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National Cancer Institute®
Ultima Vez Modificado: 21 de noviembre del 2001
UI - 21436792
AU - Dixit VK; Singh S; Shukla VK
TI - Aetiopathogenesis of carcinoma gallbladder.
SO - Trop Gastroenterol 2001 Apr-Jun;22(2):103-6
AD - Department of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221 005, India.
UI - 99444171
AU - Paolucci V; Schaeff B; Schneider M; Gutt C
TI - Tumor seeding following laparoscopy: international survey.
SO - World J Surg 1999 Oct;23(10):989-95; discussion 996-7
AD - Klinikum der Johann Wolfgang Goethe Universitat, Zentrum der Chirurgie, Klinik fur Allgemeinchirurgie, Theodor-Stern-Kai 7, D-60590 Frankfurt am Main, Germany.
The aim of the study was to determine if tumor seeding during laparoscopic surgery for cancer is a rare event or a typical complication of this procedure. Laparoscopic staging and treatment of intraabdominal tumors is increasing in gastroenterology, gynecology, and general surgery. A total of 1052 questionnaires were mailed to surgical department chairmen, members of the German Society of Surgery, Swiss Association for Laparoscopic and Thoracoscopic Surgery, and Austrian Society of Minimal Invasive Surgery asking them to list their department's experience with tumor seeding after laparoscopy for nonapparent or known malignancy. There were 607 (57.7%) surgeons who reported a total of 117,840 laparoscopic cholecystectomies, 409 incidental gallbladder carcinomas, and 412 laparoscopies on patients with colorectal carcinoma. Altogether 109 patients who developed tumor recurrence in connection with laparoscopic surgery have been reported. Port-site recurrence was identified in 70 of 409 patients (17.1%) with a median of 180 days following laparoscopic cholecystectomy for nonapparent gallbladder carcinoma. In 8 cases (11.5%) a protective plastic bag had been used for gallbladder retrieval. Six patients without port-site metastases were found to have a diffuse peritoneal carcinomatosis a median of 120 days after cholecystectomy. Of 412 laparoscopies for colorectal cancer, 19 cases (4.6%) of tumor seeding have been reported, 16 of which (3.9%) had documented port-site and scar recurrences a median of 196 days after laparoscopy. The tumor specimen was intact, and a plastic bag was used for extraction in seven cases. In 14 patients trocar-site metastases have been reported a median of 70 days after laparoscopy for different nonapparent or known malignancies. The probability of developing abdominal wall metastasis is higher after laparoscopy for cancer than after open surgery. An intact surgical specimen and the use of a plastic retrieval bag do not exclude the risk of port-site recurrences. These facts and the early appearance of peritoneal carcinosis in a few cases of intraabdominal malignancies seem to confirm a specific laparoscopic risk for intraperitoneal tumor cell seeding and implantation.
UI - 21271462
AU - Elnemr A; Ohta T; Kayahara M; Kitagawa H; Yoshimoto K; Tani T; Shimizu
TI - K; Nishimura G; Terada T; Miwa K Anomalous pancreaticobiliary ductal junction without bile duct dilatation in gallbladder cancer.
SO - Hepatogastroenterology 2001 Mar-Apr;48(38):382-6
AD - Department of Surgery II, School of Medicine Kanazawa University, Takara-machi 13-1, Kanazawa 920-0934, Japan.
