnostic in
12 (30%). Mean survival for all patients was 21.1 +/- 5.1 months and on
the basis of tumor stage was 71.4 +/- 15.4, 39.7 +/- 10.6, 19.2 +/- 2.9,
3.9 +/- 1.8, and 6.9 +/- 1.3 months for stages I, II, III, IVA, and IVB,
respectively. Mean survival was 51.1 +/- 13.5 months versus 10 +/- 1.8
months in those with curative and noncurative resections, respectively.
The presence of a portal mass was associated with a reduction in mean
survival from 28.4 +/- 7.2 months to 6.0 +/- 1.9 months. CONCLUSIONS:
Extrahepatic cholangiocarcinoma remains a dismal disease with only a
22.5% chance of a curative surgical resection, achieving a 5-year
survival rate of 44.4%. Only the absence of a portal mass was predictive
of a possible curative resection and long-term survival.
7
UI - 11677205
AU - Bjork J; Akerbrant H; Iselius L; Bergman A; Engwall Y; Wahlstrom J;
TI -
Martinsson T; Nordling M; Hultcrantz R
Periampullary adenomas and adenocarcinomas in familial adenomatous
polyposis: cumulative risks and APC gene mutations.
SO - Gastroenterology 2001 Nov;121(5):1127-35
AD - Department of Gastroenterology and Hepatology, Karolinska Hospital,
karolinska Institute, Stockholm, Sweden. bjork@ka.se
BACKGROUND & AIMS: Patients with familial adenomatous polyposis (FAP)
have a high prevalence of duodenal adenomas, and the region of the
ampulla of Vater is the predilection site for duodenal adenocarcinomas.
This study assessed the risk of stage IV periampullary adenomas
according to the Spigelman classification and periampullary
adenocarcinomas in Swedish FAP patients screened by
esophagogastroduodenoscopy (EGD). The genotype of patients with stage IV
periampullary adenomas and periampullary adenocarcinomas was also
investigated. METHODS: A retrospective study of 180 patients screened by
EGD in 1982-1999 was undertaken. Kaplan-Meier analysis was performed to
evaluate cumulative risk. Mutation analysis was carried out in patients
with periampullary adenocarcinomas diagnosed outside the screening
program, in addition to patients in the screening group with stage IV
periampullary adenomas and adenocarcinomas. RESULTS: Periampullary
adenoma stage IV was diagnosed in 14 patients (7.8%), with a cumulative
risk of 20% at age 60 years. Periampullary adenocarcinoma was diagnosed
in 5 patients (2.8%), with a cumulative risk of 10% at age 60. Three of
the adenocarcinomas occurred in patients with stage IV periampullary
adenomas compared with 2 in patients with less severe periampullary
adenomatosis at screening (odds ratio, 31; 95% confidence interval,
4.6-215). Fifteen (88%) of the APC gene mutations were detected; 12 of
these were located downstream from codon 1051 in exon 15. CONCLUSIONS:
The life time risk of severe periampullary lesions in FAP patients is
high, and an association between stage IV periampullary adenomas and a
malignant course of the periampullary adenomatosis is strongly
suggestive. Mutations downstream from codon 1051 seem to be associated
with severe periampullary lesions.
8
UI - 11677220
AU - Burke C
TI -
Risk stratification for periampullary carcinoma in patients with
familial adenomatous polyposis: does theodore know what to do now?
SO - Gastroenterology 2001 Nov;121(5):1246-8
9
UI - 11677478
AU - Kim MH; Lee SK; Seo DW; Won SY; Lee SS; Min YI
TI -
Tumors of the major duodenal papilla.
SO - Gastrointest Endosc 2001 Nov;54(5):609-20
AD - Department of Internal Medicine, Asan Medical Center, University of
Ulsan College of Medicine, Seoul, Korea.
10
UI - 11688581
AU - Murakata LA; Ishak KG
TI -
Expression of inhibin-alpha by granular cell tumors of the gallbladder
and extrahepatic bile ducts.
