Relationship between pancreaticobiliary maljunction and gallbladder carcinoma: a meta-analysis

BACKGROUND: Reports on the relationship between pancreaticobiliary maljunction (PBM) and gallbladder carcinoma (GBC) are conflicting. The frequency of PBM in GBC patients and the clinical features of GBC patients with PBM vary in different studies. DATA SOURCES: English-language articles describing the association between PBM and GBC were searched in the PubMed and Web of Science databases. Nine case-control studies fulfilled the inclusion criteria and addressed the relevant clinical questions of this analy...     

中药复方JEYS解痉镇痛抗炎作用的实验研究

目的:观察中药复方JEYS的解痉镇痛抗炎作用.方法:用乙酰胆碱(Ach)和氯化钡(BaCl2)致家兔离体胆囊平滑肌收缩,观察TCCJEYS的解痉作用;采用冰醋酸致小鼠扭体法观察TCCJEYS的镇痛作用,采用二甲苯致小鼠耳廓肿胀法观察TCCJEYS的抗炎作用.结果:TCCJEYS能抑制Ach和BaCl2引起的家兔胆囊平滑...     

Timing of Cholecystectomy in Acute Cholecystitis

Background

Cholecystitis is an inflammation of the gallbladder that most commonly occurs as a result of obstruction of the cystic duct by gallstones. The current standard of treatment for acute cholecystitis is cholecystectomy.

胆石片治疗伴胆囊结石的慢性胆囊炎肝胆气郁证：随机、双盲、对照临床试验

[目的]评价胆石片治疗伴有胆囊结石的慢性胆囊炎（肝胆气郁证）的有效性和安全性.[方法]采用随机、双盲、安慰剂平行对照、多中心临床试验设计.120例伴有结石的慢性胆囊炎患者符合本试验纳入标准,试验组和对照组各60例,分别采用胆石片（6粒/次,3次/d）及胆石片模拟剂（6粒/次,3次/d）进行为期4周的治疗.以中医证候积分（包括右胁胀痛、口苦、咽干、嗳气、恶心、厌食油腻、纳食减少、胃脘痞满、上腹饱胀、右上腹部压痛和大便秘结）和腹部超声检查进行疗效评价.以血、尿、大便常规,肝功能（ALT、AST、TBIL、DBIL）、肾功能（Bun、Cr）和心电图检查结果作为安全性评价的依据.[结果]治疗4周后,主要疗效：临床愈显率对照组为1.72％,试验组为15.25％,组间差异有统计学意义（P＜0.01）;总有效率对照组为20.69％,试验组为55.93％,组间差异有统计学意义（P＜0.01）.中医证候疗效：临床愈显率对照组为5.17％,试验组为22.03％,组间差异有统计学意义（P＜0.01）.总有效率对照组为34.48％,试验组为71.19％,组间差异有统计学意义（P＜0.01）.影像学疗效：愈显率对照组为15.38％,试验组为30.00％,组间差异无统计学意义;总有效率对照组为50.00％,试验组为72.00％,组间差异有统计学意义（P＜o.05）.安全性：2组均无严重不良事件发生.[结论]胆石片能有效治疗伴有胆囊结石的慢性胆囊炎,并有良好的安全性.     

The Gallbladder of the Electric Ray Torpedo Marmorata Risso Displays Excrescent Cholecystocytes with Merocrine and Apocrine‐Like Secretions

The gallbladder of Torpedo marmorata exhibits a mucosal surface layer of simple columnar epithelium with very tall cholecystocytes. The apical domain of each cell has few microvilli, but many mucous vesicles that are secreted by exocytosis at the cell apices. The apical regions may also elongate and undergo self‐excision while shedding mucus and cell debris into the gallbladder lumen in a manner similar to that described in mammals as a result of sex steroid treatment to induce gallstones and to that found in the cholecystitis associated with cholelithiasis. Numerous small mitochondria, spherical to elongated, are distributed throughout the cells, while the nuclei are often located in the lower third of each cell. In the lower part of the cholecystocytes, large and very densely contrasted lysosomes can be found. All cells are tightly joined by junctional complexes, including long, highly contrasted desmosomes. The fibromuscular layer is made of a loose stroma with a limited muscular component and a poor blood supply. Large diameter blood vessels can only be found in the subserosal layer. It is hypothesized that the obligatorily carnivorous diet of this ureotelic fish has resulted in the evolution of a gallbladder ultrastructure resembling that found in cholecystitis but without the associated cholelithiasis. Anat Rec, 2013. © 2012 Wiley Periodicals, Inc.     

