Squamous Cell Carcinoma in a Large Epiphrenic Esophageal Diverticulum

Carcinoma is rare in an esophageal diverticulum. The case of a 53-year-old man with a large mass in a long-standing symptomatic epiphrenic esophageal diverticulum is presented in this study. Squamous cell carcinoma in the diverticulum with pleural invasion was diagnosed after surgical diverticulectomy. The patient underwent subtotal esophagectomy with locoregional lymph node dissection and reconstruction with gastric tube because of micro-invasion at the surgical margin. The patient developed malignant pleural effusion at 6 months after surgery, and he eventually expired 3 months later. Carcinoma can develop in esophageal diverticula and is usually diagnosed at an advanced stage with poor prognosis.     

Hyperhaptoglobinemia and Carcinoma of the Gallbladder

Cancer of the gallbladder is an uncommon malignancy which is seldom diagnosed early and often denotes a poor prognosis. Two reported cases describe the association of hyperhaptoglobinemia (greater than 700 mg./dl.) and advanced carcinoma of the gallbladder. When a patient presents with liver involvement from metastatic adenocarcinoma of suspected gastrointestinal origin and a markedly elevated serum haptoglobin (greater than 700 mg./dl.), it is suggested that a high index of suspicion be held for carcinoma of the gallbladder.     

Noninvasive Carcinoma of the Gallbladder Arising in Localized Type Adenomyomatosis

We report a case of noninvasive carcinoma of the gallbladder arising in the surface mucosa of localized type adenomyomatosis. It was first detected as a polypoid lesion during routine examination with ultrasonography. The gross appearance of the resected specimen showed localized type adenomyomatosis with multiple cysts containing mucin at the fundus of the gallbladder. Microscopic study revealed noninvasive carcinoma in its surface mucosa associated with papillary adenoma in the cyst wall. The occurrence of carcinoma in adenomyomatosis is very rare, and only a few cases have been reported in the literature. Although it has been generally accepted that there is no fear of malignant transformation of adenomyomatosis, the present case suggested that it might be a possible candidate for carcinoma.     

Xanthogranulomatous Cholecystitis Masquerading as Gallbladder Carcinoma

We herein present a case of xanthogranulomatous cholecystitis which involved hoth the liver and transverse colon, clinically mimicking gallbladder carcinoma. Such cases may sometimes he judged inoperable due to extensive extra-gallbladder invasion, and thus it is necessary for physicians to take this lesion into consideration when making a diagnosis. An intraoperative biopsy is necessary, therefore, even when the feaures seem to clearly indicate inoperable carcinoma.     

Early Carcinoma of the Gallbladder, Noninvasive Carcinoma Originating in the Rokitansky-Aschoff Sinus: A Case Report

A patient was reported who underwent cholecystectomy under the diagnosis of chronic cholecystitis with calculi and adenomyomatosis, but it proved to be an early carcinoma of the gallbladder originating in and limited to the Rokitansky-Aschoff sinus (cyst-like structure). Early carcinoma of the gallbladder in this category is rare and this case report may be the first one in the literature.     

细胞粘附分子在胆囊癌中表达的意义

研究胆囊癌组织中细胞粘附分子CEA和CD44v6蛋白表达的意义。用免疫组化法检测 44例胆囊癌组织中CEA和CD44v6蛋白的表达。 44例胆囊组织中CEA和CD44v6蛋白表达的阳性率分别为 75 %和 48% ;两者的表达与肿瘤浸润外膜和淋巴结转移均呈正相关 (P <0 0 5 ) ;胆囊癌组织中CEA和CD44v6蛋白呈协同表达 (P<0 0 5 )。CEA和CD44v6蛋白与胆囊癌的发展和淋巴结转移密切相关。     

Seeding of Gallbladder Carcinoma along the Tract after Percutaneous Transhepatic Choledochoscopy