SO - Am J Surg Pathol 2001 Sep;25(9):1200-3
AD - Department of Hepatic & GI Pathology, Armed Forces Institute of
Pathology, Washington, DC 20306-6000, USA. Murakata@afip.osd.mil
This is the first report of inhibin-alpha expression in granular cell
tumors. A Medline search of the literature revealed no case reports of
granular cell tumors in any location of the body being tested for
inhibin-alpha immunohistochemically, by enzyme-linked immunosorbent
assay, by radioimmunoassay, or by immunoprecipitation. Seventeen cases
of previously diagnosed granular cell tumors of the gallbladder and
extrahepatic bile ducts with hematoxylin and eosin-stained sections, and
S-100 protein immunostain were retrieved from the archives of the Armed
Forces Institute of Pathology. All cases were reviewed for diagnostic
accuracy and then immunostained for inhibin-alpha (with endogenous
biotin blocking). All 17 (100%) cases were diffusely positive for
inhibin-alpha immunostain. Previous studies of inhibin-alpha-positive
lesions reported in the literature include sex cord stromal tumors
(granulosa cell tumors, luteinized thecomas, Leydig cell tumors),
placental and gestational trophoblastic lesions, and adrenal cortical
tumors. This study adds the granular cell tumor to the list of
inhibin-positive lesions and should prove helpful in differential
diagnosis of these lesions.
11
UI - 11681118
AU - Baskaran V
TI -
Gallbladder carcinoma: a disease of the Indo-Gangetic belt.
SO - Trop Gastroenterol 2001 Jul-Sep;22(3):172-3
12
UI - 11685029
AU - Csendes A; Burgos AM; Csendes P; Smok G; Rojas J
TI -
Late follow-up of polypoid lesions of the gallbladder smaller than 10
mm.
SO - Ann Surg 2001 Nov;234(5):657-60
AD - Department of Surgery, University Hospital, Santiago, Chile.
acsendes@machi.med.uchile.cl
OBJECTIVE: To determine the variation in number, size, and symptoms in
patients with polypoid lesions of the gallbladder. SUMMARY BACKGROUND
DATA: A polypoid lesion is any elevated lesion of the gallbladder
mucosa. Several studies have been reported in patients undergoing
cholecystectomy, but little information exits regarding the natural
history of these lesions in nonoperated patients. METHODS: A total of
111 patients with ultrasound diagnosis of polypoid lesions smaller than
10 mm were followed up by clinical evaluation and ultrasonography.
Twenty-seven patients underwent cholecystectomy. RESULTS: There was no
difference in terms of gender. Nearly 80% of the lesions were smaller
than 5 mm; they were single in 74%. In nonoperated patients, 50%
remained of similar size at the late follow-up, 26.5% increased in
number and size, and 23.5% shrank or disappeared. Among the operated
patients, 70% corresponded to cholesterol polyps. None of the patients
developed symptoms of biliary disease or gallstones or adenocarcinoma.
CONCLUSIONS: Ultrasound is useful in the follow-up of patients with
polypoid lesions of the gallbladder. Lesions smaller than 10 mm do not
progress to malignancy or to development of stones, and none produced
symptoms or complications of biliary disease.
13
UI - 11702256
AU - Sai K; Kajiwara H
TI -
An immunohistochemical study of metaplastic endocrine cells in human
gallbladder cancer.
SO - J Hepatobiliary Pancreat Surg 2001;8(5):453-60
AD - Third Department of Surgery, Toho University School of Medicine, 2-17-6,
Ohashi, Meguro-ku, Tokyo 153-8515, Japan.
BACKGROUND/PURPOSE: In order to better understand the genesis of
gallbladder cancer, we investigated the metaplastic changes and the
presence of endocrine cells in mucosal tissue in the tissues of 100
patients with cholecystitis and 50 patients with gallbladder cancer.
