Double cancer of the cystic duct and gallbladder associated with low junction of the cystic duct

Itoh, Tsuyoshi; Fuji, Nobuaki; Taniguchi, Hiroki; Yasukawa, Satoru; Yasuda, Hiroaki; Wakabayashi, Naoki; Watanabe, Taiji; Kosuga, Toshiyuki; Kashimoto, Kingo; Yanagisawa, Akio; Naito, Kazuyo

doi:10.1007/s00534-007-1245-2

Cited by 11 publications

(9 citation statements)

References 13 publications

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“…These included metachronous (n = 1) and simultaneous (n = 2) multiple biliary cancers (Table 1). In other studies, 19 (51 %) of 37 patients with simultaneous double or multiple biliary tract cancers suffered from concurrent PBM [8][9][10][11][12]. The prevalence of gallstone detection in our 43 PBM patients without biliary dilatation who developed gallbladder cancer was only 9 %, which is significantly lower than the 62 % reported among the gallbladder cancer population without PBM [13].…”

Section: Clinical Features Of Biliary Cancer Associated With Pbmcontrasting

confidence: 53%

Biliary carcinogenesis in pancreaticobiliary maljunction

et al. 2016

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Pancreaticobiliary maljunction (PBM) is a congenital malformation in which the pancreatic and bile ducts join anatomically outside the duodenal wall. Because of the excessive length of the common channel in PBM, sphincter action does not directly affect the pancreaticobiliary junction, which allows pancreatic juice to reflux into the biliary tract. According to the results of a nationwide survey, bile duct and gallbladder cancers were found in 6.9 and 13.4 % of adult patients with congenital biliary dilatation, respectively, and in 3.1 and 37.4 % of those with PBM without biliary dilatation, respectively. Biliary tract cancers develop about 15-20 years earlier in patients with PBM than in individuals without PBM; they sometimes develop as double cancers. Carcinogenesis is strongly associated with stasis of bile intermingled with refluxed pancreatic juice. Epithelial cells in the biliary tract of PBM patients are under constant attack from activated pancreatic enzymes, increased secondary bile acids, or other mutagens. This can result in hyperplastic change with increased cell proliferation activity, and in turn, oncogene and/or tumor suppressor gene mutations in the epithelia, leading to the biliary tract carcinogenesis. The carcinogenesis of biliary tract cancer accompanying PBM is considered to involve a hyperplasia-dysplasia-carcinoma sequence induced by chronic inflammation caused by the reflux of pancreatic juice into the biliary tract, which differs from the adenoma-carcinoma sequence or the de novo carcinogenesis associated with biliary tract cancers in the population without PBM. Patients with a relatively long common channel have a similar, albeit slightly lower, risk for gallbladder cancer compared with PBM patients.

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Section: Clinical Features Of Biliary Cancer Associated With Pbmcontrasting

confidence: 53%

Biliary carcinogenesis in pancreaticobiliary maljunction

et al. 2016

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“…Of 37 patients with simultaneous double or multiple biliary cancers, 19 patients (51 %) suffered from concurrent PBM [3,[27][28][29][30][31].…”

Section: Incidence and Characteristicsmentioning

confidence: 99%

Pancreaticobiliary maljunction and biliary cancer

et al. 2014

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Pancreaticobiliary maljunction (PBM) is a congenital malformation in which the pancreatic and bile ducts join anatomically outside the duodenal wall. Japanese clinical practice guidelines on how to deal with PBM were made in 2012, representing a world first. According to the 2013 revision to the diagnostic criteria for PBM, in addition to direct cholangiography, diagnosis can be made by magnetic resonance cholangiopancreatography (MRCP), 3-dimensional drip infusion cholangiography computed tomography, endoscopic ultrasonography (US), or multiplanar reconstruction images by multidetector row computed tomography. In PBM, the common channel is so long that sphincter action does not affect the pancreaticobiliary junction, and pancreatic juice frequently refluxes into the biliary tract. Persistence of refluxed pancreatic juice injures epithelium of the biliary tract and promotes cancer development, resulting in higher rates of carcinogenesis in the biliary tract. In a nationwide survey, biliary cancer was detected in 21.6 % of adult patients with congenital biliary dilatation (bile duct cancer, 32.1 % vs. gallbladder cancer, 62.3 %) and in 42.4 % of PBM patients without biliary dilatation (bile duct cancer, 7.3 % vs. gallbladder cancer, 88.1 %). Pathophysiological conditions due to pancreatobiliary reflux occur in patients with high confluence of pancreaticobiliary ducts, a common channel C6 mm long, and occlusion of communication during contraction of the sphincter. Once the diagnosis of PBM is established, immediate prophylactic surgery is recommended. However, the surgical strategy for PBM without biliary dilatation remains controversial. To detect PBM without biliary dilatation early, MRCP is recommended for patients showing gallbladder wall thickening on screening US under suspicion of PBM.

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“…In fact, of 37 patients with simultaneous double or multiple biliary tract cancers, 19 patients (51.4 %) suffered from concurrent PBM[86][87][88][89][90]. Metachronous biliary double cancers are also relatively frequent in PBM.…”

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confidence: 95%

Japanese clinical practice guidelines for pancreaticobiliary maljunction

et al. 2012

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There have been no clinical guidelines for the management of pancreaticobiliary maljunction (PBM). The Japanese Study Group on Pancreaticobiliary Maljunction (JSPBM) has proposed to establish clinical practice guidelines on how to deal with PBM, with the support of the Japan Biliary Association (JBA). Because the body of evidence-based literature is relatively small, we decided to create guidelines based on the consensus of experts, using the medical literature for reference. A total of 46 clinical questions (CQs) were considered by the members of the editorial committee responsible for the guidelines. The CQs covered distinct aspects of PBM: (1) Concepts and Pathophysiology (10 CQs); (2) Diagnosis (10 CQs); (3) Pancreatobiliary complications (9 CQs); and (4) Treatments and prognosis (17 CQs). Statements and comments for each CQ were prepared by the guidelines committee members and collaborating partners. The CQs were completed after review by members of the editorial committee, meetings of this committee, public comments on the homepages of the JSPBM and the JBA, public hearings, and assessment and approval by the guidelines evaluation board. PBM includes cases where the bile duct is dilated (PBM with biliary dilatation) and those in which it is not (PBM without biliary dilatation). In these guidelines, PBM with biliary dilatation is defined as being identical to congenital biliary dilatation of Todani type I (except for type Ib) and type IV-A, both of which are accompanied by PBM in almost all cases. These guidelines are created to provide assistance in the clinical practice of PBM management; their contents focus on clinical utility, and they include general information on PBM to make this disease more widely recognized.

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Double cancer of the cystic duct and gallbladder associated with low junction of the cystic duct

Cited by 11 publications

References 13 publications

Biliary carcinogenesis in pancreaticobiliary maljunction

Biliary carcinogenesis in pancreaticobiliary maljunction

Pancreaticobiliary maljunction and biliary cancer

Japanese clinical practice guidelines for pancreaticobiliary maljunction

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