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National Cancer Institute®
Ultima Vez Modificado: 1 de junio del 2002
UI - 11930198
AU - Myers RP; Shaffer EA; Beck PL
TI - Gallbladder polyps: epidemiology, natural history and management.
SO - Can J Gastroenterol 2002 Mar;16(3):187-94
AD - Division of Gastroenterology, University of Calgary, Calgary, Canada.
Polypoid lesions of the gallbladder affect approximately 5% of the adult population. Most affected individuals are asymptomatic, and their gallbladder polyps are detected during abdominal ultrasonography performed for unrelated conditions. Although the majority of gallbladder polyps are benign, most commonly cholesterol polyps, malignant transformation is a concern. The differentiation of benign from malignant lesions can be challenging. Several features, including patient age, polyp size and number, and rapid growth of polyps, are important discriminating features between benign and malignant polyps. Based on the evidence highlighted in this review, the authors recommend resection in symptomatic patients, as well as in asymptomatic individuals over 50 years of age, or those whose polyps are solitary, greater than 10 mm in diameter, or associated with gallstones or polyp growth on serial ultrasonography. Novel imaging techniques, including endoscopic ultrasonography and enhanced computed tomography, may aid in the differential diagnosis of these lesions and permit expectant management.
UI - 11848630
AU - Wagholikar GD; Behari A; Krishnani N; Kumar A; Sikora SS; Saxena R;
TI - Kapoor VK Early gallbladder cancer.
SO - J Am Coll Surg 2002 Feb;194(2):137-41
AD - Department of Surgical Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
BACKGROUND: The majority of patients with gallbladder cancer (GBC) have advanced disease at the time of diagnosis and are unresectable. Longterm survival is usually seen in a subset of patients with early GBC (EGBC)-cancer confined to the mucosa (pT1a) and muscularis (pT1b). Management guidelines of EGBC are not yet defined and are controversial. The purpose of this article is to evaluate the diagnostic aspects and effects of resectional procedures on survival outcome in patients with EGBC. STUDY DESIGN: EGBC was defined as cancer confined to the mucosa (pT1a) or muscularis (pT1b) according to the TNM classification. Clinicopathological details and survival data of 14 patients who had EGBC were analyzed. There were 9 women and 5 men, with a mean age of 60 years. RESULTS: A definite preoperative diagnosis was possible in only three patients and three patients were diagnosed at operation; the majority of patients were diagnosed incidentally after cholecystectomy for associated gallstones. Two patients underwent extended cholecystectomy and 12 patients underwent simple cholecystectomy. Two patients had pT1a and 12 had pT1b lesions. Mean (SD) survival was 71.5 (12.2) months and median survival was 42 months. There were five treatment failures with locoregional recurrence and death; all with pT1b tumors were treated by simple cholecystectomy. Cumulative 1-, 3-, and 5-year survival was 92%, 68%, and 68% respectively [corrected]. CONCLUSIONS: Simple cholecystectomy is an adequate treatment only for mucosal GBC. Patients with pT1b tumors require extended cholecystectomy. Incidental GBC extending up to the muscularis merits early reoperation for completion of extended cholecystectomy, which offers the only chance of cure.
UI - 12018544
AU - Puneet; Khanna R; Khanna AK
TI - Intra-operative tube stenting, palliation for jaundice in carcinoma gall bladder.
SO - J Indian Med Assoc 2001 Oct;99(10):584-6
AD - Department of Surgery, Institute of Medical Science, Banaras Hindu University, Varanasi.
Majority of patients with advanced carcinoma gall bladder have irresectable disease and require palliation for jaundice, pruritus and cholangitis. These cases presenting with jaundice are usually high risk cases to undergo any major surgical procedure like segment-III hepaticodochojejunostomy. So intra-operative tube stenting was attempted in 6 patients of carcinoma gall bladder but technically, it was possible in 4 cases only. In 2 cases because of massive locoregional disease it was not possible to cannulate the proximal part of the bile duct. The distal end of the tube was passed either in the duodenum or proximal part of the jejunum. Patients were followed up, showed good recovery from jaundice and pruritus.
UI - 12014717
AU - Buckles DC; Lindor KD; Larusso NF; Petrovic LM; Gores GJ
TI - In primary sclerosing cholangitis, gallbladder polyps are frequently malignant.
SO - Am J Gastroenterol 2002 May;97(5):1138-42
AD - Division of Gastroenterology and Hepatology, Mayo Medical School, Clinic, and Foundation, Rochester, Minnesota 55905, USA.