METHODS: All the tissue samples were submitted to Hematoxylin-eosin and
Alcian blue-periodic acid-Schiff stain. To identify endocrine cells, we
utilized Grimelius or Fontana-Masson stain. To detect intestinal
hormones, we used streptavidin-biotin staining. If a given tissue sample
presented with goblet cells or pseudopyloric cells, we determined that
it was undergoing metaplasia. To locate a focus of endocrine cells, we
used the presence of argyrophil cells and argentaffin cells. RESULTS:
Metaplastic changes and endocrine cells were observed in 50% or more of
the studied tissues that had been sampled from the lesions of chronic
cholecystitis, and from the tumor and nontumor sites of gallbladder
cancer. The tissues sampled from chronic cholecystitis patients showed
endocrine cells releasing gut hormones, and the incidence of tissue
presenting with such hormone-secreting cells tended to increase with the
degree of metaplasia. The tissues sampled from the gallbladder cancer
patients also showed endocrine cells, but the incidence in these tissues
was not significantly correlated with the degree of metaplasia. In the
tissue sampled from gallbladder cancer patients, the degree of
metaplasia and the incidence of the tissues presenting with endocrine
cells was not significantly different from the corresponding results
obtained from chronic cholecystitis tissues. However, tissues presenting
with endocrine cells occurred more frequently in samples from nontumor
sites than in samples from chronic cholecystitis sites. The incidence of
metaplastic cells and of endocrine cells correlated closely with the
genesis of highly differentiated cancers. Lysozyme, a nonspecific
defensive factor against infections, was frequently observed in the
tissues sampled from patients with chronic cholecystitis as well as
those with gallbladder cancer. CONCLUSIONS: Although metaplastic changes
and endocrine cells were observed in the tissues of chronic
cholecystitis as well as gallbladder cancer, these markers were most
frequently observed in nontumor sites close to the tumors themselves,
suggesting that these markers are closely involved in the genesis of
gallbladder cancer.
14
UI - 11720142
AU - Shyr YM; Su CH; Wu CW; Lui WY
TI -
Randomized trial of gastrojejunostomy with duodenal partition versus
antrectomy in unresectable periampullary cancer.
SO - Zhonghua Yi Xue Za Zhi (Taipei) 2001 Aug;64(8):443-50
AD - Department of Surgery, Taipei Veterans General Hospital, Taiwan, ROC.
ymshyr@vghtpe.gov.tw
BACKGROUND: A newly-designed gastrojejunostomy with duodenal partition
was hypothesized to be a relatively easier and safer gastric bypass
procedure in interrupting the "food reentry", as compared with
antrectomy, for patients with unresectable periampullary cancer.
METHODS: Thirty patients with unresectable periampullary malignancy were
randomized to receive gastrojejunostomy with either duodenal partition
or antrectomy, in addition to biliary bypass, to compare surgical risk
and efficacy of the gastric bypass between these two groups. RESULTS:
Gastrojejunotomy with either duodenal partition or antrectomy could
significantly shorten the gastric emptying time 6 weeks after operation.
There was no significant difference between these two groups in gastric
outlet obstruction (GOO) symptoms, gastric emptying time, and time for
resuming oral diet intake after operation. The median operation time was
shorter in the duodenal partition group (180 min) than in the antrectomy
group (240 min), p < 0.01. The median blood loss was less in the
duodenal partition group (250 ml) than in the antrectomy group (400 ml),
(p = 0.01). Complications occurred in 3 (20%) patients with duodenal
partition and in 7 (47%) patients with antrectomy, (p = 0.25). One
duodenal stump leakage occurred in antrectomy group. Surgical mortality
occurred in 2 patients with antrectomy. CONCLUSIONS: Duodenal partition,
with shorter operation time and less blood loss, had similar efficacy
with antrectomy in correction of GOO. Therefore, duodenal partition
could be a relatively easier and safer alternative to antrectomy in
interrupting the "food reentry" in gastrojejunostomy for patients with
unresectable periampullary cancer.
15
UI - 11720143
AU - Lin PW
TI -
Approach to the patients with unresectable periampullary malignancy.
SO - Zhonghua Yi Xue Za Zhi (Taipei) 2001 Aug;64(8):451-2
AD - Department of Surgery, Medical College, National Cheng-Kung University,
Tainan, Taiwan.
16
UI - 11715232
AU - Shabo I; Nordenskjold K; Svanvik J
TI -
[The incidence of gallbladder cancer in Sweden has decreased. The poor
prognosis can possibly be improved by radical surgery]
SO - Lakartidningen 2001 Oct 17;98(42):4584-9
AD - Institutionen for biomedicin och kirurgi, Linkopings universitet.
Ivan.Shabo@lio.se
Gallbladder cancer is a rare disease with poor prognosis and short
survival time. The condition is usually associated with gallstones and
predominantly affects women. We have taken data from the National Cancer
Register and the Cause of Death Register in Sweden and studied the
annual incidence of and mortality due to gallbladder cancer from 1988 to
1997. Incidence has declined during this period, which may be explained
by a high rate of cholecystectomies in Sweden between 1950 and 1970.