BACKGROUND/AIMS: Anomalous pancreaticobiliary junction is a rare anomaly but is a risk factor for primary carcinoma of the gallbladder. To define the relationship between anomalous pancreaticobiliary junction, especially if it is not associated with common bile duct dilatation, and gallbladder carcinoma, we retrospectively reviewed data of 126 patients with gallbladder carcinoma. METHODOLOGY: All these patients had undergone direct cholangiography either by endoscopic retrograde cholangiopancreaticography or percutaneous transhepatic cholangiography. RESULTS: Among 126 patients with gallbladder cancer, 23 patients (18.3%) exhibited anomalous pancreaticobiliary junction. Patients with anomalous pancreaticobiliary junction were younger (mean age: 54 +/- 9.1 years) than patients without anomalous pancreaticobiliary junction (mean age: 65 +/- 9.7 years). The incidence of gallstones in patients with anomalous pancreaticobiliary junction (17%) was significantly lower than in those without this anomaly (64%) (P < 0.01). Among the 23 patients with anomalous pancreaticobiliary junction, 12 patients (52%) had no bile duct dilatation and, 11 patients (48%) had bile duct dilatation in the form of fusiform or cylindrical dilatation. However, no cases with severe cystic dilatation were found. Patients of anomalous pancreaticobiliary junction without common bile duct dilatation had more advanced disease and poor prognosis than those with common bile duct dilatation. CONCLUSIONS: The present study revealed that gallbladder cancer in the patients of anomalous pancreaticobiliary junction without common bile duct dilatation was diagnosed at advanced stage and the prognosis was very poor. Therefore, if a minor abnormality is detected in the wall of acalculous gallbladder on ultrasonography, direct cholangiography should be done to exclude this anomaly.
UI - 21274204
AU - Esposito I; Friess H; Buchler MW
TI - Carcinogenesis of cancer of the papilla and ampulla: pathophysiological facts and molecular biological mechanisms.
SO - Langenbecks Arch Surg 2001 Apr;386(3):163-71
AD - Department of Visceral and Transplantation Surgery, University of Bern, Inselspital, Switzerland.
BACKGROUND: Ampullary cancer has one of the highest resectability rates and best prognoses among neoplasms arising in the periampullary region. DISCUSSION: Early diagnosis due to early symptoms can partially explain the better prognosis as compared to other cancers of the periampullary region, but biologic factors should also be taken in account. In the past few years, the molecular mechanisms underlying this disease have been investigated and alterations of genes that regulate different cell functions have been described. Mutations of K-ras and of the tumor suppressor genes APC, p16 and p53 indicate a major disturbance in cell cycle regulation. CONCLUSIONS: If the molecular profile of ampullary cancer is examined in terms of rate and type of molecular changes, it seems to be more similar to intestinal than to pancreatic cancer. Furthermore, the fact that many ampullary carcinomas arise from adenomas and the frequent finding of ampullary tumors in patients affected by polyposis syndromes also suggest that ampullary and colon cancers share common molecular mechanisms of carcinogenesis.
UI - 21274205
AU - Wittekind C; Tannapfel A
TI - Adenoma of the papilla and ampulla--premalignant lesions?
SO - Langenbecks Arch Surg 2001 Apr;386(3):172-5
AD - Institute of Pathology, University of Leipzig, Germany. email@example.com
Ampullary adenomas arising in the papilla or the ampulla Vateri, are rare, benign, neoplastic lesions. No specific aetiological factors, such as diet, chemical or environmental causes, have been identified yet. An established risk factor which is accompanied by the development of adenoma is the presence of genetically inherited polyposis syndromes, e.g. familial adenomatosis coli (FAP). Adenomas assume tubular, tubulovillous, or villous architecture and are not different from adenomas arising elsewhere in the gastrointestinal tract. The full neoplastic spectrum, ranging from mild to high grade dysplasia, up to invasive carcinoma, resembles the adenoma-carcinoma sequence of the large bowels.
UI - 21274206
AU - Vogt M; Jakobs R; Riemann JF
TI - Rationale for endoscopic management of adenoma of the papilla of Vater: options and limitations.
SO - Langenbecks Arch Surg 2001 Apr;386(3):176-82
AD - Klinikum der Stadt Ludwigshafen GmbH, Ludwigshafen am Rhein, Germany.
