National Cancer Institute®
Last Modified: April 1, 2002
UI - 10881626
AU - Kumar S; Jain A; Jain S
TI - Gallbladder carcinoma: experience of 116 cases.
SO - Trop Gastroenterol 2000 Apr-Jun;21(2):65-8
AD - Department of Surgery, Guru Teg Bahadur Hospital, Shahdara, Delhi.
BACKGROUND: Aggressive surgical treatment is now being advocated even for advanced carcinoma gall bladder (GBC). We reviewed our data of GBC over the last 5 years to analyse patient and survival characteristics in our patients. PATIENTS AND METHODS: Case records of all cases of GBC admitted to surgical wards in our hospital between 1994 to 1998 were reviewed for details such as age, sex, religion, symptoms, signs, investigations, treatment and survival. World literature was reviewed by using Medline search of the subject. RESULTS: A total of 116 patients with confirmed GBC were admitted during these five years. Their mean age was 54 +/- 11 years. Females greatly outnumbered males. The commonest symptom was abdominal pain (95%) followed by GB mass (78%). Associated gallstones were present in 67% cases. Adenocarcinoma was the commonest variety (79%). CT scan and USG were helpful in 78% and 89% cases respectively. Maximum patients (67%) presented with Nevins' stage V and most of these were treated with supportive therapy only. CONCLUSIONS: Our patients were at least a decade younger than patients in other series and presented at an advanced stage. Radiological investigations (USG and CT scan) played a vital role in diagnosing or suspecting the disease. Curative resections were performed in few cases. Our own results, though limited favour an aggressive surgical approach. Based on our observations we have recommended certain cancer preventive steps and future treatment strategies.
UI - 10968853
AU - Choi WB; Lee SK; Kim MH; Seo DW; Kim HJ; Kim DI; Park ET; Yoo KS; Lim
TI - BC; Myung SJ; Park HJ; Min YI A new strategy to predict the neoplastic polyps of the gallbladder based on a scoring system using EUS.
SO - Gastrointest Endosc 2000 Sep;52(3):372-9
AD - Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
BACKGROUND: A new method to predict neoplastic polyps of the gallbladder using a scoring system based on five endoscopic ultrasonography (EUS) variables is presented. METHODS: EUS data from patients with gallbladder polyps who were to undergo cholecystectomy were used for the construction of an EUS scoring system in polyps between 5 and 15 mm in diameter (reference group). The EUS scoring system developed from those patients was applied to other patients (validation group). RESULTS: In the reference group, size was the most significant predictor of neoplastic polyp. All polyps 5 mm or less in diameter were non-neoplastic and 94% of polyps of greater than 15 mm were neoplastic in the reference group. For polyps between 5 and 15 mm in diameter, the area under the receiver-operating characteristic curves (ROC) plots for the endoscopic scoring system was significantly greater than that under the ROC plots for polyp size alone (p < 0.01). In the validation group, the risk of neoplastic polyp was significantly higher for polyps with a score of 6 or greater compared with those with a score of less than 6 (p < 0.01). CONCLUSIONS: Our data show that a score based on five EUS variables identifies those patients at risk of neoplasia when polyps are between 5 and 15 mm in diameter. (Gastrointest Endosc 2000;52:372-9).
UI - 11427869
AU - Chung JP; Lee SJ; Lee KS; Chung JB; Lee SI; Kang JK
TI - EUS and the prediction of gallbladder neoplastic polyps: are polyps of 5 to 15 mm diameter really a homogenous group?
