An abnormal pancreatico-choledocho-ductal junction in cases of biliary tract carcinoma

Suda, Koichi; Miyano, Takeshi; Konuma, Ichiro; Matsumoto, Michio

doi:10.1002/1097-0142(19831201)52:11<2086::aid-cncr2820521120>3.0.co;2-3

Cited by 58 publications

(24 citation statements)

References 5 publications

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“…Early-stage GB cancer is often detected in resected specimens after cholecystectomy for benign diseases [1,2] . Moreover, GB cancer is sometimes detected in association with pancreaticobiliary maljunction (PBM), which is the union of the pancreatic and biliary ducts at a site outside the duodenal wall [3] . Some previous studies have described spontaneous necrosis of parathyroid and adrenal gland tumors [4][5][6][7] .…”

Section: Introductionsupporting

confidence: 80%

Spontaneous necrosis of solid gallbladder adenocarcinoma accompanied with pancreaticobiliary maljunction

Hori¹,

Wagata²,

Takemoto³

et al. 2008

WJG

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A 71-year-old Japanese man with acute cholecystitis and an incarcerated gallbladder (GB) stone was admitted. Plain ultrasonography (US) incidentally detected a mass-like lesion in the fundus. Doppler US revealed that this elevated lesion had no blood flow. Computed tomography showed a relatively low-density mass, measuring 5 cm x 4 cm in diameter, with no positive enhancement. Magnetic resonance imaging showed a mass in the fundus with a slightly low intensity on T1-weighted images and a slightly high intensity on T2-weighted images. We were agonized in making the qualitative diagnosis of mass-like lesions of the fundus, such as a benign tumor, cancer, or debris. We performed laparoscopic cholecystectomy, because the incarcerated GB stone clearly caused acute cholecystitis. Intra-operative cholangiography clearly revealed pancreaticobiliary maljunction. Amylase levels in the common bile duct and gallbladder were quite high. The elevated lesion in the fundus clearly showed severe necrosis. Although this necrotic nodule included non-viable adenocarcinoma cells, viable cancer cell nests were located in the muscularis propria and subcutaneous layer. Histopathological examination confirmed a solid adenocarcinoma. Thus, we diagnosed it as a gallbladder cancer, based on histopathological analysis of the resected specimen. We therefore undertook radical surgery, including wedge resection of the liver, radical dissection of regional lymph nodes, and resection of the extrahepatic bile duct. Histopathological findings revealed no cancer, hyperplasia or dysplasia in the additionally resected specimens. The patient was finally staged as T2, N0, H0, P0, M(-), stage Ⅱ. We present the first case of spontaneous necrosis of solid gallbladder adenocarcinoma, with a review of previous studies.

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Section: Introductionsupporting

confidence: 80%

Spontaneous necrosis of solid gallbladder adenocarcinoma accompanied with pancreaticobiliary maljunction

Hori¹,

Wagata²,

Takemoto³

et al. 2008

WJG

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“…The main pancreatic duct and the common bile duct open into the duodenum, where they frequently form a com mon channel, the incidence of which is reported to be from 55% [1] to 82% [2] . The length of the common channel ranges from 1 mm to 12 mm, with an average length of 4.4 mm [3] .…”

