CARCINOMA OF THE GALL BLADDER ASSOCIATED WITH BILIARY ANOMALIES AND THE INCIDENCE OF MUCOSAL METAPLASIA

Abstract

Department of Surgery, Hamamatsu Medical Center, Hamamatsu, Japan Thirty-seven cases of biliary anomalies (36 cases of congenital dilatation of the bile ducts with or without anomalous arrangement of the pancreatico-bile duct, 3 cases of anomalous arrangement of the pancreatico-bile duct without dilated bile duct) were treated for the past eight years.
Among these cases, four cases were associated with gall bladder cancer and four, with bile duct cancer.
This clinical evidence suggests that gall bladder cancer may also occur in high incidence (10%) as bile duct cancer (10%) in patients with these anomalies. On histological examination of these gall bladder with cancer, marked mucosal metaplasia (mucous gland and goblet cell metaplasia) was observed, and then this histologic study made us to suspect correlation of mucosal metaplasia and development of carcinoma. Therefore 19 cases of congenital dilatation of the bile ducts and 317 control cases were histological studied to investigate the incidence of mucosal metaplasia of the gall bladder.
On the histological observation, the gall bladder in congenital dilatation of the bile ducts had marked mucosal metaplasia and the results indicated its high incidence in statistcs. And it seemed that mucosal metaplasia in the gall bladder of congenital dilatation of the bile ducts was influenced by existence of anomalous arrangement of the pancreatico-bile duct.
Based on our clinical and histological study, it is suggested that close relationship may be present between mucosal metaplasia and development of carcinoma, that could be secondary to reflux of pancreatic juice in patients with anomalous arrangement of the pancreatico-bile duct.