SO - Gastrointest Endosc 2001 Jul;54(1):138-9
UI - 11740666
AU - Dinkel HP; Triller J
TI - [Primary and long-term success of percutaneous biliary metallic endoprotheses (Wallstents) in malignant obstructive jaundice]
SO - Rofo Fortschr Geb Rontgenstr Neuen Bildgeb Verfahr 2001 Dec;173(12):1072-8
AD - Institut fur Diagnostische Radiologie Inselspital Universitat Bern, Schweiz, Germany. firstname.lastname@example.org
OBJECTIVE: To assess the primary and long-term success of percutaneous metallic endoprotheses (wallstent) in malignant jaundice. METHODS: Retrospective, uncensored analysis of 86 consecutive patients (42 men, 44 women, age 34 to 90 years, mean 62 years), who were percutaneously treated with wallstents for malignant jaundice within a six-year time interval. Indications were pancreatic cancer in 9, gallbladder cancer in 15, Klatskin's tumor in 31, and metastatic disease in 31 cases. The indication for percutaneous stenting was inoperability and lack of endoscopic access. The level of the obstruction was within the liver hilus in 44, extrahepatic in 20, and within a biliodigestive anastomosis in 22 cases. Forty-five patients had undergone abdominal surgery previously. Mean survival was 8.0 months (range, 3 days to 57 months). RESULTS: In 85 of 86 cases (99 %) biliary stenting was feasible. In 82 cases (95 %) laboratory tests indicated regression of the biliary obstruction. Sixty-six patients (77 %) also experienced a clinical benefit from the procedure and in 65 (76 %) patients long-term palliation was achieved and lasted for at least three-quarters of the remaining time of survival. Technical problems with the procedure, usually stent foreshortening, were encountered in 12 cases (14 %). Thirty-days morbidity was 26 % (cholangitis in 15, pancreatitis in 3, liver failure in 2, effusion in 1, hemobilia in 1 case), thirty-day mortality was 15 %, procedure-related in one case. The reintervention rate was 20 %, the patency rate was 91 %, 73 %, and 58 % after 3, 6, and 12 months, respectively. CONCLUSION: Even after exhaustion of both surgical and endoscopic therapy options percutaneously deployed wallstents enable effective long-term palliation of malignant jaundice.
UI - 11899677
AU - Bouras N; Caudry M; Saric J; Bonnel C; Rullier E; Trouette R; Demeaux H;
TI - Maire JP [Conformal therapy of locally advanced cholangiocarcinoma of the main bile ducts]
SO - Cancer Radiother 2002 Feb;6(1):22-9
AD - Service de radiotherapie, hopital Saint-Andre, CHU de Bordeaux, 1, rue Jean-Burguet, 33075 Bordeaux, France.
PURPOSE: Retrospective study of 23 patients treated with conformal radiotherapy for a locally advanced bile duct carcinoma. PATIENTS AND METHODS: Eight cases were irradiated after a radical resection (R0), because they were N+; seven after microscopically incomplete resection (R1); seven were not resected (R2). A dose of 45 of 50 Gy was delivered, followed by a boost up to 60 Gy in R1 and R2 groups. Concomitant chemotherapy was given in 15 cases. RESULTS: Late toxicity included a stenosis of the duodenum, and one of the biliary anastomosis. Two patients died from cholangitis, the mechanism of which remains unclear. Five patients are in complete remission, six had a local relapse, four developed a peritoneal carcinosis, and six distant metastases. Actuarial survival rate is 75%, 28% and 7% at 1, 3 and 5 years, respectively (median: 16.5 months). Seven patients are still alive with a 4 to 70 months follow-up. Survival is similar in the 3 small subgroups. The poor local control among R0N+ cases might be related to the absence of a boost to the "tumor bed". In R1 patients, relapses were mainly distant metastases, whereas local and peritoneal recurrences predominated in R2. CONCLUSION: Conformal radiochemotherapy delivering 60 Gy represents a valuable palliative approach in locally advanced biliary carcinoma.
UI - 11692912
AU - Dimitrova V; Bulanov D; Tasev V; Popadiin N
TI - [Carcinoma of extrahepatic bile ducts - operative management of lesions located in the distal segments]
SO - Khirurgiia (Sofiia) 2000;56(3-4):19-24
Experience with operative management of patients presenting carcinomas located in the distal third of the extrahepatic bile ducts, accumulated in the Department of General and Operative Surgery of the Medical University--Sofia, is analyzed. The condition is characterized by manifestation of clinical signs typical of a well advanced pathological process, found in a considerable number of patients with obstructive jaundice syndrome, and necessitating surgery on an emergency basis because of the danger of hepatorenal failure development with a fatal outcome. Over a 10-year period (1989-1998), a total of 219 patients with histological evidence of carcinoma in various segments of the extrahepatic bile ducts are operated on. The series includes 107 men (48.9%) and 112 women (51.1%) at mean age 59.2 years. In 64 cases (29.2%) the process involves the distal third only (terminal choledochus and papilla Vateri). In this group 41 radical and 23 palliative operations are performed. The indications for radical resection, the basic principles of radical and palliative interventions, and the results of their practical implementation are comprehensively discussed. The basic parameters--resectability, survivorship, early postoperative lethality (EPL) and morbidity--are comparable to the ones presented in recently published reports on biliopancreatic oncosurgery.