Prognosis has traditionally been poor, with a median survival time of
3.5 months, which might be explained by the fact that the disease
usually is diagnosed at an advanced stage. Epidemiological figures show
that prognosis may have improved during the past decade. In several
retrospective studies, mainly from Japan, better results with longer
survival times are reported after extended surgery. In a small group of
11 patients with gallbladder cancer, Nevin grade II-V, who underwent
extended surgery at The University Hospital in Linkoping, there are no
signs of recurrent disease in 10 patients after a follow-up of 1-8
years.
17
UI - 11730220
AU - Wise PE; Shi YY; Washington MK; Chapman WC; Wright JK; Sharp KW; Pinson
TI -
CW
Radical resection improves survival for patients with pT2 gallbladder
carcinoma.
SO - Am Surg 2001 Nov;67(11):1041-7
AD - Department of Surgery, Vanderbilt University Medical Center, Nashville,
Tennessee 37232-4753, USA.
Radical resection (wedge resection of the gallbladder bed and dissection
of the hepatoduodenal ligament, portal, and celiac lymph nodes) has been
reported to improve survival from pathologic T2 gallbladder carcinoma
(pT2 GBCa; invasion through the muscularis without perforation of the
serosa). We report our experience and the outcome of patients with pT2
GBCa. Between 1989 and 2000 at Vanderbilt University Medical Center ten
patients were found to have pT2 disease after cholecystectomy. The
patients had an average age of 64+/-13 years and underwent either
radical resection (n = 5) or no further surgical therapy (n = 5). Of the
patients who underwent cholecystectomy only, one (20%) is still alive at
27 months and four (80%) died of recurrent GBCa between 6.5 and 21
months. For the patients who underwent radical resection all five are
alive at 15 to 83 months with no recurrence. The proportion of patients
surviving pT2 GBCa after radical resection was significantly greater
than with cholecystectomy alone (P < 0.05). The difference in length of
survival between the two groups was also significant (P < 0.05).
Morbidity after radical resection was low (pancreatic leak in one
patient), and there were no operative mortalities. Radical resection
significantly improved survival over cholecystectomy alone for patients
with pT2 GBCa. The procedure has low morbidity and mortality rates.
Therefore a radical resection operation is indicated for patients with
pT2 GBCa.
18
UI - 11727266
AU - Bornstein-Quevedo L; Gamboa-Dominguez A
TI -
Carcinoid tumors of the duodenum and ampulla of vater: a
clinicomorphologic, immunohistochemical, and cell kinetic comparison.
SO - Hum Pathol 2001 Nov;32(11):1252-6
AD - Department of Pathology, Instituto Nacional de Ciencia Medicas y
Nutricion, Salvador Zubiran, Mexico City, Mexico.
Carcinoid tumors of the ampulla of Vater (ACs) differ from duodenal
carcinoid tumors (DCs). A search for AC and DC was made between 1980 and
2000. The clinicopathologic features and follow-up were assessed.
Immunohistochemistry for panneuroendocrine markers, hormone products,
proliferating cell nuclear antigen (PCNA), Ki- 67, p21(cip1), and
p27(kip1) were performed. A blind proliferative index counting 500 cells
was made. Differences were contrasted using the Fisher exact and 2-sided
Student t test. Five ACs and 8 DCs were identified in 9 women and 4 men
with median ages of 59 and 64 years and mean tumor diameters of 1.6 and
1.85 cm, respectively. All patients with AC presented jaundice, and most
patients with DC were asymptomatic (P = .047). Metastases were present
in 4 ACs and 1 DC (P =.03). Tumor cells expressed synaptophysin and
chromogranin in 60% of ACs and in 100% and 87% of DCs. Gastrin was
expressed in 75% of DCs and 20% of ACs (P < .05). The mean value for
PCNA index was 4.0% in ACs and 3.2% in DCs, and mean values for Ki-67
were 12.2% and 10.2%, respectively (P = NS). Expression of p21(cip1) and
p27(kip1) was observed in 40% of ACs and 37.5% and 12.5% of DCs. Three
of 5 patients with AC died of the disease within an average of 11
months, and none of the patients with DC had died at 103 months of
follow-up. The more aggressive behavior of ACs is not associated with
higher proliferative indices or with different expression of cell cycle
inhibitors. Copyright 2001 by W.B. Saunders Company
19
UI - 11760569
AU - Lazcano-Ponce EC; Miquel JF; Munoz N; Herrero R; Ferrecio C; Wistuba II;
TI -
Alonso de Ruiz P; Aristi Urista G; Nervi F
Epidemiology and molecular pathology of gallbladder cancer.
