Cancer of the gallbladder associated with anomalous junction of the pancreatobiliary duct system without bile duct dilatation

Abstract

The aim of this study was to delineate clinical features and prognosis of cancer of the gallbladder associated with anomalous junction of the pancreatobiliary duct system without bile duct dilatation, and to determine methods for managing the disease. A retrospective study of seven patients is presented. A further 27 cases from the Japanese literature were reviewed retrospectively with regard to method of treatment and prognosis. In 11 of 18 patients in whom staging was known the tumour was stage V, representing advanced disease. In seven of 34 cases curative operation was performed; only two patients survived for > 3 years. This poor outcome was due largely to delayed diagnosis of cancer of the gallbladder. Prophylactic cholecystectomy is recommended in patients with this anomalous junction without bile duct dilatation or a malignant lesion in the gallbladder, because of the high incidence of cancer of the biliary tract.

Carcinogenesis of malignant lesions of the gall bladder

“…Although the high concentration of phospholipase A2 in bile is also thought to provide lithogenic circumstance, the frequency of gallstones in patients with AJPBD and gallbladder carcinoma is low. In contrast, incidence of adenomyomatosis, a fundic type, is considerably high in AJPBD patients without a cystic dilatation of common bile duct; adenomyomatosis is also proposed to be another premalignant lesion, although no direct information mechanistically supporting this has been established [42,43].…”

Clinical significance of a long common channel

“…In this study, a gallbladder carcinoma was detected in 67% of the patients with PBM without biliary dilatation. Because of the high incidence of associated biliary carcinomas, early surgical resection and reconstruction of the bile tract have been proposed [10,11].…”

Self-expandable metallic stents for malignant biliary obstruction with an anomalous pancreaticobiliary junction

“…Patients with APBJ are at high risk for biliary tract cancer, including bile duct cancer and gallbladder cancer [7][8][9][10]. Patients with biliary cancer often require biliary drainage via endoscopic stent insertion.…”

“…Frequently, APBJ is associated with choledochal cysts and carries a higher risk for the development of bile duct cancer. In addition, reported series have found a strong relationship between APBJ and gallbladder cancer in patients with no choledochal cyst [7][8][9][10]. It is generally accepted that reflux of the pancreatic juice into the biliary tract via an APBJ plays a role in the development of biliary tract cancer [1,2,11,12].…”

“…It is generally accepted that reflux of the pancreatic juice into the biliary tract via an APBJ plays a role in the development of biliary tract cancer [1,2,11,12]. In cases of biliary tract malignancy with an APBJ, radical resection is not generally performed, and the prognosis is dismal [9,10,13].…”