1/28. Synchronous carcinoma of the gallbladder in a patient with intrahepatic bile duct carcinoma.An 83-year-old woman, diagnosed as having cholelithiasis, was admitted to the Department of Surgery, Nippon Medical School, with right hypochondrial pain. ultrasonography and computed tomography revealed a mass in the gallbladder fundus and a hypovascular tumor in the anterior segment of the liver. magnetic resonance imaging showed stenosis of the intrahepatic bile duct and dilatation of its proximal portion. She was diagnosed as having intrahepatic bile duct carcinoma combined with gallbladder carcinoma. At laparotomy, there was evidence of multiple peritoneal metastases and intraoperative histological examination of the gallbladder tumor revealed adenocarcinoma. Accordingly, only cholecystectomy and needle biopsy of the liver tumor was performed. Histological examination of the gallbladder revealed papillary adenocarcinoma invading the muscularis propria with medullary growth or intermediate stroma. There was no microvessel invasion, no perineural invasion and no lymph node involvement. On the other hand, the liver tumor was a cholangiocarcinoma with a well-differentiated tubular pattern. Therefore, this was a rare case of synchronous carcinoma of the gallbladder associated with intrahepatic bile duct carcinoma.- - - - - - - - - - ranking = 1keywords = gallbladder (Clic here for more details about this article) |
2/28. Spontaneous necrosis of gallbladder carcinoma in patient with pancreaticobiliary maljunction.While gallbladder carcinoma is occasionally associated with pancreaticobiliary maljunction, spontaneous necrosis of carcinoma is extremely rare. We herein present a case of spontaneous necrosis of gallbladder carcinoma associated with direct invasion of viable cancer cell nests to the muscularis propria and subserosal layer located beneath the primary nodules. A 65-year-old Japanese man was admitted to a local hospital, complaining of repeated discomfort in the right hypochondrium. ultrasonography and computed tomography scanning revealed cholecystitis associated with gallstones. cholecystectomy was performed, and operative cholangiography demonstrated pancreaticobiliary maljunction. The resected gallbladder showed multiple mixed stones filled with necrotic debris and bile sludge. Scrutiny of the mucosal surface revealed multiple small necrotic nodules in the fundus, which were histologically confirmed to be necrotic remnants of a cancerous glandular structure. Small nests of papillary adenocarcinoma were found beneath the nodules in the muscularis propria and in the venous structure located in the connective tissues next to the divided margin of the gallbladder bed. Resection of S4a and S5 of the liver and resection of the extrahepatic bile duct was then performed to remove the remaining cancerous tissues and/or micrometastasis in the liver and bile duct. The biliary tree was reconstructed with a hepaticoduodenostomy. No cancer nests or any precancerous lesions were found in the additionally resected specimens. This case indicates a unique morphological feature of gallbladder carcinoma associated with pancreaticobiliary maljunction, which provides some insight into the pathogenesis of spontaneous necrosis of gallbladder carcinoma.- - - - - - - - - - ranking = 1.1111111111111keywords = gallbladder (Clic here for more details about this article) |
3/28. Carcinoma of the cystic duct associated with pancreaticobiliary maljunction.We report a rare case of carcinoma of the cystic duct (CCD) associated with pancreaticobiliary maljunction (PBM). A 63-year-old man had presented with relapsing cholecystitis of 4 months, duration. Computed tomography showed a distended gallbladder: however, small mass in the cystic duct was overlooked. Endoscopic retrograde cholangiopancreatography demonstrated a long common channel (20-mm-long) and fusiform dilatation of the common bile duct, findings, which were consistent with PBM. At laparotomy, we found a papillary tumor, 20 mm in diameter, that obstructed the cystic duct. The patient underwent resection of the gallbladder and the common bile duct, lymph node dissection in the hepatoduodenal ligament, and hepaticojejunostomy. Histologic study revealed a papillary adenocarcinoma confined within the subserosal space. There was no lymphatic or perineural invasion of cancer cells. The surrounding cystic ductal mucosa showed dysplasia and hyperplasia, and the gallbladder and common bile duct showed severe inflammation. The patient has been doing well for 16 months after surgery, without tumor recurrence. This case suggests a relationship between CCD and chronic biliary inflammation caused by PBM, as in cases of gallbladder carcinoma.- - - - - - - - - - ranking = 0.44444444444444keywords = gallbladder (Clic here for more details about this article) |