SO - CA Cancer J Clin 2001 Nov-Dec;51(6):349-64
AD - Epidemiology Department, Population Health Research Center, National
Institute of Public Health, Cuernavaca, Morelos, Mexico.
Gallbladder cancer is usually associated with gallstone disease, late
diagnosis, unsatisfactory treatment, and poor prognosis. We report here
the worldwide geographical distribution of gallbladder cancer, review
the main etiologic hypotheses, and provide some comments on perspectives
for prevention. The highest incidence rate of gallbladder cancer is
found among populations of the Andean area, North American Indians, and
Mexican Americans. Gallbladder cancer is up to three times higher among
women than men in all populations. The highest incidence rates in Europe
are found in Poland, the Czech Republic, and Slovakia. Incidence rates
in other regions of the world are relatively low. The highest mortality
rates are also reported from South America, 3.5-15.5 per 100,000 among
Chilean Mapuche Indians, Bolivians, and Chilean Hispanics. Intermediate
rates, 3.7 to 9.1 per 100,000, are reported from Peru, Ecuador,
Colombia, and Brazil. Mortality rates are low in North America, with the
exception of high rates among American Indians in New Mexico (11.3 per
100,000) and among Mexican Americans. The main associated risk factors
identified so far include cholelithiasis (especially untreated chronic
symptomatic gallstones), obesity, reproductive factors, chronic
infections of the gallbladder, and environmental exposure to specific
chemicals. These suspected factors likely represent promoters of
carcinogenesis. The main limitations of epidemiologic studies on
gallbladder cancer are the small sample sizes and specific problems in
quantifying exposure to putative risk factors. The natural history of
gallbladder disease should be characterized to support the allocation of
more resources for early treatment of symptomatic gallbladder disease in
high-risk populations. Secondary prevention of gallbladder cancer could
be effective if supported by cost-effective studies of prophylactic
cholecystectomy among asymptomatic gallstone patients in high-risk
areas.
20
UI - 11688258
AU - Shalimov AA; Kopchak VM; Dronov AI; Todurov IM; Diachenko VV; Duvalko
TI -
AV; Khomiak IV; Vasil'ev OV
[Clinical signs, diagnosis and surgical treatment of extrahepatic
biliary duct tumors]
SO - Klin Khir 2001 Jun;(6):11-4
Experience of surgical treatment of 271 patients the extrahepatic
biliary ducts tumor for the 1992-1999 yrs period is presented. Indirect
signs of extrahepatic biliary ducts tumor were revealed in 84% of
observations. Depending on the tumor localization the trustworthiness of
the endoscopic retrograde pancreatocholangiography method had
constituted from 79.8 to 96.4%. Correct diagnosis was established before
the operation in 94.3% of patients. Radical operation was done in 93
(34.3%) of patients, including 22 with proximal localization of tumor,
13--with central one, 10--distal, 48--terminal. Palliative operation was
performed in 178 patients, in 76 of them biliodigestive anastomosis was
done. Total postoperative mortality was 14.8%.
21
UI - 11764071
AU - Tascilar M; Offerhaus GJ; Altink R; Argani P; Sohn TA; Yeo CJ; Cameron
TI -
JL; Goggins M; Hruban RH; Wilentz RE
Immunohistochemical labeling for the Dpc4 gene product is a specific
marker for adenocarcinoma in biopsy specimens of the pancreas and bile
duct.
SO - Am J Clin Pathol 2001 Dec;116(6):831-7
AD - Department of Pathology, The Johns Hopkins Medical Institutions,
Baltimore, MD, USA.