Section: Introductionmentioning

confidence: 99%

Endoscopic diagnosis of pancreaticobiliary maljunction

Kamisawa

Takuma²,

Itokawa³

et al. 2011

WJGE

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Pancreaticobiliary maljunction (PBM) is a congenital ano maly defined as a junction of the pancreatic and bile ducts located outside the duodenal wall, usually forming a markedly long common channel. As the action of the sphincter of Oddi does not functionally affect the junction in PBM patients, continuous pancreatobiliary reflux occurs, resulting in a high incidence of biliary cancer. PBM can be divided into PBM with biliary dila tation (congenital choledochal cyst) and PBM without biliary dilatation (maximal diameter of the bile duct ≤ 10 mm). The treatment of choice for PBM is prophy lactic surgery before malignant changes can take place. Endoscopic retrograde cholangiopancreatography (ERCP) is the most effective examination method for close observation of the pattern of the junction site. When the communication between the pancreatic and bile ducts is maintained, despite contraction of the sphincter on ERCP, PBM is diagnosed. In these patients, levels of pancreatic enzymes in the bile are generally elevated, due to continuous pancreatobiliary reflux via a long common channel. Magnetic resonance cholangiopancreatography and 3Dcomputed tomo graphy can diagnose PBM, based on findings of an anomalous union between the common bile duct and the pancreatic duct, in addition to a long common channel. Endoscopic ultrasonography and intraductal ultrasonography can demonstrate the junction outside the duodenal wall, and are useful for the diagnosis of associated biliary cancer. Gallbladder wall thickness on ultrasonography can be a screening test for PBM.

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“…2,3 A number of EBDCs arise in bile ducts with an abnormal pancreatico-biliary duct junction, and their tumorigenesis is considered to be associated with inflow of pancreatic juice into the bile duct. [4][5][6][7] However, more common mechanisms for the tumorigenesis and the reasons for the biological aggressiveness of EBDCs have not yet been sufficiently elucidated, and further investigations are required.…”

mentioning

confidence: 99%

Expression of GalNAc-T3 and its relationships with clinicopathological factors in 61 extrahepatic bile duct carcinomas analyzed using stepwise sections—Special reference to its association with lymph node metastases—

et al. 2007

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Extrahepatic bile duct carcinomas (EBDCs) still result in an unfavorable prognostic outcome, and little is known about their biological aggressiveness. Recently, UDP-N-acetyl-alpha-D-galactosamine:polypeptide N-acetylgalactosaminyl transferase-3 (GalNAc-T3) was reported to be associated with differentiation and malignant potential of human carcinomas. Here, we investigated 61 EBDCs for their detailed clinicopathological features and GalNAc-T3 expression by immunohistochemistry, and then evaluated the relationships between the clinicopathological features and GalNAc-T3 expression patterns. Most of the EBDCs were massively invasive tumors with frequent vascular or perineural invasion and lymph node metastases. GalNAc-T3 expression was detected in all 61 EBDCs, and the expression patterns could be classified into granular and diffuse types. All four noninvasive or minimally invasive EBDCs were the granular type. Among the 58 minimally or massively invasive EBDCs, the GalNAc-T3 expression pattern at the luminal surface was the granular type in 38 cases (66%) and diffuse type in 20 cases (34%), while the expression pattern at the invasive front was the granular type in 26 cases (45%) and diffuse type in 32 cases (55%). Among the 38 cases with granular-type expression at the luminal surface, 26 cases (68%) remained the granular type and 12 cases (32%) became the diffuse type at the invasive front. All 20 cases with diffuse-type expression at the luminal surface remained the diffuse type at the invasive front. Diffuse-type GalNAc-T3 expression at the invasive front was significantly associated with lymph node metastasis (Po0.05). There were no significant correlations between the GalNAc-T3 expression patterns and other clinicopathological factors, including tumor differentiation, depth of invasion or overall survival. In conclusion, EBDCs alter their GalNAc-T3 expression pattern during tumor growth, and the difference in the GalNAc-T3 expression pattern may be associated with lymph node metastasis. Clinically, preoperative evaluation of GalNAc-T3 expression is considered to be useful for decisions regarding operative procedures.

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An abnormal pancreatico-choledocho-ductal junction in cases of biliary tract carcinoma

Cited by 58 publications

References 5 publications

Spontaneous necrosis of solid gallbladder adenocarcinoma accompanied with pancreaticobiliary maljunction

Spontaneous necrosis of solid gallbladder adenocarcinoma accompanied with pancreaticobiliary maljunction

Endoscopic diagnosis of pancreaticobiliary maljunction

Expression of GalNAc-T3 and its relationships with clinicopathological factors in 61 extrahepatic bile duct carcinomas analyzed using stepwise sections—Special reference to its association with lymph node metastases—

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