4/28. Double cancer of gallbladder and bile duct associated with anomalous junction of the pancreaticobiliary ductal system.We report a case of double cancer of the gallbladder and the common bile duct associated with anomalous junction of the pancreaticobiliary ductal system, and review the literature of similar case reports. A 66-year-old woman was admitted to an associated hospital complaining of upper abdominal pain, and was diagnosed as having pancreatitis. Abdominal imaging revealed an irregularly protruding mass at the body of the gallbladder and an intraluminal protrusion at the lower third of the common bile duct. Endoscopic retrograde cholangiopancreatography also revealed anomalous junction of the pancreaticobiliary ductal system with congenital biliary dilatation of 14 mm in the largest diameter. She underwent surgical resection of the gallbladder, the extrahepatic bile duct and the gallbladder bed of the liver with a dissection of the regional lymph nodes for double cancer of the gallbladder and the bile duct associated with anomalous junction of the pancreaticobiliary ductal system. She is still alive 33 months after surgery without any signs of recurrence. There were 12 patients (including our case) reported in the literature who had double cancer of the gallbladder and the extrahepatic bile duct associated with anomalous junction of the pancreaticobiliary ductal system. Only 33% of these 12 patients had jaundice. Tumors of the 12 patients were commonly early-stage cancer both in the gallbladder (36%) and in the extrahepatic bile duct (73%). Therefore, we concluded that precise preoperative imaging of the total biliary tract should be required in order to detect early-stage cancer in patients with anomalous junction of the pancreaticobiliary ductal system before planning surgical procedures, and consideration should be given to the possibility of multiple occurrences of biliary tract cancers.- - - - - - - - - - ranking = 1.2222222222222keywords = gallbladder (Clic here for more details about this article) |
5/28. Carcinoma of the cystic duct: case report.A case of carcinoma of the cystic duct is presented and comprehensive review of the literature was provided. Since no characteristic clinical signs are present, the diagnosis can only be made incidentally at the time of laparotomy for non-visualizing gallbladder. Even then histological study of the resected specimen is mandatory. In our present case after the confirmation of the diagnosis the second look exploration was done. However, careful examination of the bile duct system failed to find evidence of carcinomatous involvement suggesting that carcinoma found in the cystic duct was of a primary and not a secondary invasion. The present case constitutes the nineteenth case which meets completely the criteria proposed by Farrar. Since the only hope or cure lies with the early diagnosis of the disease, early exploratory laparotomy and prophylactic removal of nonfunctioning or calculous gallbladder are recommended.- - - - - - - - - - ranking = 0.22222222222222keywords = gallbladder (Clic here for more details about this article) |
6/28. Unexpected bile duct carcinoma presenting with port-site metastasis after laparoscopic cholecystectomy for cholecystolithiasis.On March 1, 1999, a 71-year-old woman was diagnosed as having cholecystolithiasis, for which she underwent laparoscopic cholecystectomy at a local hospital. Intraoperative cholangiography was not performed. No malignant lesion was detected in the gallbladder. In March 2000, a subcutaneous tumor was pointed out at the port site in her abdomen, and resected. Histological examination revealed metastatic adenocarcinoma. On detailed examination, endoscopic retrograde cholangiopancreatography (ERCP) revealed a tumor, about 2 cm in diameter, in the lower bile duct. On June 1, she underwent pylorus-preserving pancreatoduodenectomy at our institute, and several disseminated lesions were detected at the port site and in the abdominal cavity. There have been few reports of bile duct carcinoma that developed peritoneal dissemination caused by leakage of bile during cholecystectomy. Leakage of bile should be prevented during laparoscopic cholecystectomy, even in patients not diagnosed as having cancer preoperatively.- - - - - - - - - - ranking = 0.11111111111111keywords = gallbladder (Clic here for more details about this article) |
