THE SPECTRUM OF CHOLESTATIC HEPATIC DISEASE.
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A carcinoma of the gallbladder was transplantable in Syrian golden hamsters. The tumor was induced by subcutaneous injection of N-nitrosobis (2-oxopropyl) amine (BOP) following dissection of the common duct and preparation of a cholecysto-duodenostomy. The histology revealed a poorly differentiated adenocarcinoma. The tumor was inoculated into the cavity of the gallbladder and subcutaneous tissue of the hamster and was transplantable (uptake rate was 100%). This tumor expressed blood group-related antigens, including A, H, and P-glycoproteins. To our knowledge, this is the first report of carcinoma of the gallbladder transplantable in a laboratory animal.
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We report an unusual case of synchronous triple early cancers of the stomach, gallbladder and sigmoid colon. The patient was a 70-year-old man. Gastrointestinal endoscopy at a medical check-up initially revealed early gastric cancer. A thorough preoperative investigation showed a gallbladder tumour and early colon cancer. Endoscopic mucosal resection was performed for the colon cancer. Microscopically, the specimen showed well-differentiated adenocarcinoma involving the submucosal layer. Distal partial gastrectomy (D1) and simple cholecystectomy with lymph node dissection were also performed. The histopathological diagnosis was well-differentiated adenocarcinoma in the stomach (T1, N0, M0; Stage IA) and poorly differentiated papillary adenocarcinoma (T1, N0, M0; Stage I) in the gallbladder. The patient was doing well with no evidence of recurrence 6 months after surgery.
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Comparison has been made between slow infusion hepatic angiographic studies obtained before and after the intra-arterial injection of prostaglandin F2 alpha. The prostaglandin injection resulted in increased caliber of the hepatic arteries, increased opacification of the parenchyma of the liver and improved visualization of the wall of the gallbladder. Poorly vascularized metastatic lesions were better shown on the prostaglandin studies, and carcinoma of the gallbladder was diagnosed in two instances. The demonstration of highly vascularized metastatic tumor was enhanced on the prostaglandin studies, but further improved after the injection of angiotensin.
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Cyclin D1 overexpression is remarkably frequent in several human carcinomas and is believed to be a critical event in oncogenesis. We examined cyclin D1 expression, p53 expression, and the Ki-67 labeling index by immunostaining in human gallbladder mucosa in conditions varying from normal to malignant tissue. We also examined K-ras codon 12 mutations in these tissues with a two-step polymerase chain reaction. Nuclear cyclin D1 overexpression was observed in 48% of carcinomas occurring independently of adenoma, but not in adenomas, carcinomas arising in adenomas, or nonneoplastic lesions. Cytoplasmic cyclin D1 overexpression was observed in about 15% of abnormal specimens, irrespective of the type of epithelial abnormality. Carcinomas showing nuclear cyclin D1 overexpression had significantly higher Ki-67 labeling indexes than those with no overexpression. Moderately to poorly differentiated adenocarcinomas showed a higher incidence of nuclear cyclin D1 overexpression than papillary to well differentiated carcinomas. Specimens with cyclin D1 overexpression showed a high incidence of lymph permeation, venous permeation, and lymph node metastasis. We conclude that nuclear cyclin D1 overexpression is a critical event importantly associated with cell proliferation and invasive growth in gallbladder carcinogenesis, and that cyclin D1 immunostaining may become a useful marker for evaluating gallbladder carcinomas.
Gallbladder cancer is the fifth most common gastrointestinal cancer in the US (5,000 new cases each year). Primary bile duct cancer (cholangiocarcinoma) is seen most often in patients with risk factors including primary sclerosing cholangitis (PSC), bile duct stones, and fluke infestation. Both cancers have a poor prognosis, in part because they present late. Malignant tumors of the gallbladder and bile ducts are rarely curable by surgery. Benign tumors of the biliary tree are rare, and with the exception of biliary papillomatosis and carcinoids, are not considered premalignant.
Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive lipid-storage disorder characterised by xanthomas, neurological dysfunctions and premature atherosclerosis. A case of a well differentiated adenocarcinoma of the gallbladder occurring in a 57-year-old Japanese man with CTX, confirmed clinically, biochemically and at autopsy is reported together with analyses of the sterol 27-hydroxylase (CYP27) and p53 genes. A missense mutation of the p53 (G for C) was detected in the gallbladder adenocarcinoma. Direct sequence analysis also showed a silent mutational substitution of unknown significance, C for A, in CYP27 at codon 89. In the past, CTX patients have only demonstrated this infrequently, indicating no direct relationship between CYP27 dysfunction and tumour development. Thus, the present case of gallbladder cancer appears to be a chance occurrence.
The main goal of the study was to analyze thoroughly the results of a cohort study. Such an analysis renders it possible to eliminate certain neoplasms as those not related to the observed exposure. The cohort study was carried out in a group of workers, covering 11,342 persons (5472 men and 5870 women), employed for at least one year during the years 1945-1985 in a rubber footwear plant. The cohort study was continued until the end of December 1997. Of all the sites of malignant neoplasms observed in the cohort, significant, exposure-related excess mortality was found to be due to malignant neoplasms of larynx and lung in men, and malignant neoplasms of gallbladder and lung in women. For these neoplasms, the values of observed risk among those exposed were significantly higher than among non-exposed. Moreover, in a certain interval of employment duration, an increase in risk rates with increasing duration of employment under exposure was observed, which suggests the presence of dose-response relationship. For all these sites, a relevant trend was shown by the RR values calculated in relation to the group of persons non-exposed but employed in the same plant. The internal reference group used to calculate RR values allowed to eliminate the effect of confounding variables, which is not always possible when the general population is used as the reference group.