The results of surgical treatment for hilar cholangiocarcinoma were clinicopathologically evaluated to clarify prognostic factors. Among 42 patients with hilar cholangiocarcinoma treated in our department, curative resection was achieved only in 6 of 25 patients whom underwent surgery. These 25 surgically resected cases consisted of 9 cases of ss tumor,8 of se tumor, and 8 of si tumor. Although curative resection was achieved in 4 of the 9 patients with ss tumor, the other were all positive for resected stump including 2 patients with both positive stumps (hm & dm). Surgery for hilar cholangiocarcinoma resulted in non-curative resection in 14 of the 16 patients with se or si tumor. In 6 patients in whom curative resection was achieved,1-,3-, and 5-year survival rates were 83.3%,83.3%, and 55.6%, respectively. In the remaining 19 patients in whom curative resection was not achieved,1-,3-, and 5-year survival rates were 55.7%,5.6%, and 0%, respectively.
Since all patients with hilar cholangiocarcinoma treated in our department, had advanced tumors at the time of diagnosis, many of them had positive bile stumps even after hepatectomy, resulting in non-curative resection. Thus, the outcome of non-curative resection cases was the same poor prognostis as that of non-operative cases.

View full abstract

Male Lewis rats treated intravenously with a single dose of dibuthyltin dichloride (DBTC)showed epithelial damage in the extrahepatic bile duct, chronic inflammation, and sequential obstruction and cystic dilatation of the bile duct. In the liver, cholangiolitis and proliferation of bile ducts was characteristic, and the animals with marked inflammation showed cirrhosis-like structures. Taking these facts together, we consider these DBTC treated rats to be a model of bile duct dilatation or biliary cirrhosis found in humans.
Bile duct dilatation in humans is thought to be related to an abnormal pancreatico-choledochal duct junction. Also in this model, one of the cause of pathologic condition may owe to the anastomosis of pancreatic duct and bile one. So we may have a clue to solving the mechanism whereby bile duct dilatation occurs in human.

View full abstract

The purpose of the present study was to clarify the pattern of progress of gallbladder carcinoma and the factors determining the prognosis for life. The resected lesions of 69 patients with gallbladder cancer were classified depending on depth of invasion of gallbladder wall into the following four types: m (n=11), mp (n=7), ss (n=30) and se, si (n=21). The curative resection rate was 83.3%in ss carcinoma group and 19.0% in se, si carcinoma group.55.2% of the patients who underwent curative resection survived for more than five years, while none of those who underwent noncurative resection survived for more than three years. According to the presence of lymph node metastasis, the 5 ys survival rate of negative one was 50.4%, while the 5 ys survival rete of positive one was 5.7%. The 5 ys survival rate was 35.6% in the binf (-) group, while no patients who were classified into the binf (+) group survived for more than three years. Other factors having a poor prognoses included stage III and IV, macroscopic types other than the papillary type and the location of Gn (+). All patients who underwent resection of advanced gallbladder carcinoma and survived for more than five years underwent curative resection and showed binf (-). Regarding the positive of lymph node metastasis, only one patient with positive n1 survived for more than 5 years.

View full abstract

A-69-year-old woman, who had a chief complaint of right hypochondralgia, was admitted for acute cholecystitis. She was diagnosed as porcelain gallbladder by abdominal X-P, ultrasonography and CT. No preoperative close examination revealed gallbladder cancer. Cholecystectomy was performed and elevated lesion of the gallbladder was diagnosed as cancer by intraoperative frozen examination, so liver bed resection and D2 lymph node dissection was added. Porcelain gallbladder is often complicated with gallbladder cancer, therefore operation has to be selected.

View full abstract

Although mucin-producing carcinoma of the pancreas has been well documented, there are few reports on mucin-producing carcinoma of the gallbladder. Here we report two cases of early gallbladder carcinoma with marked secretion of mucous. In both cases, obstruction of the cystic duct was caused by abundant mucous and acute cholecystitis was occurred subsequently. ERCP disclosed a filling defect in the common bile duct and ultrasonography revealed debris-like echos in the gallbladder in both cases. The tumor was detected by CT scanning or ultrasonography before surgery, and the diagnosis of mucin-producing carcinoma was made. When surgery was performed, a tumor with abundant mucous was detected in the gallbladder. Histologically, the depth of invasion was limited to the muscular layer, so a diagnosis of early gallbladder cancer was made.