7/28. Synchronous triple early cancers occurring in the stomach, colon and gallbladder.We report an unusual case of synchronous triple early cancers of the stomach, gallbladder and sigmoid colon. The patient was a 70-year-old man. Gastrointestinal endoscopy at a medical check-up initially revealed early gastric cancer. A thorough preoperative investigation showed a gallbladder tumour and early colon cancer. Endoscopic mucosal resection was performed for the colon cancer. Microscopically, the specimen showed well-differentiated adenocarcinoma involving the submucosal layer. Distal partial gastrectomy (D1) and simple cholecystectomy with lymph node dissection were also performed. The histopathological diagnosis was well-differentiated adenocarcinoma in the stomach (T1, N0, M0; Stage IA) and poorly differentiated papillary adenocarcinoma (T1, N0, M0; Stage I) in the gallbladder. The patient was doing well with no evidence of recurrence 6 months after surgery.- - - - - - - - - - ranking = 0.77777777777778keywords = gallbladder (Clic here for more details about this article) |
8/28. Early gallbladder carcinoma associated with primary sclerosing cholangitis and ulcerative colitis.patients troubled with primary sclerosing cholangitis (PSC) and ulcerative colitis (UC) are at high risk for cholangiocarcinoma, whereas cancer of the gallbladder (GBC) is rarely reported to develop in that population. A Japanese man aged 62 years with a 14-year history of PSC and UC had been found to have a protruding lesion of the gallbladder by screening sonography. The preoperative examination suggested the lesion to be GBC at an early stage. pathology examination after cholecystectomy proved that the lesion was papillary adenocarcinoma localized in the mucosal layer. Although the prognosis of GBC is poor, the outcome of cholecystectomy against early GBC is relatively good. Early detection of the tumor is required for a better prognosis of patients with GBC. According to the review of the literature, PSC and UC patients are regarded as a high-risk group not only for cholangiocarcinoma but also GBC. It is advocated that clinicians perform repeated radiographic examinations including sonography for patients with PSC and UC even if the diseases are being controlled.- - - - - - - - - - ranking = 0.66666666666667keywords = gallbladder (Clic here for more details about this article) |
9/28. Elevated serum alpha-fetoprotein levels in primary gallbladder carcinoma without hepatic involvement.BACKGROUND. Elevated serum alpha-fetoprotein (AFP) levels, although frequently associated with hepatocellular carcinoma, have also been reported in cases of primary gallbladder carcinoma. methods. The case of a 56-year-old man with a markedly elevated serum AFP level and primary gallbladder carcinoma without detectable hepatic involvement is reported. RESULTS. The patient had right upper quadrant abdominal pain and a palpable right upper quadrant mass. Computerized tomography scan of the abdomen showed a large, subhepatic mass consistent with the gallbladder, and normal liver parenchyma. liver enzyme levels were normal. Management included cholecystectomy followed by postoperative radiation therapy to the gallbladder bed and portal areas and systemic chemotherapy. At the end of therapy, the AFP level had returned to normal. CONCLUSIONS. gallbladder carcinoma is rarely diagnosed before surgery, which sometimes inhibits operative planning. AFP may be a useful preoperative tumor marker in differentiating the patient with primary gallbladder carcinoma from the patient with gallbladder hydrops.- - - - - - - - - - ranking = 1.1111111111111keywords = gallbladder (Clic here for more details about this article) |
10/28. Synchronous cancer of the biliary tract and pancreas associated with anomalous arrangement of the pancreaticobiliary ductal system.A 58-year-old man on abdominal ultrasonography and CT had an irregularly elevated lesion at the neck of the gallbladder and a cyst of approximately 6.5 cm in diameter at the pancreatic tail. Percutaneous transhepatic cholangiography revealed a 2-cm shadow defect at the neck of the gallbladder and an irregular, translucent 30 x 12 mm lesion in the intrapancreatic bile duct. Total pancreatectomy and extended cholecystectomy with regional lymph node dissection was performed. An anomalous arrangement of the pancreaticobiliary ductal system (AAPBD) was demonstrated by postoperative contrast radiography of resected specimen. The lesions of the gallbladder and common bile duct were papillary adenocarcinoma. In addition, papillary adenocarcinoma was limited almost entirely to the mucosal layer of the main pancreatic duct and its branches, from the junction of the common bile duct and pancreatic duct to the pancreatic tail. The three tumors were not continuous. The cyst at the pancreatic tail was a pseudocyst. This case represents synchronous cancer of the gallbladder, common bile duct, and pancreas associated with AAPBD.- - - - - - - - - - ranking = 0.44444444444444keywords = gallbladder (Clic here for more details about this article) |
| | Next -> |