BACKGROUND: Several studies and our own results prove that endoscopic therapy in selected cases of benign adenomas is safe and technically feasible. In patients refusing surgery or patients with high comorbidity and poor physical health status, endoscopic resection is an excellent alternative. DISCUSSION: The decision for endoscopic or surgical excision of adenomas is determined by general health status, histology, size, location, and depth of the lesion. In carcinoma of the papilla of Vater it is important to assess the tumoral ductal infiltration correctly to determine whether endoscopic resection is a viable option. Intraductal ultrasound is essential before initiating treatment and it therefore contributes to conservative therapy in patients with tumors of the papilla of Vater. Temporary placement of a short pancreatic duct stent may protect against pancreatitis and might allow more excessive ablation of adenomatous tissue, especially around the pancreatic duct orifice. After endoscopic sphincterotomy, biliary and pancreatic endoprostheses can be inserted easily in cases of obstructed pathways or cholangitis and pancreatitis due to tumor obstruction. Argon plasma coagulation can be used to treat oozing tumor hemorrhages or to vaporize tumoral residues after endoscopic snare resection. Endoscopic surveillance is essential after surgical or endoscopic resection of adenomas of the papilla of Vater.
UI - 21274214
AU - Tazuma S; Kajiyama G
TI - Carcinogenesis of malignant lesions of the gall bladder. The impact of chronic inflammation and gallstones.
SO - Langenbecks Arch Surg 2001 Apr;386(3):224-9
AD - First Department of Internal Medicine, Hiroshima University School of Medicine, Japan. firstname.lastname@example.org
Gallbladder carcinoma is an uncommon but highly malignant tumor with a poor 5-year survival rate. The presence of gallstones is a well-established risk factor for gallbladder carcinoma, and the risk seems to correlate with stone size. Metaplastic changes of the gallbladder epithelium present in chronic cholecystitis may be a premalignant lesion. Solitary polyps with a size of greater than 1 cm are recognized as a predisposing factor for gallbladder carcinoma when their characteristics are echopenic, sessile, and high cell density. Endoscopic ultrasound is the most useful technique to detect the early changes of malignancy in polyps. Anomalous junction of pancreaticobiliary ducts (AJPBD) without a choledochal cyst and porcelain gallbladder is an additional risk factor for gallbladder malignancy. At the molecular level, it has been proposed that chronic inflammation of the gallbladder may lead to the loss of p53 gene heterozygosity and excessive expression of p53 protein. Furthermore, a proposed mechanism underlying the high risk of gallbladder carcinoma in patients with AJPBD is that chronic reflux of pancreatic juice causes intestinal metaplasia, hyperplasia, and dysplasia with the mutation of p53 and K-ras. In contrast, the causal relationship between porcelain gallbladder and malignancy is yet to be established. In this article, recognition of risk factors for gallbladder carcinoma was summarized with special attention to gallstones and chronic inflammation.
UI - 21419011
AU - Aoki T; Inoue K; Tsuchida A; Kasuya K; Koyanagi Y
TI - Dye-staining stereomicroscopic examinations for fine mucosal structures of the gallbladder.
SO - Dig Surg 2001;18(4):298-304
AD - Department of Surgery, Tokyo Medical University, Tokyo, Japan.
BACKGROUND: In order to diagnose an unsuspected gallbladder carcinoma and to examine whether a differential diagnosis could be made between cancer and noncancerous lesions during surgery, we evaluated the findings of fine structures of various types of gallbladder mucosa. METHODS: We used stereomicroscopy with a dye-contrast technique under water and measured the maximum blood vessel diameters of the gallbladder mucosa: normal gallbladder, chronic cholecystitis, and carcinoma. RESULTS: All normal gallbladders showed fine-reticular-type findings. In chronic cholecystitis, 5.8% of the specimens (n = 69) had fine reticular type, 87.0% had rough reticular type, and 7.2% had atrophic type. All the cases of adenomyomatosis (n = 16) showed rough reticular type. In eight specimens of pancreaticobiliary maljunction, 75% of them showed high reticular type, and the other 25% showed papillary type. The two adenoma specimens showed fine granular type. In five gallbladder carcinomas, the lattice-like pattern completely disappeared and showed rough granular type. The average of maximum vessel diameters in the gallbladder mucosa were 41.0 microm in normal gallbladders, 99.1 microm in patients with chronic cholecystitis, and 614.8 microm in patients with a carcinoma. There were significant differences among them (p < 0.05). CONCLUSION: This study showed that differential diagnosis between cancer and noncancerous lesion is possible by dye-staining mucosal pattern and measurement of maximum vessel diameters by stereoscopic examination. Copyright 2001 S. Karger AG, Basel
UI - 21463167
AU - Muguruma N; Okamura S; Ichikawa S; Tsujigami K; Suzuki M; Tadatsu M;
TI - Kusaka Y; Okita Y; Yano M; Ito S Endoscopic sonography in the diagnosis of gallbladder wall lesions in patients with gallstones.
