Between 1987 and 1997, endoscopic ultrasound (EUS) was performed in 2,099 patients with gallbladder disease. In 368 patients, gallbladder was resected. BUS demonstrated protruded le sion in 120 patients and thickening of the gallbladder wall in 248. Clinicopathological study was performed on resected specimens to evaluate accuracy of EUS diagnosis. EUS depicted 116 of 120protruded lesions (97%). These included 8 cholecystitis,59 benign polypoid lesions,15adenomyomatoses,6 adenomas,25 carcinomas and 3 miscellaneous lesions. EUS accurately cha racterized 99 lesions (85%). Thickening of the gallbladder wall included 208 cholecystitis,31adenomyomatoses,1 hyperplastic mucosa and 8 carcinomas. EUS correctly characterized 23 3lesions (94%). Depth of invasion of carcinoma was 100% accurate in early carcinomas limited to the mucosa and propria muscle layer,54% in subserosal carcinomas, and 83% in carcinomas wit h invasion beyond the serosa. In subserosal carcinomas microinvasion and differentation of carcinoma from fibrosis were difficult to diagnose with EUS.
EUS is highly valuable in the diagnosis and characte rization of gallbladder lesions.

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Five gallbladder carcinomas and 6 bile duct carcinomas occurred in 30 cases with congenital choledochal cyst, and 19 gallbladder carcinomas occurred in 30 with pancreaticobiliary maljunction without biliary dilatation. The average age of the patients with gallbladder carcinoma associated with pancreaticobiliary maljunction was 59.7 years old, which is about 10 years younger than that of those with gallbladder carcinoma without pancreaticobiliary maljunction. Gallstones were detected only in 13% of cases with gallbladder carcinoma with pancreaticobiliary maljunction, which is less frequent than 62% of gallbladder carcinoma without pancreaticobiliary maljunction. The average age of the patients with bile duct carcinoma associated with pancreaticobiliary maljunction was 54.8 years old, which is about 15 years younger than that of those with bile duct carcinoma without pancreaticobiliary maljunction. In biliary carcinomas associated with pancreaticobiliary maljunction,1 multiple gallbladder carcinoma,3 multiple bile duct carcinomas, and 1 double carcinoma of gallbladder and bile duct were detected. We should suspect multiple foci in biliary carcinoma associated With pancreaticobiliary maljunction.

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Docetaxel is a taxoid that has been semisynthesized from the precursor (10-deacetyl baccatin III)derived from the needles of the European yew, Taxus baccata. This agent is a mitotic spindle poison that increases the rate of microtubules assembly and inhibits the depolymerisation of microtubles. A basic study on the effect of docetaxel to a human gallbladder carcinoma cell line (NOZ C-1strain) obtained from cultured human gallbladder cells was carried out. Cytotoxic effects against NOZ C-1 were both concentration and time dependent. The proliferation of NOZ C-1 was inhibited with docetaxel in concentration over 5 ng/ml, and the cells of NOZ C-1 decreased in number under exposure to 100 ng/ml of docetaxel. When observed under microscope, the cells became larger and multinucleated. Indirect immunofluorescence staining of tubulin and electron microscopy showed abnormal microtubules bundle in plasma of NOZ C-1 cells. The results suggest that docetaxel has an excellent antitumor effect for the treatment of advanced human gallbladder carcinoma.

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To know the relationship between protein and gene level status of estrogen receptor and biliary carcinogenesis, expression of estrogen receptor protein and gene mutation were examined in 59cases with biliary carcinoma and 3 benign biliary disease. Expression of estrogen receptor was immunohistochemically determined using a nested PCR and single strand conformation polymorphism method. ER protein was positive in 8 cases (26.7%) of 30 cases with gallbladder carcinoma and 1 case (3.4%) of 29 cases with bile duct carcinoma, while negative in 3 cases with benign biliary disease. Mutation of ERα gene was observed in 5 cases out of 20 cases with gallbladder carcinoma. The expression of ER protein and ER gene mutation were independent from the conventional. clinicopathological factors including histological type, depth of mural invasion, a nd clinical stage. Survival analysis indicated that the cases with positive ER expression had a poor clinical outcome compared with the cases of negative ER expression. These results suggest that the expression of ER protein of gallbladder carcinoma is a prognostic indicator independent from known factor that had a negative impact on survival. These clinical evidences may support the hypothesis that ERα-E₂ complex works as a promoter stimulating cell cycle of gallbladder carcinoma.

