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PubMed1989

Familial occurrence of anomalous pancreaticobiliary duct union associated with gallbladder neoplasms.

The authors present two cases of anomalous pancreaticobiliary duct union that occurred in a mother and her daughter; the former was associated with gallbladder adenocarcinoma, and the latter, gallbladder adenoma with high grade dysplasia. This disorder has been considered a developmental anomaly, although the true etiology has not been known. This is the first report of familial occurrence of this anomaly, and it may point to the presence of a genetic factor in its development. Another implication is the presence of histological features which suggest the possible sequence of anomalous pancreaticobiliary duct union to intestinal metaplasia to adenoma or dysplasia to cancer of the gallbladder.

Adenocarcinoma↗
PubMed2003

[X-linked hyper-IGM syndrome associated to sclerosing cholangitis and gallbladder neoplasm: clinical case].

We report a 11 years old male diagnosed as a X-linked hyper-IgM syndrome that presented with recurrent infections and sclerosing cholangitis and later developed a gallbladder cancer. Immunological evaluation showed decreased levels of serum IgG and IgA with elevated levels of IgM. Study of CD40 ligand expression on mitogen activated peripheral blood mononuclear cells revealed total absence of this marker on T lymphocytes. Molecular analysis detected, in the patient and his mother, a nonsense mutation in exon 1 of the transmembrane segment of the CD40 ligand. He also presented elevation of alkaline phosphatases and mild elevation of liver enzymes. Liver biopsy demonstrated the presence of idiopathic sclerosing cholangitis. The patient was started on monthly IVIG therapy at 400 mg/kg, as well as ursodeoxycholic acid and vitamin E, with normalization of his IgG and IgM levels a decrease in the incidence of infections and normalization of liver function. Three years after diagnosis, we detected the presence of polyps inside the gallbladder that were reported at biopsy as adenocarcinoma. He underwent hepatic bisegmentectomy (VI B-V) and local lymphadenectomy.

Adenocarcinoma↗
PubMed1976

[The primary gallbladder neoplasm].

From 1960 to 1975 in the Surgical Clinic of the Medical Academy Erfurt altogether 77 patients with a primary malignoma of the gall-bladder were observed. Symptomatology and findings are non-characteristic. 64 times a laparotomy was carried out, whereby in 51 cases the intervention had to be finished as test laparotomy. 13 times a cholecystectomy or a biliodigestive anastomosis was carried out. The average survival time of the patients with test laparotomy was 53 days. A survival time of more than one year could nertainty. Issuing from this the author adopts a definite attitude to carcinogenesis and the importance of lithiasis.

Alkaline Phosphatase↗
PubMed1992

Carcinoid tumor of the gallbladder: laparoscopic resection and review of the literature.

A 75-year-old woman with mild elevation of liver function test results was found to have an asymptomatic mass localized to the gallbladder by computed tomographic scan and ultrasonography. Endoscopic retrograde cholangiopancreatography revealed a fixed 2 x 4 cm filling defect in the gallbladder wall, consistent with a gallbladder neoplasm. The gallbladder and intramural neoplasm were excised successfully by use of uncomplicated laparoscopic cholecystectomy. Pathologic analysis revealed a carcinoid tumor of the gallbladder. All previously reported gallbladder carcinoid tumors in the Western literature are reviewed. Laparoscopic cholecystectomy has potential for application for the treatment of selected gallbladder neoplasms, with special preoperative assessment and intraoperative considerations being important.

Aged↗
PubMed2001

Gallbladder benign neoplasms: relationship with lithiasis and cancer (ultrasonographic study).

BACKGROUND: The aim of this study is to clarify the prevalence of gallbladder benign neoplasms, their ultrasonographic appearance and their relationship with gallbladder lithiasis and cancer. METHODS: This study was carried out on 9000 consecutive patients having ultrasound of upper abdomen. Only adenomas and papillomas are considered as true benign neoplasms of the gallbladder. Adenomiomatosis and cholesterol polyps, often erroneously labelled as benign neoplasms, were excluded. Patients were followed-up by ultrasound every three months up to two years. RESULTS: The prevalence of benign neoplasms was 1.19%. Papillomas were found more frequently than adenomas both in males (68.51%) and in females (94.33%). Gallstones were not concomitant with benign neoplasms in any case. Neither stones nor growth of gallbladder benign neoplasms were recorded within the two-year follow-up period. CONCLUSIONS: Papillomas were more frequent than adenomas. No gallstone was concurrent with gallbladder benign neoplasms in our series. However, when gallstones are evidenced at ultrasound, further attention is recommended to discover probable concomitant neoplasms. Papillomas and adenomas more than 1 cm in diameter should be quarterly followed-up, while smaller masses could be six-monthly controlled. Surgery should be indicated for large-sized or rapidly growing masses because of the risk for cancer development.

Journal Article↗
PubMed2003

Progression of gene hypermethylation in gallstone disease leading to gallbladder cancer.

BACKGROUND: Aberrant methylation of tumor-suppressor genes is associated with a loss of gene function that can afford selective growth advantages to sporadic neoplastic cells arising during gallbladder inflammation. METHODS: Fifty-four gallbladder neoplasms were selected from tumor banks in the United States and Chile. Each of the neoplasms was subjected to methylation-specific polymerase chain reaction to detect promoter methylation associated with six candidate tumor-suppressor genes (p16, APC, methylguanine methyltransferase, hMLH1, retinoic acid receptor beta-2, and p73) implicated in multiple human cancer types. RESULTS: Aberrant methylation of any of the six candidate tumor-suppressor genes was detected in 72% of the gallbladder neoplasms, 28% of the cases of chronic cholecystitis, and in only 1 of the 15 normal gallbladder controls. The four most commonly methylated genes in the gallbladder cancers were p16 (56%), p73 (28%), APC (27%), and hMLH1 (14%). Significant differences in gene methylation were discovered between US gallbladder cancers and those from Chile, where gallbladder cancer is one of the leading causes of cancer-related deaths. APC methylation was present in 42% of the US cases but in only 14% of the Chilean tumors (P =.028). p73 methylation was common among the Chilean cancers (40%) compared with those from the United States (13%; P =.034). CONCLUSIONS: The acquisition of hypermethylation at multiple tumor-suppressor gene-promoter sites may contribute to tumor formation and progression within the chronically inflamed gallbladder. The apparent differences in methylation patterns among the Chilean and US gallbladder cases may indicate a unique biology associated with this cancer in different parts of the world.