An implant metastasis developed along the tract after percutaneous transhepatic cholecystoscopy 5 months after initial placement of the catheter into the gallbladder. Percutaneous transhepatic cholecystoscopy is conducted by insertion of choledochofiberscope into the gallbladder through the dilated sinus tract established around a catheter inserted into the gallbladder. The catheter had been placed for total of 15 days. Two days after the removal of the catheter, cholecystectomy supplemented by partial resection of the liver was carried out because of the extent of a gallbladder carcinoma. The choledochofiberscope used was Olympus CHF type 4B, with a thinner flexible part 5.0 mm in diameter. It is not surprising that carcinoma of the biliary tract or pancreas may seed along the tract of a biliary drainage catheter, but only few reports describing such incidence related to percutaneous transhepatic biliary drainage have previously been published. Physicians should be aware of this complication whenever a firm nodule develops at the site of previous entry of a biliary drainage catheter in a patient with malignant obstruction.     

A Case-Control Assessment of Risk Factors for Gallbladder Carcinoma

Gallbladder carcinoma is an uncommon, but highlyfatal disease. Its symptoms frequently mirror those ofgallstone disease, and in most instances, diagnosis isan incidental finding at surgery. While risk factors have been suggested for this cancer,many may in reality simply be a consequence of the olderage of the population. This study is one of the few toapproach this question by using a case-control study design comparing gallbladder carcinomapatients with a gallstone population, coupled withmultivariate analysis to determine age-independent riskfactors. Univariate analyses showed gallbladdercarcinoma patients to be older than gallstone patientsand to have many age-associated diseases. Followingmultiple regression adjustment for age, this disease wasassociated with female gender and with a previous history of gallstone symptoms. Carcinomapatients were less likely to have cholesterol gallstonesin their gallbladders at surgery. A previous history ofsmoking was a substantial risk but of borderline statistical significance. Previous studiesreport associations that may be due to the older age ofthe gallbladder carcinoma patient. Our results show thatafter adjusting for age with multivariate analysis, gallbladder cancer subjects were predominantlyfemale, more likely to report previous gallstonesymptomology, and to smoke. While gallstones were notuniversally isolated from carcinoma patients atcholecystectomy, when present, they were less frequentlyclassified as cholesterol gallstones based on visualinspection. Further cohort studies which target thesepopulations will allow us to gain a more solid consensus on the risk factors for this disease.     

Is Radical Surgery in Locally Advanced Gallbladder Carcinoma Justified?

Objectives: Advanced gallbladder carcinoma is associated with a dismal long term prognosis. The aim of the present study was to evaluate the effectiveness of radical surgery in advanced stages of gallbladder carcinoma.
Methods: The course of 66 patients operated for advanced gallbladder carcinoma was evaluated in a retrospective study; 14% of patients had stage II, 29% had stage III, and 57% had stage IV tumors. Twelve patients underwent cholecystectomy (CHE) and lymphadenec-tomy of the hepatoduodenal ligament (LA); 17 patients underwent cholecystectomy combined with segment IV/V liver resection (CHE + LR) and LA; and 10 patients underwent right extended hemihepatectomy (EHH). Complete tumor resection (RO) was achieved in six patients with CHE and LA, in 14 patients with CHE combined with segment IV/V LR and LA, and in all patients with right EHH. Resections with microscopic residual tumor (R1) were performed in nine patients. Mean follow-up was 15.4 months (range 3–90 months).
Results: The periopertive mortality rate was 1.5%, and the morbidity rate was 20%. In RO resections, mean survival was 23.3, 25.0, and 26.3 months for the patients who underwent CHE and LA, CHE combined with segment IV/V LR and LA, and right EHH, respectively. After 24 months, 46.4% of the patients with R0 resection were still alive compared with none of the patients with residual tumor. In the patients with R0 resection, no difference in survival was detected when node-negative status (pN0) was compared with positive locoregional lymph nodes (pN1a), whereas the degree of dedifferentiation (G2/G3) influenced survival.
Conclusions: If complete resection is achieved, radical surgical procedures, including segment IV/V liver resection and extended right hepatectomy, significantly improve survival rates with an acceptable morbidity and mortality rate.     