SO - J Clin Ultrasound 2001 Sep;29(7):395-400
AD - Second Department of Internal Medicine, School of Medicine, The University of Tokushima, 3-18-15, Kuramoto-cho, Tokushima 770-8503, Japan.
PURPOSE: The purpose of this study was to evaluate the diagnostic accuracy of endoscopic sonography (EUS) in the detection of gallbladder wall lesions in patients with and without gallstones. METHODS: We retrospectively reviewed the medical records, sonograms, and sonographic reports of 62 patients who underwent cholecystectomy for gallbladder wall lesions evaluated by EUS. We assessed the accuracy of EUS in diagnosing gallbladder wall lesions in the presence or absence of gallstones and on the basis of the size and number of stones and the size of the gallbladder wall lesions. We also evaluated the effect of acoustic shadowing. The EUS results were compared with the histopathologic results. RESULTS: EUS correctly diagnosed the gallbladder wall lesions in 17 (71%) of 24 patients with gallstones and in 34 (89%) of 38 patients without gallstones. The diagnostic accuracy of EUS was 86% in patients with gallbladder wall lesions smaller than 20 mm and 79% in patients with gallbladder wall lesions 20 mm or larger. The diagnostic accuracy was 75% in patients with gallstones smaller than 5 mm and 67% in patients with stones 5 mm or larger. The accuracy was 67% in patients with 1-5 stones and 83% in patients with 6 or more stones. None of these differences was statistically significant. Acoustic shadowing did not affect the diagnostic accuracy of EUS. CONCLUSIONS: The diagnostic accuracy of EUS for gallbladder wall lesions is not affected by the presence of gallstones. However, better diagnostic criteria must be established based on larger studies, and technical refinements of the equipment are needed to increase the accuracy of EUS in the diagnosis of gallbladder wall lesions. Copyright 2001 John Wiley & Sons, Inc.
UI - 21436738
AU - Roa I; Villaseca M; Araya J; Roa J; de Aretxabala X; Ibacache G; Garcia
TI - M [CD44 (HCAM) expression in subserous gallbladder carcinoma]
SO - Rev Med Chil 2001 Jul;129(7):727-34
AD - Unidad de Anatomia Patologica y Citopatologia Hospital Temuco, Departamento de Cirugia, Facultad de Medicina, Universidad de la Frontera, Temuco, Chile.
BACKGROUND: HCAM or CD44 is a multifunctional cell adhesion molecule, related to cell-cell, cell-extracellular matrix interactions and involved in tumor invasion. AIM: To study the importance of CD44 expression in subserous gallbladder carcinoma. MATERIAL AND METHODS: One hundred five samples (93 female) of subserous gallbladder carcinoma and 33 non tumoral gallbladder were studied. CD44 was stained using the streptavidine-biotin technique, using human anti CD44 antibodies. Eighty subjects with carcinoma were followed for a period up to 105 months. RESULTS: Mean age of patients was 62.6 years old, all tumors were adenocarcinoma, all were silent and 13% were well differentiated. CD44 was expressed in all controls and in 91%, the expression was normal. In 57% of cancer samples, CD44 expression was abnormal, in 50% it was less expressed and in 24%, it was not expressed. No differences in CD44 expression was observed between mucosa from control samples and mucosa adjacent to the tumor or superficial or deep tumoral areas. Global five years survival was 40%. No significant differences in survival were observed in those tumors with a lower of absent CD44 expression. Six patients with a higher expression died before 18 months of follow up. CONCLUSIONS: Nearly 50% of subserous gallbladder carcinomas show an abnormal CD44 expression.
