Early gallbladder carcinoma associated with primary sclerosing cholangitis and ulcerative colitis

Yamamoto, Takatsugu; Uki, Kiyoko; Takeuchi, Kazuo; Nagashima, Natsuko; Honjo, Hajime; Sakurai, Norio; Okuda, Chikao; Watanabe, Goro; Mori, Masaya; Kawakami, Yasushi

doi:10.1007/s00535-002-1126-z

Cited by 22 publications

(15 citation statements)

References 18 publications

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“…Moreover, a review of the literature shows that patients with PSC and patients with ulcerative colitis are regarded as a high-risk group, not only for cholangiocarcinoma but also for gallbladder carcinoma. 8,9 Because there was a chance of gallbladder carcinoma being complicated with PSC in our patient, we performed surgery after we had explained the procedure in detail and received her informed consent, even though there was a possibility of PSC. It is therefore necessary to keep the risk of PSC in mind for the diagnosis and treatment of such localized biliary stenosis.…”

Section: Discussionmentioning

confidence: 99%

Primary sclerosing cholangitis in which differential diagnosis from gallbladder carcinoma was difficult

Kobayashi

Hosotani

Imai

et al. 2005

J Hepatobiliary Pancreat Surg

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We report a case of localized primary sclerosing cholangitis (PSC) which was difficult to distinguish from gallbladder carcinoma. A 75-year-old woman with elevated serum bilirubin was hospitalized and underwent endoscopic nasobiliary drainage (ENBD). There was no history of diseases such as gallbladder stone, pancreatitis, or ulcerative colitis. Cholangiography through the ENBD tube showed localized stenosis of the common bile duct; the gallbladder could not be seen. Angiography showed no encasement of the hepatic artery. Ultrasonography showed a tumor in the cystic duct, and the tumor had invaded the gallbladder and common bile duct. We diagnosed gallbladder carcinoma on radioimaging, and performed an S4aS5 subsegmentectomy of the liver and resection of the extrahepatic biliary tree. Pathologically, no malignant cells were detected, and fibrosis around bile ducts and infiltration of inflammatory cells into hepatic tissue were found. It is well known that PSC is sometimes difficult to differentially diagnose from cholangiocarcinoma. Our case is of high interest because ultrasonography showed findings suggestive of gallbladder carcinoma. It is therefore necessary to keep the possibility of PSC in mind for the diagnosis and treatment of such localized biliary stenosis.

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Section: Discussionmentioning

confidence: 99%

Primary sclerosing cholangitis in which differential diagnosis from gallbladder carcinoma was difficult

Kobayashi

Hosotani

Imai

et al. 2005

J Hepatobiliary Pancreat Surg

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“…Other conditions associated with an increased risk of GBC are xanthogranulomatous cholecystitis, 25 chronic typhoid infection, 26 adenomyomatosis of the gallbladder, and inflammatory bowel disease. 27,28 Pathology The dysplasia-carcinoma sequence for GBC has been proposed in the literature. Black demonstrated areas of carcinoma in situ in most specimens with invasive GBC.…”

Section: Risk Factors and Pathogenesismentioning

confidence: 99%

Diagnosis and Surgical Management of Gallbladder Cancer: A Review

Reid

Medina

Donohue

2007

Journal of Gastrointestinal Surgery

210

154

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Gallbladder cancer is one of the most lethal carcinomas and continues to pose many challenges for surgeons. Identifiable risk factors for carcinoma of the gallbladder include cholelithiasis, an anomalous pancreaticobiliary junction, and focal mucosal microcalcifications. Adenocarcinoma is the primary histologic type in most patients and the tumor is frequently associated with Kras and p53 mutations. Radiologic and endoscopic advances in endoscopic ultrasonography and magnetic resonance cholangiopancreatogram, plus helical computed tomography, have enhanced preoperative staging. Surgical options include cholecystectomy for disease limited to the mucosa (Tis/T1) or a radical cholecystectomy (subsegmental resection of segments IVB and V plus a hepatoduodenal ligament lymphadenectomy) for advanced disease without signs of distant metastasis (T2-4/N0-N2). Some surgeons have advocated more radical hepatic resection including extended right hepatectomy or central bisegmentectomy plus caudate lobectomy. Japanese surgeons have reported studies that included patients having a pancreaticoduodenectomy to improve distal ductal margins and lymphadenectomy for T3 and T4 cancers. These patients have a lower rate of local recurrence but no survival advantage. Options for adjuvant therapy remain limited. Radiation therapy with fluorouracil radiosensitization is the most commonly used postoperative treatments. Current trials are investigating the role of capecitabine, oxaliplatin, and bevacizumab in the management of gallbladder carcinoma.

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“…It is characterized by progressive inflammation and fibrosis of the intrahepatic and extrahepatic bile ducts leading to biliary cirrhosis and eventually liver failure. [4][5][6] Markers for the disease, its activity, and reliable predictors for clinical endpoints are sparse. 3 Moreover, PSC harbors an increased risk for hepatobiliary cancer.…”

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confidence: 99%