UI - 11788896
AU - Nomura M; Yamakado K; Nomoto Y; Nakatsuka A; Ii N; Shoji K; Takeda K
TI - Clinical efficacy of brachytherapy combined with external-beam radiotherapy and repeated arterial infusion chemotherapy in patients with unresectable extrahepatic bile duct cancer.
SO - Int J Oncol 2002 Feb;20(2):325-31
AD - Department of Radiology, Mie University School of Medicine, Mie 514-8507, Japan. email@example.com
The objective of this study was to evaluate the clinical efficacy of brachytherapy combined with external-beam radiotherapy and repeated arterial infusion chemotherapy in improving stent patency and prognosis in patients with unresectable bile duct cancer as compared with brachytherapy alone. Seventeen patients were treated. Five patients received brachytherapy alone before stent placement. Twelve patients received brachytherapy combined with external-beam radiotherapy (n=5), repeated hepatic arterial infusion chemotherapy using an implanted catheter and port (n=1), or both (n=6). Mean survival was significantly improved in the group that received combined therapy as compared with the group that received brachytherapy alone (16.2 months vs. 4.6 months, p<0.01). Although stent occlusion rates were similar in the two groups (42% vs. 40%), there was a trend towards longer stent patency in the combined therapy group than in the brachytherapy group (22 months vs. 3.6 months, p<0.2). Radiation gastritis necessitating gastrectomy developed in 1 patient who received external-beam radiotherapy at more than 50 Gy. Brachytherapy combined with external-beam radiotherapy and repeated hepatic arterial infusion chemotherapy increases survival compared with brachytherapy alone in patients with unresectable bile duct cancer.
UI - 11762811
AU - Gallardo JO; Rubio B; Fodor M; Orlandi L; Yanez M; Gamargo C; Ahumada M
TI - A phase II study of gemcitabine in gallbladder carcinoma.
SO - Ann Oncol 2001 Oct;12(10):1403-6
AD - Seccion Oncologia, Hospital Clinico Jose Joaquin Aguirre Universidad de Chile, Santiago. firstname.lastname@example.org
BACKGROUND: Due to the high mortality rates from gallbladder carcinoma in Chile, we conducted a phase II trial to test the efficacy and safety of gemcitabine in patients with locally advanced or metastatic carcinoma and no prior chemotherapy received gemcitabine 1,000 mg/m2 over 30 minutes weekly for three weeks followed by a week of rest. RESULTS: Patients received a median of 4.2 cycles (range 1-10). Out of the 25 patients whose response could be evaluated, 9 went into partial remission, an overall response rate of 36% (95% confidence interval (95% CI): 17.1% to 57.9%). In six (25.0%) patients, the cancer remained stable, and in 10 (40%) it progressed. Median survival time was 30 weeks (range 7-80+. Hematological toxicities were mild, with no cases of febrile neutropenia or hemorrhage. However, four and one patient(s) had grades 1-2 and 3-4 neutropenia, respectively, and two patients had grade 2 thrombocytopenia. Nine patients experienced grade 1-2 nausea/vomiting, but were able to continue treatment. There were no toxic deaths. CONCLUSIONS: In this phase II trial, gemcitabine is an active chemotherapy in metastatic or inoperable gallbladder carcinoma, with a manageable toxicity profile.
UI - 11882761
AU - Weber SM; DeMatteo RP; Fong Y; Blumgart LH; Jarnagin WR
TI - Staging laparoscopy in patients with extrahepatic biliary carcinoma. Analysis of 100 patients.