OBJECTIVE: The management of gallbladder polyps/masses in patients with primary sclerosing cholangitis (PSC) (i.e., cholecystectomy vs observation) remains problematic. Given the risk of biliary tract cancer in PSC in the face of the benign nature of most gallbladder polyps in the general population, our aim was to determine the prevalence of gallbladder cancer in PSC patients with a gallbladder mass who had undergone cholecystectomy. METHODS: The case records of all patients with PSC undergoing a cholecystectomy at the Mayo Clinic between 1977-1999 were reviewed. RESULTS: Of the 102 patients with PSC who underwent a cholecystectomy, 14 of 102 (13.7%) had a gallbladder mass. In the subset of patients with gallbladder masses, eight of 14 (57%) had adenocarcinomas (seven primary adenocarcinomas and one metastatic cholangiocarcinoma); the other six had benign masses (five adenomas and one cholesterol polyp). In those patients with benign masses, 33% had associated epithelial cell dysplasia; in patients with primary gallbladder cancers, 57% had associated dysplasia. The patients with primary gallbladder adenocarcinoma had a favorable outcome after cholecystectomy, with a 36-month survival of 66%. CONCLUSIONS: In conclusion, gallbladder neoplasms in PSC patients are malignant in approximately 40-60% of the cases. The presence of gallbladder epithelial cell dysplasia suggests a dysplasia-carcinoma sequence in PSC similar to that observed in ulcerative colitis. Consideration should be given to performing a cholecystectomy in PSC patients with gallbladder polyps. If a cholecystectomy is not performed, careful interval follow-up is warranted.
UI - 11986018
AU - Weiland ST; Mahvi DM; Niederhuber JE; Heisey DM; Chicks DS; Rikkers LF
TI - Should suspected early gallbladder cancer be treated laparoscopically?
SO - J Gastrointest Surg 2002 Jan-Feb;6(1):50-6; discussion 56-7
AD - Department of Surgery, Division of General Surgery, University of Wisconsin-Madison, Madison, WI 53792, USA.
Early gallbladder cancer (EGC), defined as T1 and T2 disease, is frequently curable when completely excised without bile spillage. The objective of the present study was to determine what effect initial laparoscopic cholecystectomy has on outcome in patients with EGC. Of 89 patients referred to our institution with gallbladder cancer over an 11-year period, 26 had undergone initial laparoscopic cholecystectomy. Sixteen of the 26 patients had T1 or T2 disease and are the subjects of this report. These patients were reviewed retrospectively to assess preoperative diagnosis, intraoperative bile spillage, and outcome (recurrence and survival). In addition, the Western literature was reviewed to determine the impact of initial laparoscopic cholecystectomy on recurrence and survival of patients with EGC. Six patients had a preoperative ultrasound consistent with a mass in the gallbladder wall. Seven (44%) had documented bile spillage during the laparoscopic cholecystectomy. T stage based on the laparoscopic cholecystectomy was T1 (n = 1) and T2 (n = 15). Twelve patients underwent reexploration of whom seven underwent further radical excision (gallbladder liver bed resection and extensive lymphadenectomy). After a mean follow-up of 20.1 months (range 4 to 39 months), 69% of patients have had a recurrence or died. Three patients had a port-site recurrence. Five (71%) of seven patients with bile spillage at laparoscopic cholecystectomy have had a recurrence or died of disease. A review of the Western literature on EGC initially removed by laparoscopic cholecystectomy (including the present series) yielded 21 patients with T1 and 42 patients with T2 disease. One-year Kaplan-Meier survival (T1 = 89%, T2 = 71%) and 3-year Kaplan-Meier survival (T1 = 47%, T2 = 40%) of these patients is worse than prior reports for open cholecystectomy. An initial laparoscopic cholecystectomy with its potential for bile spillage can convert potentially curable EGC to incurable disease. Patients with preoperative findings suspicious for gallbladder cancer should undergo open exploration with intent to perform a radical cancer operation as a primary procedure if the diagnosis is confirmed intraoperatively.
UI - 12023580
AU - Chang HJ; Jee CD; Kim WH
TI - Mutation and altered expression of beta-catenin during gallbladder carcinogenesis.
SO - Am J Surg Pathol 2002 Jun;26(6):758-66
AD - Department of Pathology, Seoul National University College of Medicine, Korea.