Adenocarcinoma↗
PubMed1983

Histogenesis of epithelial neoplasms of human gallbladder I. Dysplasia.

In order to find a relationship between normal gallbladder epithelium and dysplastic epithelium, histological and histochemical examinations were made on gallbladder specimens obtained from cholecystetomies and special attention was paid to the relationship of the different metaplasias. Epithelial pseudostratification increases in mitotic figures and hyperchromatism accord well with the degrees of dysplasia of surface epithelium. The relationship of the ratio of cell and nuclear size and complexity of glandular branching is more meaningful in degrees of dysplasia of glandular epithelium. Epithelial dysplasia in the surface and glandular epithelium was divided into three types: mild, moderate and severe. This classification was made on the basis of specimens containing dysplasia selected from an extensive gallbladder material. The frequency of dysplasias of different degrees was clarified in 71 cholecystectomia gallbladders. No dysplastic changes were demonstrated in 47 gallbladders (66.2%), and in 10 of these metaplasia was present, 24 gallbladders (33.8%) exhibited dysplastic changes; metaplasia was present in 20 cases (83.3%) and in 14 (58.3%) in the dysplastic region. Severe dysplasia was present only in one case, moderate in 6 and mild dysplasia alone in 17 cases. Dysplasia was found in glands only in 3 cases. In dysplastic epithelium, the mucin reaction was similar to that in the metaplastic epithelium. It contained mainly nonsulphated acid mucin and neutral mucin. With gradually increasing degree of dysplasia the amount of mucin. With gradually increasing degree of dysplasia the amount of mucin clearly decreased. The present results indicate that dysplasia often develops in metaplastic epithelium.

Adult↗
PubMed1983

Histogenesis of epithelial neoplasms of human gallbladder II. Classification of carcinoma on the basis of morphological features.

The material consisted of 83 gallbladders with primary carcinoma. Non-malignant bordering mucosa was present in 37 specimens and in 34 of these (92%) it was metaplastic, mostly (78.4%) of antral type. In all but one case the bordering epithelium contained dyplasias of different degrees and thus the dysplasia had manifested in metaplastic epithelium. According to their degree of differentiation, the carcinomas were divided in three groups. In groups 1 and 2 the structure was intestinal. Group 1, which had the highest degree of differentiation, contained papillary and glandular structures. Group 2 contained similar glandular structures but, unlike group 1, no goblet and no enterochromaffin cells. In group 3 (anaplastic carcinomas) the mode of growth was infiltrative or solid. The amount of mucin decreased with the degree of differentiation. Histochemically, there were no differences between the groups, but the mucin was mainly non-sulphated acid mucin as in the metaplastic and dysplastic areas surrounding the tumour, thus differing from the normal gallbladder epithelium containing sulphated acid mucin. In 52 cases it was possible to investigate the superficial part of the tumour. The carcinoma structure was of a high degree of differentiation (group 1) in 29 (55.8%) cases, which all had structures of group 2 in the deeper layers. These results indicate that the structure of the carcinoma is not permanent, it dedifferentiates at the deeper invasive layers. In only two cases (3.8%) was the anaplastic structure of group 3 already on the surface without the intermediate stages of groups 1 and 2.

Adenocarcinoma↗
PubMed1997

Cyclin E expression in benign and malignant epithelial neoplasms of the gallbladder.

Cyclins are the regulatory subunits of cyclin-dependent kinase and play an important role in cell proliferation. Many tumors, such as colon, breast and gastric carcinomas are known to be involved in the deregulation or amplification of cyclins, especially cyclin E, which involves the restriction point of G1-S transition. We investigated the expression of cyclin E in benign and malignant epithelial tumors of the gallbladder and compared the results with the activity of cell proliferation by the Ki67 antigen using immunohistochemical staining. Cyclin E was expressed in the adenocarcinoma tissue in 33.3% of patients (4 out of 12 cases), whereas only one out of 8 cases of adenoma expressed cyclin E (12.5%). There was a correlation between cyclin E expression and the Ki67 labeling index. These results suggest that the high expression of cyclin E in adenocarcinoma of the gallbladder is related to a high rate of cell proliferation.

Adenocarcinoma↗
PubMed1990

[CT in the staging of neoplasms of the gallbladder].

The authors report the results of 50 cases of gallbladder carcinoma studied by means of CT, which were observed since 1984. Twenty-five cases were confirmed at surgery and 25 were selected among those in which CT, clinical history, natural disease evolution and matching with other instrumental and laboratory examinations were highly suggestive of gallbladder carcinoma. The high incidence is reported of such CT signs, which may be considered typical, as the presence of soft tissue in gallbladder area (92%), liver infiltration (78%), and the presence of metastatic lymph nodes (36%); they may or may not be associated to less specific signs. CT appears as the most reliable examination for both diagnosis and staging of the disease. Unfortunately, due to the wide range of aspecific clinical signs, diagnosis is in most cases late and the disease has therefore a fatal outcome.

Adult↗