SO - Ann Surg 2002 Mar;235(3):392-9
AD - Department of Surgery, Hepatobiliary Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
OBJECTIVE: To evaluate the benefit of staging laparoscopy in patients with gallbladder cancer and hilar cholangiocarcinoma. SUMMARY BACKGROUND DATA: In patients with extrahepatic biliary carcinoma, unresectable disease is often found at the time of exploration despite extensive preoperative evaluation, thus resulting in unnecessary laparotomy. resectable gallbladder cancer (n = 44) and hilar cholangiocarcinoma (n = 56) were prospectively evaluated. All patients underwent staging laparoscopy followed by laparotomy if the tumor appeared resectable. Surgical findings, resectability rate, length of stay, and operative time were analyzed. RESULTS: Patients underwent multiple preoperative imaging tests, including computed tomography scan, ultrasound, magnetic resonance cholangiopancreatography, and direct cholangiography. Laparoscopy identified unresectable disease in 35 of 100 patients. In the 65 patients undergoing open exploration, 34 were found to have unresectable disease. Therefore, the overall accuracy for detecting unresectable disease was 51%. There was no difference in the accuracy of laparoscopy between patients with gallbladder cancer and hilar cholangiocarcinoma. Laparoscopy detected the majority of patients with peritoneal or liver metastases but failed to detect all locally advanced tumors. In patients undergoing biopsy only, laparoscopic identification of unresectable disease significantly reduced operative time and length of stay compared with patients undergoing laparotomy. The yield of laparoscopy was 48% in patients with gallbladder cancer (56% in those who did not undergo previous cholecystectomy), but only 25% in patients with hilar cholangiocarcinoma. However, in patients with locally advanced but potentially resectable hilar cholangiocarcinoma, the yield of laparoscopy was greater, 36% (12/33, T2/T3 tumors) versus 9% (2/23, T1 tumors). CONCLUSIONS: Laparoscopy identifies the majority of patients with unresectable hilar cholangiocarcinoma or gallbladder carcinoma, thereby reducing both the incidence of unnecessary laparotomy and the length of stay. The yield of laparoscopy is lower for hilar cholangiocarcinoma but can be improved by targeting patients at higher risk of occult unresectable disease. All patients with potentially resectable primary gallbladder cancer and patients with T2/T3 hilar cholangiocarcinoma should undergo staging laparoscopy before surgical exploration.
UI - 11920595
AU - Kawamoto T; Shoda J; Asano T; Ueda T; Furukawa M; Koike N; Tanaka N;
TI - Todoroki T; Miwa M Expression of cyclooxygenase-2 in the subserosal layer correlates with postsurgical prognosis of pathological tumor stage 2 carcinoma of the gallbladder.
SO - Int J Cancer 2002 Mar 20;98(3):427-34
AD - Department of Gastrointestinal Surgery, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan.
Postsurgical recurrence at distant sites frequently occurs in pathological tumor stage 2 (pT(2)) carcinoma of the gallbladder even though the carcinoma is limited to the gallbladder wall. Little is known, however, about the molecular events leading to its development and progression. A large body of evidence suggests that cyclooxygenase-2 (COX-2) is up-regulated in carcinoma tissues and plays roles in promoting cell-proliferation, growth and metastasis of carcinoma cells. In the present study, immunohistochemistry was performed to determine the expression levels of COX-2 in the subserosal layer of 33 cases of pT(2) gallbladder carcinoma in which curative resections had been performed and to determine the correlations of the expression levels of COX-2 with mode of recurrence and postsurgical survival. Immunostaining of COX-2 in the epithelia was recognized in more than 80% of normal epithelia, noncancerous pathological lesions of the gallbladder except for intestinal metaplasia and pT(1-4) carcinoma specimens. Intense staining was observed in large percentages of hyperplastic lesions (65%), pT(2) carcinoma specimens (76%) and pT(3) and pT(4) carcinoma specimens (64%) compared to the percentages of normal epithelia and other pathological lesions (0-25%). Intense staining was also observed in the adjacent stroma in pT(2) carcinoma specimens (33%) and in those in pT(3) and pT(4) carcinoma specimens (43%) but only in small percentages of the stroma adjacent to normal epithelia and pathological lesions (0-8%). In situ hybridization confirmed the existence of COX-2 mRNA in both the cancerous epithelia and adjacent stroma of pT(2)-pT(4) carcinomas. In 33 cases of pT(2) carcinoma, distant recurrence, i.e., liver metastasis, was seen in 3 of 9 cases of pT(2) carcinoma (33%, P<0.05) with intense stromal staining in the subserosal layer and in 1 of 24 cases (4%) without intense staining, whereas no significant correlation was found between parameters of pathological malignancies (histological grade, lymphatic permeation, venous permeation and lymph node metastasis) and the intensity of stromal staining in the subserosal layer. The postsurgical survival outcome was significantly poorer in the former than in the latter (p = 0.010). In pT(2) gallbladder carcinoma, upregulation of COX-2 in the stroma adjacent to the cancerous epithelia in the subserosal layer correlates with the aggressiveness of the disease, such as the tendency to form distant recurrences. This phenotype may serve as a unique biological feature associated with the malignant behavior of pT(2) gallbladder carcinoma. Copyright 2002 Wiley-Liss, Inc.
