¿Es el cáncer de la vesícula biliar una enfermedad de mal pronóstico en Chile?

E, Iván Roa; U, Xabier de Aretxabala; S, Juan Roa; O, Juan C Araya; H, Miguel Villaseca; G, Pablo Guzmán; S, Luis Burgos

doi:10.4067/s0034-98872002001100014

Cited by 7 publications

(10 citation statements)

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“…Despite the advances in medical imaging it is still difficult to diagnose gallbladder cancer preoperatively. A gallbladder carcinoma is suspected preoperatively in only 20%-30% of all patients, the other 70%-80% of all cases are detected intraoperatively, or incidentally discovered by the pathologist (6,14) , consistent with our results. Through the anatomopathologic examination directed to this disease it has been demonstrated that nearly 25% of these carcinomas can be detected in early stages (14) .…”

Section: Discussionsupporting

confidence: 91%

“…A gallbladder carcinoma is suspected preoperatively in only 20%-30% of all patients, the other 70%-80% of all cases are detected intraoperatively, or incidentally discovered by the pathologist (6,14) , consistent with our results. Through the anatomopathologic examination directed to this disease it has been demonstrated that nearly 25% of these carcinomas can be detected in early stages (14) . Therefore, the morphologic study has a significant impact in the diagnosis of this cancer, lowering the number of cases that could be underdiagnosed (14) .…”

Section: Discussionsupporting

confidence: 91%

“…However, most series reported in the literature only included advanced-stage carcinomas, what is partially responsible for the general pessimism surrounding this disease (14) . Several studies, mostly in Japan and Chile have shown that when detected and treated in its early stages the 5-year survival is higher than 90% (3,8,9,11,14,15,20) . Patients with early carcinoma -defined as tumor confined to the mucosa or the muscularis propria according to the TNM staging system -have a real chance of curative treatment.…”

Section: Introductionmentioning

confidence: 99%

“…Despite the advances in medical imaging most cases (70%-80%) of gallbladder cancer are only discovered incidentally on histopathological examination after cholecystectomy performed for presumed benign biliary disease (14) . Therefore, the morphologic study has a significant impact in the diagnosis of this cancer, lowering the number of cases that could be underdiagnosed (14) and guiding extent of surgical resection.…”

Section: Introductionmentioning

confidence: 99%

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Gallbladder carcinoma: clinicopathological study of 24 cases

Veloso¹,

Rodrigues²

2011

J. Bras. Patol. Med. Lab.

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Introduction: Despite preoperative procedures, gallbladder carcinoma is commonly detected intraoperatively or on anatomopathologic examination after cholecystectomy. Objective: To study the clinical-morphological aspects and evolution of patients with primary gallbladder carcinoma. Methods: We reviewed medical records and pathologic material of all patients diagnosed with gallbladder carcinoma at our institution from 1997 to 2008. Results: Twenty-four cases with primary carcinoma were studied, predominantly among female patients, mean age of 61.1 years. The most common clinical symptom was upper right hypochondriac pain. Five patients were diagnosed in early stages and 19 were in advanced stages. Only seven patients were diagnosed with carcinoma preoperatively, all of them in advanced stages. As to macroscopic examination, three early cases were identified as type IIa, two type IIb and 13 advanced cases were flat and infiltrating. Histologically, there were 23 adenocarcinomas and one adenosquamous carcinoma. Simple cholecystectomy was performed in seven patients, extended cholecystectomy in four patients, cholecystectomy and omentectomy in one patient, and tumor biopsy in only two patients. The median survival rate for patients in early stages was 59 months, and for pT2, pT3 and pT4 stages were 22 months, nine months and three days, respectively. Conclusion: There was a prevalence of advanced neoplasias diagnosed through anatomopathological examinations with poor prognosis. Furthermore, earlier detection contributed to higher survival rate. Investigation of anatomopathologic features, specially the macroscopic patterns of gallbladder carcinoma, is essential to improve diagnostic accuracy and to provide a definite treatment. abstract key wordsGallbladder Carcinoma Surgical pathology resumo Introdução: Não obstante estudos pré-operatórios, o câncer da vesícula biliar é frequentemente detectado durante a cirurgia ou no exame anatomopatológico após colecistectomias. Objetivo: Avaliar as principais apresentações clinicomorfológicas e a evolução de pacientes com carcinoma da vesícula biliar. Métodos: Foram revisados prontuários médicos e material anatomopatológico de todos os pacientes com carcinoma de vesícula biliar diagnosticados em nosso hospital de 1997 a 2008. Resultados: Foram encontrados 24 carcinomas primários, com predomínio em mulheres, média de idade de 61,1 anos. A apresentação clínica mais frequente foi de dor em hipocôndrio direito. Cinco pacientes foram diagnosticados em estádios precoces e 19, em estádios avançados. O diagnóstico pré-operatório de câncer foi realizado em sete pacientes, todos em estádios avançados. Ao exame macroscópico, três cânceres precoces eram tipo IIa e dois, IIb. Treze casos avançados eram aplanados e infiltrantes, 23 eram adenocarcinomas e um era adenoescamoso. Colecistectomia simples foi realizada em sete pacientes, colecistectomia associada à ressecção do leito hepático em quatro, colecistectomia e omentectomia em um e apenas biópsia do tumor em dois pacientes. A média de sob...