We immunohistochemically labeled 72 biopsy specimens from the
extrahepatic biliary tree and pancreas for Dpc4 protein and correlated
expression with histologic diagnosis and patient follow-up. Specimens
were classified histologically as follows: nonneoplastic, 35;
neoplastic, 22; atypical, 15. Loss of expression of Dpc4 protein was
identified in 12 specimens; 11 were histologically diagnostic of
carcinoma. The 12th specimen was from a patient whose biopsy specimen
initially was diagnosed as "atypical," but clinical follow-up revealed
adenocarcinoma. Of the 12 atypical biopsy specimens with intact
expression for Dpc4, follow-up later revealed that 10 were
adenocarcinoma. Loss of expression of Dpc4 protein was never identified
in a benign specimen. Immunohistochemical labeling for the Dpc4 gene
product is a specific marker of carcinoma in biopsy specimens of the
pancreas and extrahepatic bile ducts and is marginally helpful in
classifying atypical specimens. The sensitivity for carcinoma is low.
This latter finding is not unexpected, because the DPC4 tumor suppressor
gene is inactivated in only about half of pancreatic and biliary
malignant neoplasms. Importantly, loss of Dpc4 expression has been
reported in in situ carcinomas, suggesting that loss of expression
should not be equated with invasive carcinoma.
22
UI - 10965326
AU - Ng WT
TI -
Bile duct carcinogenesis after excision of extrahepatic bile ducts in
pancreaticobiliary maljunction.
SO - Surgery 2000 Sep;128(3):492-4
23
UI - 11605158
AU - Adamek HE; Riemann JF
TI -
[Differential expression of metastasis-associated genes in papilla of
Vater and pancreatic cancer correlates with disease stage]
SO - Z Gastroenterol 2001 Oct;39(10):909-10
AD - Med. Klinik C, Klinikum Ludwigshafen, Bremserstr, Ludwigshafen, Germany.
MedCLu@t-online.de
24
UI - 11711793
AU - Yoshimitsu K; Honda H; Aibe H; Shinozaki K; Kuroiwa T; Irie H; Asayama
TI -
Y; Masuda K
Radiologic diagnosis of adenomyomatosis of the gallbladder: comparative
study among MRI, helical CT, and transabdominal US.
SO - J Comput Assist Tomogr 2001 Nov-Dec;25(6):843-50
AD - Department of Clinical Radiology, Graduate School of Medical Sciences,
Kyushu University, Fukuoka, Japan. yoshimitsu@dr.hosp.kyushu-u.ac.jp
PURPOSE: The goal of this work was to evaluate the diagnostic accuracy
of transabdominal ultrasound (US), helical CT, and MRI in the diagnosis
of adenomyomatosis (ADM) of the gallbladder. METHOD: Twenty patients
with surgically proven ADM were included, all of whom underwent
preoperative US, helical CT with 3 mm collimation, and MRI with
half-Fourier rapid acquisition with relaxation enhancement (RARE). All
images were retrospectively reviewed by two radiologists, and the
presence of ADM was assessed at three compartments (neck, body, and
fundus) of the organ. Receiver operating characteristic analysis was
performed, and sensitivity, specificity, and accuracy were calculated
for each modality. RESULTS: The A z values (area under the curve) for
MRI, helical CT, and US were 0.98, 0.85, and 0.72 for the Reader 1,
respectively, showing no statistically significant interobserver
difference in any of the three modalities. MRI showed a significantly
higher A z value than helical CT or US (p < 0.1). The accuracies of MRI,
helical CT, and US were 93, 75, and 66%, respectively. CONCLUSION: Among
the three modalities tested, MRI with half-Fourier RARE sequence was the
most accurate for diagnosing ADM.
25
UI - 11726870
AU - Shah SK; Costamagna G
TI -
Can unilateral stent placement be adequate in patients with Klatskin
tumors of Bismuth-type III and IV?
SO - Gastrointest Endosc 2001 Dec;54(6):804-5
26
UI - 11525368
AU - Huang CS; Lien HH; Jeng JY; Huang SH
TI -
Role of laparoscopic cholecystectomy in the management of polypoid
lesions of the gallbladder.
SO - Surg Laparosc Endosc Percutan Tech 2001 Aug;11(4):242-7
AD - Department of General Surgery, Cathay General Hospital, Taipei, Taiwan.
cshuang@msl.cgh.org.tw
This retrospective clinicohistopathologic study was performed to
delineate the role of laparoscopic cholecystectomy in the management of
polypoid lesions of the gallbladder. One hundred forty-three consecutive
patients who had a preoperative sonographic diagnosis of polypoid
lesions of the gallbladder with a diameter less than 1.5 cm and who
underwent laparoscopic cholecystectomy at Cathay General Hospital were
included in the analysis. Histopathologic study showed that 22 (15.4%)
patients had true tumors, including adenoma (16), adenoma with focal
adenocarcinoma (2), adenocarcinoma (3), and carcinoid tumor (1).