View full abstract

A case of pancreaticobiliary maljunction with multiple gallbladder carcinomas recognized different expression of p53 proteins is reported. A-49-year old woman was recognized an irregular elevated lesion of 19×10 mm in diameter at the fundus of gallbladder by abdominal ultrasonography. ERCP revealed pancreaticobiliary maljunction and cylindrical dilatation of extrahepatic bile duct. Under the diagnosis of pancreaticobiliary maljunction with gallbladder carcinoma, resection of gallbladder and extrahepatic bile duct, and dissection of lymph nodes in hepatoduodenal ligament was performed. Resected specimen revealed two papillary lesions, such as 20×20×10 mm (lesion A) and 5×7×3 mm (lesion B) at the fundus of gallbladder. Pathologically, lesion A was tub₂, and lesion B was tub₁, and the depth of both lesions was mucosal layer. In the lesion A, mitotic rate was 7/10HPF and rate of apoptosis was 2/10HPF, on the other hand, in the lesion B,25/10HPF and 10/10HPF respectively. In the lesion A, Ki-67 LI was 7.7% and expression of p53 proteins was negative, on the other hand, in the lesion B,27.8% and positive respectively. This case suggested that abnormality of regulation of cell cycle to carcinogenesis was different, though two carcinomas were occurred at the same environment.

View full abstract

We experienced a case of hepatic tumor hard to distinguish from intrahepatic cholangiocellular carcinoma by rnulticentric carcinogenesis and intrahepatic metastasis of hepatohilar tumor. The patient was a 67 years-old man. He had received extended right hepatic lobectomy for hepato-hilar bile duct tumor on December 1996.
Macroscopically, the tumor showed papillary growth to be clogged near the hepato-hilar bile duct with a: stalk. Histologically, it classified papillary adenocarcinoma, m, ly₀, v₀, pn₀. On February 2001, a hepatic tumor (3 cm) was detected in the segment 2. Partial resection of the lateral segment was performed and the tumor showed similar character with preceding tumor. Its pathogenesis was considered by two alternatives, a hematogenous or lymphogenous metastasis of first tumor and a newly developed carcinoma based on carcinoma-dysplasia sequence. Therefore we should take care of such as remaining dysplasia or skip lesion.

View full abstract

Extrahepatic bile duct anomalies are not so rare and care should be taken in operation for such anomalies. We report a case of gallbladder cancer associated with pancreaticobiliary maljunction with long accessory hepatic duct. A 72-year-old man was admitted to our hospital, he complained of right hypochondralgia. Ultrasonography revealed tumor of gallbladder. ERCP, CT and abdominal angiography showed gallbladder cancer associated with pancreaticobiliary maljunction. A long accessory hepatic duct was seen on ERCP. We recognized this bile duct arising from left caudate lobe and draining into the lower bile duct intraoperatively. Attention must be paid to the presence of unexpected biliary anomalies for the operation of pancreaticobiliary maljunction or bile duct dilatation. In dissection of hepatoduodenal ligament, we have to pay attention to the presence of accessory hepatic duct like this case.

View full abstract

A 17-year-female was found to have hematuria at a medical examination at her school. She was admitted to our hospital because abdominal US and CT showed dilatation of common bile duct. The Wirsung duct was short and smooth in pancreaticography from the papilla of Vater, pancreaticography from an accessory papilla was done. This study clarified that the dorsal pancreatic duct had no connection with the vental pancreatic duct, and indicated that the pancreas divisum was associated with pancreaticobiliary maljunction. The extra hepatic bile duct resection was underwent without accessory papilloplasty. The coexistensce of both anomalies has rarely been reported. We conclude that careful attention should be paid to possible association of pancreas divisum in cases with pancreaticobiliary maljunction.

View full abstract