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Gallbladder carcinoma: clinicopathological study of 24 cases

Veloso¹,

Rodrigues²

2011

J. Bras. Patol. Med. Lab.

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“…Consideramos que el carcinoma subseroso de la vesícula biliar es una etapa intermedia entre los carcinomas incipientes, grupo claramente definido por su evolución biológica (89% de sobrevida a 5 años), y los carcinomas serosos con un pronóstico significativamente peor (10% de sobrevida a 5 años) 4,[25][26][27] .…”

Section: Discussionunclassified

Contenido de ADN y sobrevida en el carcinoma subseroso de la vesícula biliar

et al. 2004

Rev. méd. Chile

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(Rev Méd Chile 2004; 132: 794-800C hile presenta una de las mayores frecuencias de cáncer de vesícula biliar (CV) del mundo, en ambos sexos, con una tasa de mortalidad que sobrepasa 14 x 100.000 habitantes 1-3 . El cáncer vesicular incipiente presenta una sobrevida cercana a 90% a cinco años, en cambio, los que tienen compromiso de la serosa no alcanzan el 20% 4,5 .En el CV se distinguen distintos estadios clínicos y patológicos, siendo el carcinoma subseroso (CSS) el de mayor dificultad en su evaluación clínica, histológica y pronóstica 6,7 . En este estadio, el tumor está confinado a una túnica cuyos límites A R T Í C U L O D E I N V E S T I G A C I Ó N 795son imprecisos y no claramente reconocibles en el estudio histológico 8 .Entre los factores inherentes al tumor y que determinan un comportamiento de mayor o menor agresividad está el contenido de ADN de las células tumorales 9-11 . El contenido aneuploide de ADN está relacionado con la existencia de poblaciones celulares cuyo comportamiento biológico puede variar considerablemente 11,12 . Se ha demostrado que la medición de la ploidia a través de citometría de flujo es una herramienta complementaria en la caracterización de diferentes procesos neoplásicos 13,14 .Las poblaciones celulares de tumores como carcinomas son heterogéneas desde el punto de vista morfológico y biológico. Se asume que esta heterogeneidad es el reflejo de la heterogeneidad genética a nivel celular, por lo cual un mismo tumor puede presentar clones con un distinto patrón de ploidia. Ha sido demostrado que cantidades anormales de ADN en las células tumorales son un factor pronóstico en algunas neoplasias 12,15,16 . Existe escasa información respecto del cáncer de la vesícula biliar y contenido de ADN y, menos aún, en relación al grupo de carcinomas subserosos [17][18][19][20] .El objetivo de este trabajo es determinar el contenido de ADN en carcinomas subserosos de la vesícula biliar, correlacionar estos hallazgos con variables clínicas y anatomopatológicas e intentar evaluar su importancia como factor pronóstico en esta etapa de la enfermedad. MATERIAL Y MÉTODOSelección de los casos. De los archivos de la Unidad de Anatomía Patológica del Hospital Temuco, se seleccionaron 120 pacientes con carcinomas subserosos de vesícula biliar que tuvieron seguimiento clínico. En todos estos casos, el diagnóstico se hizo mediante el mapeo completo de la pieza quirúrgica.Obtención de suspensiones nucleares. Se realizaron 3 cortes de 20 micrones para la obtención de núcleos y un corte consecutivo de 4 micrones, teñido con hematoxilina eosina. En esta última preparación se marcaron las áreas representativas del tumor a microdisecar. De cada uno de los casos y del mismo corte, se seleccionaron áreas de mucosa tumoral y no tumoral, estas últimas fueron utilizadas como control interno. En las preparaciones 20 micrones, se realizó la microdisección de las áreas seleccionadas (micro disector hidráulico Narishige) y del tejido no tumoral.Digestión enzimática. Se realizó con pepsina al 0,5% a pH 1,5 (Sigma),...

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