UI - 11683173
AU - Mukai S; Miyazaki K; Yakushiji H
TI - The role of E-cadherin in the differentiation of gallbladder cancer cells.
SO - Cell Tissue Res 2001 Oct;306(1):117-28
AD - Department of Surgery, Saga Medical School, Saga, Japan.
Cell adhesion molecules are essential for development and maintenance of epithelial architecture. To clarify the role of these molecules in the morphology of gallbladder cancers, four human gallbladder cancer cell lines (GB-d1, KMG-C, GBK-1, and G-415) were examined in vitro. They showed noticeably different morphologies in our standard gel cultures (SC). GB-dl and KMG-C formed cystic and spheroid structures, respectively, which seemed to represent well-differentiated and moderately differentiated cancers, respectively. GBK-1 and G-415 showed branching and "pseudoglandular" structures, respectively, both of which seemed to indicate original dedifferentiated cancers. In floating gel culture (FC), only GB-d1 showed a highly increased tendency toward cyst formation. Expression of E-cadherin and alpha-catenin in the gallbladder cancer cell lines was investigated by Western-blotting analysis. Expression was detected in GB-d1 and KMG-C, but not in GBK-1 and G-415 cells. Furthermore, E-cadherin expression in GB-dl was 1.82 times greater in FC than in SC, while E-cadherin expression levels of KMG-C did not change. Neither GB-d1 nor KMG-C showed any difference in a-catenin expression between SC and FC. Immunostaining of GB-d1 revealed that these proteins were localized to the cell membrane. In contrast, heterogeneous localization of these proteins was detected in the spheroid structures of KMG-C, in both SC and FC. Electronmicroscopic examination revealed that reestablishment of the junctional complex occurred only in GB-d1 cells cultured in FC. The formation of cystic structures in GB-d1 was completely inhibited by an antibody against human E-cadherin. Both expression of E-cadherin and its membranous localization are required for well-differentiated-type morphogenesis in gallbladder cancer cells.
UI - 11919480
AU - Lim JH; Yi CA; Lim HK; Lee WJ; Lee SJ; Kim SH
TI - Radiological spectrum of intraductal papillary tumors of the bile ducts.
SO - Korean J Radiol 2002 Jan-Mar;3(1):57-63
AD - Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-dong, Kangnam-gu, Seoul 135-710, Korea. email@example.com
Papillary tumor of the bile duct is characterized by the presence of an intraductal tumor with a papillary surface comprising innumerable frondlike infoldings of proliferated columnar epithelial cells surrounding slender fibrovascular stalks. There may be multiple tumors along the bile ducts (papillomatosis or papillary carcinomatosis), which are dilated due to obstruction by a tumor per se, by sloughed tumor debris, or by excessive mucin. Radiologically, the biliary tree is diffusely dilated, either in a lobar or segmental fashion, or aneurysmally, depending on the location of the tumor, the debris, and the amount of mucin production. A tumor can be depicted by imaging as an intraductal mass with a thickened and irregular bile duct wall. Sloughed tumor debris and mucin plugs should be differentiated from bile duct stones. Cystically or aneurysmally, dilated bile ducts in mucin-hypersecreting variants (intraductal papillary mucinous tumors) should be differentiated from cystadenoma, cystadenocarcinoma and liver abscess.
