A case of gallbladder cancer during follow-up of primary sclerosing cholangitis

Abstract

A 44-year-old male patient was suspected to have gallbladder cancer during the follow-up for primary sclerosing cholangitis (PSC) and ulcerative colitis. He underwent gallbladder bed resection and lymphadenectomy. Pathological findings showed a well-differentiated adenocarcinoma with serosal invasion, and biliary intraepithelial neoplasia (BilIN) on the background mucosal surface. It has been reported that the mechanism of biliary carcinogenesis is the accumulation of oxidative stress due to persistent cholangitis and hepatitis, which leads to DNA damage and biliary carcinogenesis. The involvement of BilIN in biliary carcinogenesis in PSC has been suggested. In the present case, BilIN-1 to 3 lesion was observed in the gallbladder mucosa of the noncancerous area. Therefore, a mechanism of BilIN-mediated multi-step carcinogenesis from chronic inflammation caused by PSC was suspected.