Gallbladder carcinoma has two main morphologic developmental pathways: a dysplasia-carcinoma sequence and an adenoma-carcinoma sequence. beta-Catenin is a key regulator of the cadherin-mediated cell adhesion system, and altered expression and mutation of beta-catenin have been identified in many human malignancies. To clarify its role in gallbladder carcinogenesis, we investigated mutation and immunohistochemical expression of beta-catenin in adenomas, dysplasias, and carcinomas. We classified adenomas according to the expression of apomucins and cytokeratin and compared the mutational and expression pattern among each type. beta-Catenin mutations were identified in 58% (14 of 24) of the adenomas, and they were absent from all carcinomas (37 cases) and dysplasias (13 cases). Altered expression of beta-catenin, such as nuclear or cytoplasmic expression and loss of membranous expression, was also significantly higher in adenomas than in dysplasias or carcinomas (p <0.001). Of the adenomas, papillary adenomas and tubular adenomas of intestinal type showed infrequent beta-catenin abnormality, which was similar to the carcinomas. The cytoplasmic and nuclear expression of beta-catenin in carcinomas was correlated with less aggressive tumor behavior; in particular, cytoplasmic expression was associated with improved patient outcome (p = 0.028). Gallbladder adenoma may be a heterogeneous entity, and the majority of adenomas are not responsible for carcinoma progression.
UI - 12016370
AU - Schwartz LH; Black J; Fong Y; Jarnagin W; Blumgart L; Gruen D; Winston
TI - C; Panicek DM Gallbladder carcinoma: findings at MR imaging with MR cholangiopancreatography.
SO - J Comput Assist Tomogr 2002 May-Jun;26(3):405-10
AD - Department of Radiology, Memorial Sloan-Kettering Cancer Center, and Weill Medical College of Cornell University, New York, New York 10021, USA. email@example.com
PURPOSE: To describe magnetic resonance (MR) imaging and MR cholangiopancreatography (MRCP) findings in gallbladder carcinoma, and to correlate these findings with available surgical and biopsy information. METHODS: Preoperative MR images (T1-weighted spin-echo, T2-weighted fast spin-echo, single shot fast spin-echo, and dynamic gadolinium-enhanced gradient echo) in 34 patients with gallbladder carcinoma were retrospectively reviewed for appearance of the primary neoplasm and for demonstration of hepatic, peritoneal, duodenal, and nodal involvement. Imaging findings were then compared with surgical findings (n = 19 patients) and histologic findings (n = 15 patients). RESULTS: Gallbladder carcinoma manifested at MR imaging as focal gallbladder wall thickening with an eccentric mass in 76% (26/34) of cases. The most common types of regional spread demonstrated were direct liver invasion in 91% (31/34), lymphadenopathy in 76% (26/34), and biliary tract invasion in 62% (21/34). Sensitivity for direct hepatic invasion was 100%, and was 92% for lymph node metastasis. CONCLUSION: MRI and MRCP can provide information relevant to preoperative staging of gallbladder carcinoma.
UI - 12040819
AU - Weinstein D; Herbert M; Bendet N; Sandbank J; Halevy A
TI - Incidental finding of gallbladder carcinoma.
SO - Isr Med Assoc J 2002 May;4(5):334-6
AD - Department of Surgery B, Assaf Harofeh Medical Center, Zerifin, Israel.
BACKGROUND: Carcinoma of the gallbladder is diagnosed in 0.3-1.5% of all cholecystectomy specimens. OBJECTIVES: To establish the overall rate of gallbladder carcinoma and unexpected gallbladder carcinoma based on our experience. METHODS: We retrospectively evaluated all consecutive cholecystectomies performed in our ward during a 6 year period in order to determine the incidence of gallbladder carcinoma and to identify common characteristics of this particular group of patients. RESULTS: Of the 1,697 cholecystectomies performed in our ward during the 6 years, gallbladder carcinoma was diagnosed in six patients (0.35%) but was not suspected prior to surgery in any of them. In accordance with the literature, the occurrence in women (5/6) was higher than in men (1/6). The mean age was 70 years (range 55-90). The most common symptom was abdominal pain; the majority (5/6) had cholelithiasis, and the pathologic report confirmed the diagnosis of adenocarcinoma in all six patients. CONCLUSIONS: The overall incidence of unsuspected gallbladder carcinoma in our series was 0.35%. We could not find any common characteristics for this particular group of patients when compared to patients with non-malignant pathology.
UI - 11974462
AU - Puhalla H; Bareck E; Scheithauer W; Ploner M; Stiglbauer W; Depisch D
TI - [Therapy of gallbladder carcinoma. Experience of a central hospital]
SO - Chirurg 2002 Jan;73(1):50-6
AD - Chirurgische Abteilung, Allgemeines offentliches Krankenhaus, Wiener Neustadt, Osterrreich.