UI - 21439475
AU - Kaushik SP
TI - Current perspectives in gallbladder carcinoma.
SO - J Gastroenterol Hepatol 2001 Aug;16(8):848-54
AD - Department of General Surgery, Government Medical College and Hospital, Chandigarh, India. email@example.com
Carcinoma gallbladder (CaGB) is not a common malignancy in a large number of countries in the world, except Chile, Japan, some parts of India, and a few other regions. Lacunae exist even today in terms of understanding of its epidemiology, aetiopathogenesis, and in the early pick up of malignanacy, as well as in choosing the most appropriate treatment option for a given case. While Japanese surgeons have advocated radical resections for CaGB and have shown good outcome resulting in long- term survival, others have not felt convinced about the desirability of undertaking such morbid surgical procedures in all patients. Also, radical resections have not always resulted in a tumor-free state and a cure in a large percentage of cases. Under the circumstances, the clinician's mind is often confused as to the most beneficial option for that patient once curative resection is not possible. Palliation of the jaundice and/or gastric outlet obstruction relieves the symptoms but does not prolong survival. The role of adjuvant chemotherapy with or without cytoreductive surgery has not been fully explored in CaGB. The present review quotes experience that seems to support the above contention. However, a number of well-designed multicentric trials are required to confirm the above philosophy of treatment for the benefit of patients suffering from CaGB.
UI - 21439496
AU - Watanabe O; Haga S; Okabe T; Kumazawa K; Shiozawa S; Tsuchiya A;
TI - Kajiwara T; Hirotani T; Aiba M Amputation neuroma of common bile duct with obstructive jaundice.
SO - J Gastroenterol Hepatol 2001 Aug;16(8):945-6
UI - 21468691
AU - Quan ZW; Wu K; Wang J; Shi W; Zhang Z; Merrell RC
TI - Association of p53, p16, and vascular endothelial growth factor protein expressions with the prognosis and metastasis of gallbladder cancer.
SO - J Am Coll Surg 2001 Oct;193(4):380-3
AD - Department of Surgery, Xinhua Hospital, Shanghai Second Medical University, China.
BACKGROUND: Tumor suppressor genes were studied in gallbladder disease including cancer for correlation. VEGF (vascular endothelial growth factor) expression was assessed against Nevin staging and metastasis of gallbladder carcinoma. The importance of p53, p16, and VEGF in gallbladder cancer was estimated. STUDY DESIGN: Twenty-four gallbladder carcinomas, 20 gallbladder adenomas, and 18 chronic cholecystitis specimens were immunohistochemically and histopathologically investigated for the relation of p53, p16, and VEGF to Nevin staging and pathologic grading. RESULTS: The expression rate of abnormal p53 in gallbladder carcinomas was significantly higher than that in gallbladder adenoma and chronic cholecystitis (p = 0.003, p = 0.014). The expression rate of abnormal p53 in Nevin staging S1, S2, S3 gallbladder carcinoma was significantly higher than that in S4, S5 (p = 0.01). Abnormal p16 was highest in carcinoma, next in adenoma, and lowest in chronic cholecystitis (p = 0.031, p = 0.017). Gallbladder carcinoma expressed VEGF far more often than adenoma or cholecystitis (p = 0.001); VEGF-positive rates were lower in S1, S2, S3 than S4, S5 by Nevin staging of gallbladder cancer (p = 0.044). CONCLUSION: Mutation of p53 and p16 genes might correlate with progression of of gallbladder carcinoma. Analysis of p53 and p16 can estimate the prognosis of gallbladder cancer. VEGF expression correlates with Nevin staging in gallbladder cancer.