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We experienced five cases of recurrence of cancer at the percutaneous transhepatic bile duct drainage (PTBD) puncture site after resection of bile duct malignancies. All the patients had undergone a curative surgery of pylorus-preserving pancreatoduodenectomy (PPPD); 4 for lower bile duct cancer and 1 for cancer of the papilla of Vater. Recurrence at the PTBD tract was found from 3 months to 1 year after operation. Four cases had recurrent tumors resected. Nonetheless, all the 5 patients died 1-3 years after the first surgery due to cancer. We consider PTBD as an unfavorable measure of biliary drainage for obstructive jaundice caused by malignancy in terms of cancer implantation and poor prognosis even after re-resection.

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A 44-year-old woman had previous, history of sigmoidectomy for sigmoid colon cancer with histological findings of moderately differentiated adenocarcinoma about 3 years earlier. CT of the abdomen revealed multiple tumors of S₈, S₆, and S₃ segments of the liver. The tumors were suspected to extend into right (B post, S_8c) and left (B_3b) intrahepatic ducts with CT and endoscopic retrograde cholangiography. We diagnosed multiple liver metastases from colon cancer extending into the intrahepatic bile ducts. She underwent hepatic resection of the right lobe and segment 3. Histological findings showed moderately differentiated adenocarcinoma, and intraductal extension into the intrahepatic bile ducts. The patterns of the bile ducts extension were demonstrated to be intraductal tumor thrombus and superficial spread.

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We reported two cases of localized primary sclerosing cholangitis (PSC) mimicking bile duct cancer in our department.
Case 1: a 72-years-old woman was admitted to the hospital, because she was pointed out elevations of serum enzymes(ALP, γ-GTP). Ultrasonography and abdominal CE-CT scan revealed dilatation of the left hepatic bile duct. Endoscopic retrograde cholangiography (ERC)revealed the obstructed left hepatic bile duct. We suspected bile duct cancer and performed left hepatic lobectomy. Pathological examination of the resected specimen revealed sclerosing cholangitis.
Case 2: a 78-years-old woman was admitted with a chief complaint of epigastric pain. Gastrofiberscope revealed gastric ulcer (active stage) in the gastric angle. Ultrasonography revealed a cystic lesion in the left hepatic lobe. Percutaneous transhepatic cholangiography (PTC) revealed a narrowed lesion 1 cm in length which was localized in the left intrahepatic bile duct (IHBD). We suspected cholangiocellular carcinoma and perfomed left hepatic lobectomy. Pathological examination of the resected specimen revealed sclerosing cholangitis
According to the standard criterion, final diagnosis of primary sclerosing cholangitis was made in both cases. It is considered that localized PSC is difficult to diagnose and surgical resection is recommended because of high possibility of the progression of the lesion and the combinations with cholangiocellular carcinoma.

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This paper describes a case of septum formation in the common hepatic duct revealed through the intraoperative cholangiography in the laparoscopic cholecystectomy. A 37-year old woman who had suffered from epigastralgia was admitted to our hospital for treatment. Laparoscopic chole cystectomy (LC) was perfomed under diagnosis of incarceration of the gallstone into the cystic duct. Intraoperative cholangiography showed a linear longitudinal defect in the common hepatic duct, like a duplication of common hepatic duct. The existence of septum formation in the common hepatic duct was suggested in postoperative DIC-CT and ERCP. Her postoperative course was satisfactory. She has been in good health without liver dysfunction, as of 1 year after the operation. It is important to pay attention to the possibility of the choledocholithiasis due to biliary retention in septum formation of the common hepatic duct.

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