INTRODUCTION: There are various options for the treatment of gallbladder carcinoma; however, only radical resection offers a chance for prolonged survival. METHODS: The aim of this study was to analyze retrospectively patients suffering from gallbladder carcinoma in a central hospital in Austria. From 1986 to 1999, 77 patients were treated in this surgical department. The median age of the patients was 71.3 years. RESULTS: In 28 patients the cancer was resected and 22 persons underwent palliative surgery. An explorative laparotomy was performed in 16 patients. Eleven patients had no surgical therapy, 10 persons received gemcitabine or a combination chemotherapy regimen consisting of leucoverin, 5-fluorouracil and mitomycin C. The median survival of patients without chemotherapy following radical resection (n = 15) was 10.7 months (one patient with metastatic cancer was excluded) and for patients with tumor remaining margins (n = 8) 3.2 months (P = 0.023). Without chemotherapy the median patient survival following palliative resection (n = 17) and explorative laparotomy (n = 15) was 1.5 months and 2.1 months. The median survival without surgical therapy was 1.6 months. Chemotherapy was administered to four of the resected patients (median survival 16.5 months), in five patients following palliative surgery and in one patient after explorative laparotomy (median survival 4.3 months) (P = 0.034). In a multivariate analysis, tumor resection (P = 0.034) and tumor-free resection margins (P = 0.025) proved to be the most important determinants for patient survival. CONCLUSION: Tumor resection is the most important factor for a prolonged patient survival. Following radical resection in an early tumor stage and combining this approach with an established chemotherapy, patient survival could be increased significantly.
UI - 11992798
AU - Brooks AD; Mallis MJ; Brennan MF; Conlon KC
TI - The value of laparoscopy in the management of ampullary, duodenal, and distal bile duct tumors.
SO - J Gastrointest Surg 2002 Mar-Apr;6(2):139-45; discussion 145-6
AD - Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA.
Laparoscopy identifies radiologically occult advanced disease in patients with pancreatic adenocarcinoma. The value of laparoscopy in the management of peri-ampullary tumors was determined. One hundred forty-four patients with radiologically resectable nonpancreatic adenocarcinoma, periampullary tumors were identified from a prospective laparoscopic unresectability included histologically proved peritoneal or hepatic metastases, distant nodal involvement, arterial involvement, and local extension outside the resection field. Median age at operation was 70 years (range 31 to 87 years) and 56% of the patients were men. An adequate laparoscopy was performed in 134 cases (93%). Laparoscopy identified 13 patients (10%) with unresectable disease. Of 121 patients with laparoscopic resectable disease, 111 (92%) went on to subsequent resection; CT correctly predicted resectability in 82%. Laparoscopy spared 36% of unresectable patients a nontherapeutic laparotomy. Patients with resectable disease were treated by pancreaticoduodenectomy (n = 91, 76%), ampullectomy (n = 12, 10%), duodenal resection (n = 10, 9%), or bile duct excision (n = 6, 5%). The addition of diagnostic laparoscopy to dynamic CT scanning in this selected patient population identifies an additional 10% of patients with unresectable disease. We believe that laparoscopy should be used in a selective manner for preoperative staging of patients suspected of having nonpancreatic periampullary tumors.
UI - 11992815
AU - Serra I; Diehl AK
TI - Number and size of stones in patients with asymptomatic and symptomatic gallstones and gallbladder carcinoma.
SO - J Gastrointest Surg 2002 Mar-Apr;6(2):272-3; discussion 273
UI - 11963497
AU - Hartenfels IM; Dukat A; Burg J; Hansen M; Jung M
TI - [Adenomas of Vater's ampulla and of the duodenum. Presentation of diagnosis and therapy by endoscopic interventional and surgical methods]
SO - Chirurg 2002 Mar;73(3):235-40
AD - St. Hildegardis-Krankenhaus, Abteilung fur Chirurgie, Hildegardstrasse 2, 55131 Mainz.
BACKGROUND: Adenoma of the ampulla of Vater and the duodenum are rare tumors. The leading symptoms are unspecific; sometimes they are due to the disturbances of the passage or erosion of the tumor. Early and correct diagnosis and the appropriate therapy are of decisive importance because these tumors are precancerous. PATIENTS AND METHODS: We report the cases of seven patients with periampullary adenoma of the duodenum, in one case with incorporation of the the distal bile duct. The diagnostic steps and the surgical treatment are reported and discussed. In achieving a definitive diagnosis, endoscopic retrograde cholangiopancreatography is of paramount importance. Three patients subsequently underwent partial pancreatoduodenectomy (Whipple's procedure); in three patients transduodenal local tumor excision was performed. Postoperative course was without complications in each case and no operative mortality occurred. One patient was treated by argon-coagulation. RESULTS: The histopathological examination showed a tubular villous adenoma in six cases and in one case a villous adenoma (ranging from low to high grade dysplasia). Because there is evidence of an adenoma-carcinoma-sequence, radical surgical treatment is recommended, even in adenoma with low grade dysplasia, in spite of the absence of malignancy.
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