Metachronous double cancer of the gallbladder and common bile duct

Fujii, Tsutomu; Kaneko, Tetsuya; Sugimoto, Hiroyuki; Okochi, Osamu; Inoue, Soichiro; Takeda, Shin; Nagasaka, Tetsuro; Nakao, Akimasa

doi:10.1007/s00534-003-0880-5

Cited by 21 publications

(21 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These included metachronous (n = 1) and simultaneous (n = 2) multiple biliary cancers (Table 1). In other studies, 19 (51 %) of 37 patients with simultaneous double or multiple biliary tract cancers suffered from concurrent PBM [8][9][10][11][12]. The prevalence of gallstone detection in our 43 PBM patients without biliary dilatation who developed gallbladder cancer was only 9 %, which is significantly lower than the 62 % reported among the gallbladder cancer population without PBM [13].…”

Section: Clinical Features Of Biliary Cancer Associated With Pbmcontrasting

confidence: 50%

Biliary carcinogenesis in pancreaticobiliary maljunction

et al. 2016

View full text Add to dashboard Cite

Pancreaticobiliary maljunction (PBM) is a congenital malformation in which the pancreatic and bile ducts join anatomically outside the duodenal wall. Because of the excessive length of the common channel in PBM, sphincter action does not directly affect the pancreaticobiliary junction, which allows pancreatic juice to reflux into the biliary tract. According to the results of a nationwide survey, bile duct and gallbladder cancers were found in 6.9 and 13.4 % of adult patients with congenital biliary dilatation, respectively, and in 3.1 and 37.4 % of those with PBM without biliary dilatation, respectively. Biliary tract cancers develop about 15-20 years earlier in patients with PBM than in individuals without PBM; they sometimes develop as double cancers. Carcinogenesis is strongly associated with stasis of bile intermingled with refluxed pancreatic juice. Epithelial cells in the biliary tract of PBM patients are under constant attack from activated pancreatic enzymes, increased secondary bile acids, or other mutagens. This can result in hyperplastic change with increased cell proliferation activity, and in turn, oncogene and/or tumor suppressor gene mutations in the epithelia, leading to the biliary tract carcinogenesis. The carcinogenesis of biliary tract cancer accompanying PBM is considered to involve a hyperplasia-dysplasia-carcinoma sequence induced by chronic inflammation caused by the reflux of pancreatic juice into the biliary tract, which differs from the adenoma-carcinoma sequence or the de novo carcinogenesis associated with biliary tract cancers in the population without PBM. Patients with a relatively long common channel have a similar, albeit slightly lower, risk for gallbladder cancer compared with PBM patients.

show abstract

Section: Clinical Features Of Biliary Cancer Associated With Pbmcontrasting

confidence: 50%

Biliary carcinogenesis in pancreaticobiliary maljunction

et al. 2016

View full text Add to dashboard Cite

show abstract

“…However, metachronous multiple bile duct cancer is very rare. Because biliary tract cancers are usually advanced by the time of diagnosis, and surgery involves a broad bile duct resection with curative intent, the chances of developing a metachronous double biliary cancer are slim [7][8][9][10][11][12][13][14][15][16][17] . In 1932, Warren and Gates proposed the three still generally accepted criteria that had to be met in order to consider malignant tumors as multiple primary tumors rather than recurrences: first, each of the tumors must present a definite picture of malignancy; second, each tumor must have a different histological appearance; third, the possibility that one might be a metastatic lesion from a former lesion must be excluded [18] .…”

Section: Discussionmentioning

confidence: 99%

“…Most of them develop in the gallbladder and bile duct [4][5][6] . On the other hand, metachronous multiple biliary cancers are rare, with only 11 cases reported in the world literature [7][8][9][10][11][12][13][14][15][16][17] . In Korea, one case was reported in 1997 when a 61-year-old man underwent curative resection for bile duct cancer 30 mo after a radical cholecystectomy to cure gallbladder cancer [17] .…”