Tumorlike lesions were found in 121 (84.6%) patients and included
cholesterol polyp (106), adenomyomatous hyperplasia (10), inflammatory
polyp (3), and papillary hyperplasia (2). The mean diameter of malignant
polypoid lesions of the gallbladder was 1.35 +/- 0.42 cm, which was
significantly larger than that of cholesterol polyps (0.66 +/- 0.40 cm,
P = 0.0001) but not significantly larger than that of adenomyomatous
hyperplasias (1.12 +/- 0.42 cm) and adenomas (1.08 +/- 0.47 cm). The
mean age of patients with malignant polypoid lesions of the gallbladder
(61.2 +/- 13.3 years old) was significantly older than that of patients
with adenomyomatous hyperplasia (46.6 +/- 13.4 years, P = 0.03),
cholesterol polyps (44.5 +/- 10.5 years, P = 0.0003), and adenomas (41.4
+/- 9.4 years, P = 0.0008). Clinical follow-up showed that most (98.6%)
patients benefited from the minimal invasiveness of laparoscopic
cholecystectomy with satisfactory surgical results. We conclude that
laparoscopic cholecystectomy is a reliable, safe, and minimally invasive
biopsy procedure and definite management of polypoid lesions of the
gallbladder with a diameter less than 1.5 cm.
27
UI - 11462891
AU - Bruha R; Petrtyl J; Kubecova M; Marecek Z; Dufek V; Urbanek P; Kodadova
TI -
J; Chodounsky Z
Intraluminal brachytherapy and selfexpandable stents in nonresectable
biliary malignancies--the question of long-term palliation.
SO - Hepatogastroenterology 2001 May-Jun;48(39):631-7
AD - 1st Medical Department and Department of Radiology, Charles University
Teaching Hospital, Prague 2, Czech Republic. bruha@cesnet.cz
BACKGROUND/AIMS: To evaluate the effect of a combination of intraluminal
brachytherapy and metallic stent implantation in the treatment of
patients with nonresectable biliary tumors. METHODOLOGY: Thirty-two
patients aged 41-80 years with nonresectable biliary
malignancies--Klatskin's tumor (n = 17), gallbladder carcinoma (n = 11)
and carcinoma of papilla Vateri (n = 4)--were treated with a combination
of intraluminal brachytherapy (source Ir192, high-dose radiation
regimen, total dose 30 Gy) and metallic stent implantation. Intraluminal
brachytherapy and stent insertion (metallic, spiral-Z stent) were
performed percutaneously in all patients. RESULTS: The mean survival in
patients with Klatskin's tumor was 457 days (range: 64-1186; median: 358
days), in patients with gallbladder carcinoma 237 days (range: 92-609;
median: 210 days) and in patients with carcinoma of papilla Vateri 850
days (range: 48-1518; median: 1277 days). The rate of 2-year survival in
these groups as 27, 0 and 50%, respectively. The survival time differed
significantly at the 5% level. The mean time of stent patency was 418,
220 and 850 days, respectively. No complications related directly to
intraluminal brachytherapy were observed. CONCLUSIONS: Intraluminal
brachytherapy combined with stent implantation is a safe method and
appears to prolong survival in inoperable patients with Klatskin's tumor
and carcinoma of papilla Vateri compared with nontreated patients in
previous studies. In contrast no similar effect should be expected in
patients with gallbladder carcinoma.
28
UI - 10349172
AU - Sanz P; Calvo A; Tobella L; Salazar S; Daher V; Castillo S; Nielsen E;
TI -
Smok G; Csendes A; Serra I
[Chromosome anomaly and flow cytometry in gallbladder adenocarcinoma]
SO - Rev Med Chil 1998 Nov;126(11):1301-10
AD - Servicio de Genetica, Escuela de Salud Publica, Universidad de Chile,
Santiago de Chile.