UI - 11857099
AU - Madisch A; Wiedbrauck F; Marquard F; Stolte M; Hotz J
TI - [5-Fluorouracil-induced colitis--a review based upon consideration of 6 cases]
SO - Z Gastroenterol 2002 Feb;40(2):59-66
AD - Klinik fur Gastroenterologie, Allgemeines Krankenhaus Celle, Germany. firstname.lastname@example.org
BACKGROUND: At increasing use of high-dose 5-fluorouracil-based chemotherapy for metastatic colorectal and gastric cancer complicated which we looked for involvement of small intestine. We report summing up on the 6 cases including both endoscopic and histological findings in both sites of the gut.CASE REPORTS: In 2 men and 4 women (age 49-78 years) with advanced colon (n = 2), gastric (n = 3 ) and gallbladder (n = 1) cancer a palliative weekly high-dose infusional 5-fluorouracil (2,6 g/m(2)/24 h) and folinic acid (500 mg/m(2)/2 h) chemotherapy was performed. Few days after 1-5 chemotherapy courses the patients were admitted to our hospital with abdominal pain and partly severe watery diarrhea (up to 20 times evacuations/per day). The stool cultures were negative and there were no proof both of clostridium difficile and his toxin A and B. In 4 patients colonoscopy showed different grades of colitis up to diffuse erythema and microlesions, 2 patients had no visible lesions. In 4 patients endoscopy of the upper GI-tract showed a severe inflammation (n = 1) and a fibrinopurulent exsudate, severe edema and isolated ulcerations (n = 3) of jejunum after gastrectomy or duodenum with intact stomach. In the histological assessment different grades of 5-FU-induced colitis without (n = 2) or with (n = 4) involvement of the upper small intestine destruction of the superficial mucosa and crypts (epitheliumapoptosis) were found. 5 patients were treated by antibiotics (vancomycin n = 2, metronidazole n = 3), glucocorticoids (n = 5) and Saccaromyces cerevisiae (n = 3). After 8-10 days the patients were complete free of symptoms. One patient died due to the enterocolitis.CONCLUSIONS: The present cases demonstrate that high-dose 5-fluorouracil-based chemotherapy not only induces a colitis but also may involve the upper small intestine tract. Consequently, it represents an increasing and serious adverse event of high-dose chemotherapy. The etiology of the enterocolitis (drug- or bacterial-induced) needs further investigations in order to find a causal therapy and/or prophylaxis.
UI - 11907727
AU - Sato M; Ishida H; Konno K; Naganuma H; Komatsuda T; Watanabe S; Ishida
TI - J; Hirata M Localized gallbladder carcinoma: sonographic findings.
SO - Abdom Imaging 2001 Nov-Dec;26(6):619-22
AD - First Department of Internal Medicine, Akita University School of Medicine, Hondo, Japan.
Our study of color (seven cases) and contrast (three cases) Doppler results of seven cases with gallbladder carcinoma localized in the gallbladder wall (TNM stage T1) showed that the presence or absence of blood flow signals distinguishes gallbladder carcinoma in stage T1b (muscular involvement) from tumefactive biliary sludge and that injection of contrast medium markedly increased diagnostic confidence. Thus, when color Doppler sonography is ambiguous, contrast-enhanced Doppler sonography is the next line of investigation. However, actual color Doppler sonography is still not fully capable of displaying fine blood flow signals from gallbladder carcinoma in stage T1a (mucosal involvement), and greater Doppler sensitivity is mandatory for this purpose.
UI - 11907728
AU - Tamada K; Kanai N; Wada S; Tomiyama T; Ohashi A; Satoh Y; Ido K; Sugano
TI - K Utility and limitations of intraductal ultrasonography in distinguishing longitudinal cancer extension along the bile duct from inflammatory wall thickening.
SO - Abdom Imaging 2001 Nov-Dec;26(6):623-31
AD - Department of Gastroenterology, Jichi Medical School, Yakushiji, Tochigi, Japan.