UI - 21268433
AU - Schauer RJ; Meyer G; Baretton G; Schildberg FW; Rau HG
TI - Prognostic factors and long-term results after surgery for gallbladder carcinoma: a retrospective study of 127 patients.
SO - Langenbecks Arch Surg 2001 Mar;386(2):110-7
AD - Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilian University, 81377 Munich, Germany.
BACKGROUND: The surgical management of gallbladder cancer is controversial, especially as to the indications for reoperation, extended resection, and aggressive treatment in advanced tumor stages. METHODS: Records and follow-ups of 127 patients with gallbladder carcinoma who underwent surgery between 1980 and 1997 were examined according to the pTNM and Nevin staging systems. Factors predictive for survival were obtained from histopathologic staging and surgical procedures. RESULTS: Surgery for gallbladder cancer was associated with an overall 5-year survival rate of 6.6%. Curative resection was possible in 35.5% of cases, which resulted in 5-year survival rates of 20%. Noncurative surgery revealed poor prognosis, with median survival time limited to 3.2 months, independently of macroscopic or microscopic tumor residues. None of the latter patients survived longer than 24 months. Surgery of stage I/II cancer showed a 5-year survival rate of 64.5%. In stage III/IV tumors, resectability was only 20.4%. However, curative surgery in advanced stages significantly increased median survival from 3.2 to 19.4 months. CONCLUSIONS: Only complete tumor resection can provide long-term survival, even in advanced stages. Because negative surgical margins and UICC stage are the strongest predictors for survival, reoperation is required with all incidental findings above the T1b stage.
UI - 21291615
AU - Sanz-Altamira PM; O'Reilly E; Stuart KE; Raeburn L; Steger C; Kemeny NE;
TI - Saltz LB A phase II trial of irinotecan (CPT-11) for unresectable biliary tree carcinoma.
SO - Ann Oncol 2001 Apr;12(4):501-4
AD - Division of Hematology/Oncology, Boston Center for Liver Cancer, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts 02215, USA.
BACKGROUND: Unresectable adenocarcinomas of the biliary tree have a very poor prognosis. No good chemotherapeutic regimen is available. Irinotecan has not yet been fully tested in this disease. We evaluated its activity in unresectable bile duct cancers. PATIENTS AND METHODS: Twenty-five consecutive eligible patients at our two institutions were treated with irinotecan at a starting dose of 125 mg/m2. A cycle consisted of once-a-week treatments for four consecutive weeks, followed by two weeks of rest. All patients were required to have histologically confirmed diagnosis, clinically documented metastatic or unresectable carcinoma and measurable disease. Patients were evaluated for response, toxicity, and survival. RESULTS: A total of 83 cycles of therapy were delivered. Two patients had a partial response (8%; 95% confidence interval (CI): 0%-18%) and ten additional patients had stable disease for at least two months (40%; 95% CI: 20.8%-59.2%). The therapy was well tolerated, with moderate myelosuppression and diarrhea as the main toxicities. The overall median survival was 10 months. CONCLUSIONS: Irinotecan has minimal activity in biliary tree carcinomas, but is well tolerated with appropriate supportive care, and produces occasional objective responses.
UI - 21457977
AU - Afzal S; Kristiansen VB; Rosenberg J
TI - [Gallbladder polyps]
SO - Ugeskr Laeger 2001 Sep 10;163(37):5003-6
AD - Kirurgisk afdeling D, Amtssygehuset i Glostrup.
Polyps in the gall bladder are detected in 4-5% of the population and most of them are benign. However, they can be premalignant and the prognosis for gall bladder carcinoma is still poor. As with other cancers, treatment at an early stage is therefore, considered essential to improve the prognosis. Because of the very low morbidity after laparoscopic cholecystectomy we recommend laparoscopic cholecystectomy when a polyp in the gall bladder is detected by ultrasonography. A wait and see attitude with repeated ultrasonography twice a year may be chosen, if there are contra-indications to laparoscopic cholecystectomy. If the lesion increases in size, cholecystectomy should be performed.
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