胆囊癌组织中nm23H1和PTEN基因蛋白表达及其临床意义

目的:探讨nm23H1和PTEN基因蛋白在胆囊癌中表达的意义.方法:应用免疫组化方法,检测52例胆囊腺癌、20例胆囊腺瘤和10例慢性胆囊炎组织中nm23H1和PTEN表达水平.结果:在胆囊癌中nm23H1和PTEN表达阳性率分别为51.9%和42.3%,其表达阳性率均明显低于胆囊腺瘤和慢性胆囊炎(P＜0.05).nm23H1和PTEN表达与胆囊癌的分化程度、浆膜浸润和转移密切相关(P＜0.05).nm23H1和PTEN蛋白表达呈正相关(γ=0.56,P＜0.05).结论:检测nm23H1和PTEN基因蛋白表达可作为评价胆囊癌生物学行为的参考指标.     

Small Cell Carcinoma of the Gallbladder Arising in a Patient with Pancreaticobiliary Maljunction without Bile Duct Dilatation

We report a 36–year-old female patient with small cell carcinoma of the gallbladder with liver metastasis, that was associated with pancreaticobiliary maljunction (PBM) without bile duct dilatation. On admission, a gallbladder mass and multiple liver tumors were detected by US, CT and ERCP. Moreover, ERCP clearly demonstrated an abnormally long common channel between the pancreatic and bile ducts, indicating PBMwithout choledochal dilatation. US-guided biopsy of the tumor histopathologically confirmed small cell carcinoma. The serum neuron-specific enolase (NSE) level was very high. Transarterial chemo-embolization followed by systemic chemotherapy resulted in marked tumor reduction, but this was followed by rapid exacerbation. The patient died of the tumor 145 days after admission. The proposed mechanism of the car-cinogenesis of this rare gallbladder malignancy under the preexisting condition of PBM was discussed. (Dig Endosc 1999, 11: 246–249)     

Prediction of Prognosis in Gallbladder Carcinoma by Mucin and p53 Immunohistochemistry

Mucin core proteins are known to be present in various organs and are specifically expressed with carcinogenesis and closely associated with the prognoses of various malignant tumors in the digestive tract such as colorectal cancer. The present study evaluated correlations between mucin and p53 expression and prognosis of gallbladder cancer using surgically resected tissue specimens from 26 patients with gallbladder carcinoma surgically treated at our hospital. Immunohistochemical staining was performed using MUC1, MUC2, and p53 monoclonal antibody. The level of antigen expression in the lesion was classified into four stages: none(−), slight(+), moderate (++), and severe (+++). According to the UICC classification, histopathological grading, levels of T, N, and M factors, and tumor stages were compared with regard to the correlations with mucin and p53 expression. All cases were classified into two groups according to the results of mucin immunohistochemistry: group A (MUC1, ≥{++}; and MUC2, ≤+) and group B (MUC1, < ++; or MUC2, > +). Postoperative survival periods were compared between the two groups and p53-positive and -negative groups. Neither histological grading nor T factor correlated with mucin or p53 expression, respectively. Moreover, neither N factor nor M factor correlated with mucin or p53 expression. Furthermore, stage grouping did not correlate with mucin or p53 expression. However, when the correlation between the postoperative survival period and mucin expression was evaluated, the mean postoperative surgical period was significantly shorter in Group A than in Group B (1.02 years in Group A vs 2.92 years in Group B; P = 0.016). There was no relationship between postoperative survival period and p53 positivity. Mucin expression was independent of various tumor growth factors and clearly reflected the prognosis of gallbladder cancer. Because the relative malignancy of gallbladder cancer could be evaluated by examining the level of glycoprotein expression in tumor tissue, mucin could be a more important marker than p53 for predicting prognosis in gallbladder carcinoma using surgically resected tissue specimens.