BACKGROUND: We wanted to distinguish wall thickening caused by cancer extension from that caused by inflammation after placing a biliary catheter on intraductal ultrasonography (IDUS). METHODS: We studied 51 patients with biliary tract malignancies who had undergone placement of biliary drainage catheters before IDUS. IDUS was performed from a transhepatic (n = 34) or transpapillary (n = 17) route with a thin-caliber ultrasonic probe (2.0 mm in diameter, 20-MHz frequency). At the hepatic side of the tumor, the thickness, asymmetry, outer margin, inner margin, and internal echoes of the bile duct wall were reviewed prospectively and correlated with the histologic findings of the surgically resected specimens in all cases. RESULTS: When IDUS showed wall thickening in a semicircular fashion, notched outer margin, rigid inner margin, papillary inner margin, and heterogeneous internal echoes, each finding had a positive predictive value for diagnosing cancer extension (100%, 100%, 83%, 100%, and 90%, respectively). When these factors were used as the diagnostic criteria of cancer extension, IDUS accurately demonstrated suitable surgical margins in 76% of all patients and 71% of patients with bile duct carcinoma. CONCLUSION: Wall thickening in a semicircular fashion, notched outer margin, rigid or papillary inner margin, and heterogeneous internal echoes are specific for cancer extension. However, surgical margins can be inaccurately assessed in some patients.
UI - 11552481
AU - Dixit VK; Singh S; Shukla VK
TI - Aetiopathogenesis of carcinoma gallbladder.
SO - Trop Gastroenterol 2001 Apr-Jun;22(2):103-6
AD - Department of Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi-221 005, India.
UI - 11963322
AU - Bheerappa N; Sastry RA
TI - Pancreatico-biliary ductal union.
SO - Trop Gastroenterol 2001 Oct-Dec;22(4):190-3
AD - Department of Surgical Gastroenterology, Nizam's Institute of Medical Sciences, Hyderabad-500 082, India.
A long common channel distal to the pancreaticobiliary junction is the commonest anomalous arrangement of the pancreaticobiliary ductal system and is mostly observed in patients with congenital choledochal cysts. APBDU without choledochal cyst is a high-risk condition for the development of gallbladder carcinomas. Prophylactic excision of the extrahepatic biliary system and reconstruction of the biliary tract with hepatico-jejunostomy are recommended. APBDU should always be kept in mind when a patient with a long history of abdominal pain is found to have gall bladder wall thickness even without gallstones on imaging by a CT Scan or Ultra Sound. ERCP should be performed in these patients in order to detect APBDU. This may allow early detection of carcinoma of the biliary tract. Presence of common channel may be associated with a lower incidence of gallstones. However it requires corroboration by other studies. On the other hand carcinoma of the gall bladder appears to have a close association with abnormally long common channel.
UI - 11963335
AU - Vij U; Baskaran V
TI - Value of serum CEA and AFP in the diagnosis and prognosis of carcinoma gallbladder.
SO - Trop Gastroenterol 2001 Oct-Dec;22(4):227-9
AD - Department of Reproductive Biology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110 029. email@example.com
BACKGROUND/OBJECTIVE: The poor prognosis of carcinoma of the gallbladder (CAGB) is attributable to delayed presentation in the absence of specific clinical findings in the early stages. To ascertain whether the commonly available serum tumour markers (carcino-embryonic antigen-CEA and alpha foeto protein-AFP) could be used for distinguishing CAGB from other biliary disorders and in assessing the prognosis of patients with CAGB, serum levels of these markers in patients with CAGB and those with cholelithiasis were studied. METHODS: Estimation of serum CEA in 28 patients with CAGB and 30 patients with cholelithiasis and AFP in some of these cases was done by enzyme immunoassay. RESULTS: The mean values of CEA and AFP were 15.1 ng/ml and 166.5 ng/ml respectively for the CAGB group and 12.6 ng/ml and 166.5 ng/ml respectively for the cholelithiasis group. There was no statistical difference between the groups (p > 0.05). These markers did not show any statistically significant correlation with the stage of disease or length of survival in the patients with CAGB. CONCLUSION: Serum levels of CEA and AFP do not have any diagnostic or prognostic significance in the management of CAGB.
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