Section: Introductionmentioning

confidence: 99%

“…The etiology of double biliary tract cancer has not been defined, but it is generally accepted that the anomalous union of the pancreatobiliary duct (AUPBD) plays an important role in the development of multiple biliary tract cancers. Kaneko et al [8] and Fujii et al [13] reported that 50%-62.5% of cases of synchronous double biliary tract cancers were associated with AUPBD. A close relationship is known to exist between cancer of the bile duct system and AUPBD.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Metachronous bile duct cancer nine years after resection of gallbladder cancer

Joo

Kim²,

Jeon³

et al. 2009

WJG

View full text Add to dashboard Cite

We report a rare case of a 74-year-old man with metachronous gallbladder cancer and bile duct cancer who underwent curative resection twice, with the operations nine years apart. At the age of 65 years, the patient underwent a cholecystectomy and resection of the liver bed for gallbladder cancer. This was a welldifferentiated adenocarcinoma, with negative resection margins ( T2N0M0, stage ⅠB). Nine years later, during a follow-up examination, abdominal computed tomography and MRCP showed an enhanced 1.7 cm mass in the hilum that extended to the second branch of the right intrahepatic bile duct. We diagnosed this lesion as a perihilar bile duct cancer, Bismuth type Ⅲ a, and performed bile duct excision, right hepatic lobectomy and Roux-en-Y hepaticojejunostomy. The histological diagnosis was a well-differentiated adenocarcinoma with one regional lymph node metastasis (T1N1M0, stage ⅡB). Twelve months after the second operation, the patient is well, with no signs of recurrence. This case is compared with 11 other cases of metachronous biliary tract cancer published in the world medical literature.

show abstract

“…Of 37 patients with simultaneous double or multiple biliary cancers, 19 patients (51 %) suffered from concurrent PBM [3,[27][28][29][30][31].…”

Section: Incidence and Characteristicsmentioning

confidence: 99%

Pancreaticobiliary maljunction and biliary cancer

et al. 2014

View full text Add to dashboard Cite

Pancreaticobiliary maljunction (PBM) is a congenital malformation in which the pancreatic and bile ducts join anatomically outside the duodenal wall. Japanese clinical practice guidelines on how to deal with PBM were made in 2012, representing a world first. According to the 2013 revision to the diagnostic criteria for PBM, in addition to direct cholangiography, diagnosis can be made by magnetic resonance cholangiopancreatography (MRCP), 3-dimensional drip infusion cholangiography computed tomography, endoscopic ultrasonography (US), or multiplanar reconstruction images by multidetector row computed tomography. In PBM, the common channel is so long that sphincter action does not affect the pancreaticobiliary junction, and pancreatic juice frequently refluxes into the biliary tract. Persistence of refluxed pancreatic juice injures epithelium of the biliary tract and promotes cancer development, resulting in higher rates of carcinogenesis in the biliary tract. In a nationwide survey, biliary cancer was detected in 21.6 % of adult patients with congenital biliary dilatation (bile duct cancer, 32.1 % vs. gallbladder cancer, 62.3 %) and in 42.4 % of PBM patients without biliary dilatation (bile duct cancer, 7.3 % vs. gallbladder cancer, 88.1 %). Pathophysiological conditions due to pancreatobiliary reflux occur in patients with high confluence of pancreaticobiliary ducts, a common channel C6 mm long, and occlusion of communication during contraction of the sphincter. Once the diagnosis of PBM is established, immediate prophylactic surgery is recommended. However, the surgical strategy for PBM without biliary dilatation remains controversial. To detect PBM without biliary dilatation early, MRCP is recommended for patients showing gallbladder wall thickening on screening US under suspicion of PBM.

show abstract

Metachronous double cancer of the gallbladder and common bile duct

Cited by 21 publications

References 12 publications

Biliary carcinogenesis in pancreaticobiliary maljunction

Biliary carcinogenesis in pancreaticobiliary maljunction

Metachronous bile duct cancer nine years after resection of gallbladder cancer

Pancreaticobiliary maljunction and biliary cancer

Contact Info

Product

Resources

About