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Ultima Vez Modificado: 1 de enero del 2002
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.
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.
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. firstname.lastname@example.org
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.
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.
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.
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.
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. email@example.com
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.
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
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.
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.
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. firstname.lastname@example.org
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.
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.
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. email@example.com
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.
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.
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.
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.
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
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.
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%.
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.
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
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. firstname.lastname@example.org
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.
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. email@example.com
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.
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. firstname.lastname@example.org
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.
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.
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.
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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