Precancerous conditions of biliary tract cancer in patients with pancreaticobiliary maljunction: reappraisal of nationwide survey in Japan

Abstract

It is widely known that pancreaticobiliary maljunction (PBM), an anomalous arrangement of the pancreaticobiliary ductal system, is frequently associated with biliary tract cancer in patients with or without bile duct dilatation. In 1985, we surveyed patients with PBM who had been operated on at 133 Japanese institutions. A close relationship was shown between biliary tract carcinogenesis and PBM, according to the type of maljunction and age distribution: PBM patients with cystic dilatation had a high risk of bile duct cancer, even in those who were young (aged less than 20 years); the incidence of gallbladder cancer increased markedly in PBM patients over 40 years old with cystic dilatation, while it gradually increased with age in the PBM patients without cystic dilatation. Therefore, we recommend surgical treatment for patients with PBM even if they have no symptoms.

Pancreaticobiliary maljunction and carcinogenesis to biliary and pancreatic malignancy

“…The average age of patients of biliary tract cancer with PBM is 10 years younger than that of cancer without PBM [5], and very young teenagers having carcinoma with PBM [22,23] were reported, which were not seen in cancer patients without PBM.…”

“…From a questionnaire conducted at 133 Japanese hospitals, Hasumi et al [5] revealed that the incidence of PBM was 3.3% among the 12,399 patients who underwent hepatobiliary tract surgery. Approximately 10.4% of all the gallbladder cancer cases had PBM, and 4.4% of the bile duct cancer cases had PBM, in this paper.…”

A phase I/II trial of TAC-101, an oral synthetic retinoid, in patients with advanced hepatocellular carcinoma

“…(Abou-Alfa et al 2006;Llovet et al 2007) The patients treated in this study of TAC-101 generally were a moderate to poor-prognostic group: a majority had cirrhosis (21/28, 75%); 75% (21/28) were ECOG PS 1, 32% had HCV, and 5 pts were CLIP score 3 or higher, which is predictive of very poor prognosis. (Hasumi et al 2000;Llovet and Bruix 2000) We believe this study of TAC-101 provides suggestion of disease stabilization and prolonged survival in a representative advanced HCC patient population. In addition, 2 patients experienced PR and decreased tumor vascularization several months after stopping TAC-101 and without further treatment.…”

Self-expandable metallic stents for malignant biliary obstruction with an anomalous pancreaticobiliary junction

“…Frequently, APBJ is associated with choledochal cysts and carries a higher risk for the development of bile duct cancer. In addition, reported series have found a strong relationship between APBJ and gallbladder cancer in patients with no choledochal cyst [7][8][9][10]. It is generally accepted that reflux of the pancreatic juice into the biliary tract via an APBJ plays a role in the development of biliary tract cancer [1,2,11,12].…”

“…Keywords Acute pancreatitis Á Anomalous pancreaticobiliary junction Á ERCP Á Biliary drainage Á Malignant biliary obstruction Á Metallic stent Anomalous pancreaticobiliary junction (APBJ) is a rare congenital malformation of the biliary tract that occurs with an incidence of 0.9% to 8.7% at endoscopic retrograde cholangiopancreatography (ERCP) [1][2][3][4][5][6] and of 3.3% at biliary surgery [1,7]. Frequently, APBJ is associated with choledochal cysts and carries a higher risk for the development of bile duct cancer.…”