Endoscopic ultrasound‐guided fine‐needle aspiration diagnosis of large cell neuroendocrine carcinoma of the gallbladder and common bile duct: Report of a case

Endoscopic ultrasound‐guided fine‐needle aspiration (EUS‐FNA) allows a reliable and accurate diagnosis of neoplasms of the gallbladder and bile ducts. We report the cytopathologic findings of a case of large cell neuroendocrine carcinoma (LCNEC) of the gallbladder and extrahepatic bile ducts in a 67‐year‐old woman who presented with progressive abdominal pain and jaundice. EUS‐FNA of the mass involving the common bile duct and of a porta hepatis lymph node showed abundant cellularity with tumor cells arranged singly and occasionally in tight and loose clusters and rosette‐like structures in a background showing extensive necrotic debris. The tumor cells were predominantly plasmacytoid, showed a moderate amount of focally vacuolated cytoplasm and large round to oval hyperchromatic nuclei with prominent nucleoli, numerous mitoses, and apoptotic bodies. The differential diagnosis included poorly differentiated adenocarcinoma, lymphoma, melanoma, and poorly differentiated neuroendocrine carcinoma (NEC), large cell type. The tumor cells were strongly and diffusely positive for cytokeratin AE1/AE3, CD56, synaptophysin, and chromogranin and showed a very high proliferative fraction on Ki67 staining, supporting the diagnosis of a high‐grade NEC. Due to the large size of the neoplastic cells, moderate amounts of cytoplasm and prominent nucleoli, a diagnosis of LCNEC was made on the EUS‐FNA sample. Despite the prompt institution of chemotherapy, the patient died shortly thereafter and the diagnosis was confirmed at autopsy. This is to our knowledge the first case of LCNEC of the gallbladder and bile ducts diagnosed by EUS‐FNA. Diagn. Cytopathol. 2013;41:1091–1095. © 2012 Wiley Periodicals, Inc.     

Nuclear cyclin D1 overexpression is a critical event associated with cell proliferation and invasive growth in gallbladder carcinogenesis

Cyclin D1 overexpression is remarkably frequent in several human carcinomas and is believed to be a critical event in oncogenesis. We examined cyclin D1 expression, p53 expression, and the Ki-67 labeling index by immunostaining in human gallbladder mucosa in conditions varying from normal to malignant tissue. We also examined K-ras codon 12 mutations in these tissues with a two-step polymerase chain reaction. Nuclear cyclin D1 overexpression was observed in 48% of carcinomas occurring independently of adenoma, but not in adenomas, carcinomas arising in adenomas, or nonneoplastic lesions. Cytoplasmic cyclin D1 overexpression was observed in about 15% of abnormal specimens, irrespective of the type of epithelial abnormality. Carcinomas showing nuclear cyclin D1 overexpression had significantly higher Ki-67 labeling indexes than those with no overexpression. Moderately to poorly differentiated adenocarcinomas showed a higher incidence of nuclear cyclin D1 overexpression than papillary to well differentiated carcinomas. Specimens with cyclin D1 overexpression showed a high incidence of lymph permeation, venous permeation, and lymph node metastasis. We conclude that nuclear cyclin D1 overexpression is a critical event importantly associated with cell proliferation and invasive growth in gallbladder carcinogenesis, and that cyclin D1 immunostaining may become a useful marker for evaluating gallbladder carcinomas. Received: March 9, 1999 / Accepted: July 23, 1999     

Sludge and stone formation in the gallbladder in bedridden elderly patients with cerebrovascular disease: influence of feeding method

Purpose. The incidence of gallbladder sludge or gallstone formation in bedridden patients with cerebrovascular disease (CVD) remains obscure. The aim of this study was to determine the incidence, relationship to feeding method, and mechanisms of gallbladder sludge and gallstone formation in elderly patients with CVD. Methods. Using ultrasonography, we determined the development of gallbladder sludge and gallstone over a 12-month period, the area of the gallbladder, the gallbladder contractile response to cerulein, and fasting levels of plasma cholecystokinin (CCK) in 40 bedridden elderly patients with CVD. The patients were divided into three groups based on the feeding method: oral ingestion (OI), nasogastric feeding (NF), and total parenteral nutrition (TPN). Results. Gallbladder sludge and gallstone were not observed in any of the 14 OI patients, but occurred in 6 and 1 of the 11 NF patients, and in 14 and 3 of the 15 TPN patients, respectively. Fasting gallbladder areas were significantly larger in the TPN group than in the other two groups. The TPN group showed a marked decrease in cerulein-induced gallbladder contractility. Fasting plasma CCK levels were lower in the TPN group than in the OI group. Conclusions. Our results indicate that elderly patients with CVD confined to bed over long periods are not necessarily at risk of gallbladder sludge or gallstone formation, and the development of these features may be associated with the feeding method. The predisposition of CVD patients on TPN to gallbladder disease is probably caused by failure of gallbladder contraction, resulting from insufficient secretion of CCK and impaired sensitivity of the gallbladder to CCK. Received: August 1, 2000 / Accepted: December 1, 2000     

Mixed (composite) glandular-endocrine cell carcinoma of the gallbladder

Background

A mixed pattern of glandular and neuroendocrine elements is rare in tumours at any site within the gastrointestinal tract but particularly so in the gallbladder.

Case outline

A 72-year-old woman presented with abdominal pain and jaundice and was found to have a large mass in the fundus of the gallbladder.The mass was radically excised to include a wedge of liver and the hepatoduodenal lymph nodes. Histopathological examination of the resected gallbladder showed an invasive tumour composed of both adenocarcinoma and endocrine cell carcinoma, with apparent transitions between them. The patient received no further treatment and died two months later.

Discussion

There are 14 previous case reports of mixed adeno/endocrine carcinoma of the gallbladder. Histochemical similarities between the two neoplastic components of the present tumour would support their origin from a common precursor cell, but the alternative hypothesis of coincidental neoplastic change in two different cell types cannot be excluded.