29
UI - 11756769
AU - Seidel G; Zahurak M; Iacobuzio-Donahue C; Sohn TA; Adsay NV; Yeo CJ;
TI -
Lillemoe KD; Cameron JL; Hruban RH; Wilentz RE
Almost all infiltrating colloid carcinomas of the pancreas and
periampullary region arise from in situ papillary neoplasms: a study of
39 cases.
SO - Am J Surg Pathol 2002 Jan;26(1):56-63
AD - Department of Pathology, Johns Hopkins Medical Institutions, Baltimore,
Maryland, USA.
Colloid carcinomas of organs such as the breast, colon, and prostate
have been well characterized. However, up until now there have been only
a few studies of colloid carcinomas of the pancreas and periampullary
region, and the number of colloid carcinomas in these studies has been
limited. A search of our files revealed 39 resections for pancreatic and
periampullary carcinomas with colloid differentiation. All neoplasms
were extensively sampled. "Carcinomas with colloid differentiation" were
defined as tumors associated with abundant extracellular mucin
containing free-floating mucinous epithelial cells. Cases with >50%
colloid differentiation were classified as "colloid carcinomas," whereas
those with less were termed "carcinomas with focal colloid features."
Cases with no colloid differentiation at all were designated "carcinomas
without colloid differentiation." Of the 39 carcinomas, 31 were colloid
carcinomas, and eight were carcinomas with focal colloid features.
Twenty-seven were centered in the pancreas, seven were in the duodenum,
and five were in the ampulla of Vater. Remarkably, 38 of the 39
carcinomas (97%) arose in association with an intraductal papillary
mucinous neoplasm or a tubular/tubulovillous adenoma. Of the patients
with colloid carcinomas, the 2-and 5-year actuarial survival rates were
69% and 29%, respectively. There was no significant difference in
survival rates between patients with colloid carcinomas and patients
with adenocarcinomas without colloid differentiation, whether or not the
latter arose in association with intraductal papillary mucinous
neoplasms or tubular/tubulovillous adenomas. In a multivariate model
colloid differentiation was not an independent predictor of patient
survival, while other factors such as tumor location, perineural
invasion, vascular invasion, and margin status after resection
independently influenced patient survival. Most colloid carcinomas of
the pancreas and periampullary region arise in association with a
well-defined in situ papillary neoplasm. The diagnosis of a pancreatic
or periampullary colloid carcinoma should encourage the pathologist to
search for an associated low-grade in situ component. In addition,
colloid carcinomas of the pancreas and periampullary region do not
necessarily have a better prognosis than carcinomas without colloid
differentiation. Instead, other factors such as tumor location,
perineural invasion, vascular invasion, and margin status after
resection are far more important.
30
UI - 11776851
AU - Cao L; Peng S; Duchrow M
TI -
[Expression of P-glycoprotein in benign and malignant gallbladder
neoplasms]
SO - Zhonghua Zhong Liu Za Zhi 1999 Mar;21(2):119-21
AD - Department of Surgery, Second Affiliated Hospital, Zhejiang Medical
University, Hangzhou 310009.
OBJECTIVE: To evaluate the relationship between P-glycoprotein
expression and anti-cancer drug resistance of gallbladder carcinoma and
the use of P-glycoprotein as a biomarker of gallbladder carcinoma, the
expression of P-glycoprotein was detected in benign and malignant
gallbladder neoplasms and normal gallbladder tissues. METHODS: Alkaline
phosphatase anti-alkaline phosphatase (APAAP) method was used to detect
the expression of P-glycoprotein in different gallbladder tissues
(gallbladder carcinoma, 26 cases; benign gallbladder neoplasm, 14 cases;
and normal gallbladder tissue, 9 cases). The relationship between
expression of P-glycoprotein, TNM stages and other clinical data of
gallbladder carcinoma was also analyzed. RESULTS: Immunohistochemical
staining with a monoclonal antibody JSB-1, P-glycoprotein was positive
in 76.9% (20/26) of gallbladder carcinomas, in 35.7% (5/14) of benign
gallbladder neoplasms and in 33.3% (3/9) of normal gallbladder tissues
(P < 0.05). With another monoclonal antibody UIC-2, the positive rates
were 69.2% (18/26), 21.4% (3/14) and 11.1% (1/9), respectively (P <
0.01). There was no significant correlation between P-glycoprotein
expression and gallbladder carcinoma TNM staging. CONCLUSION: The
results suggest that P-glycoprotein probably play
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