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1.
Pan Afr Med J ; 38: 144, 2021.
Artigo em Francês | MEDLINE | ID: mdl-33912314

RESUMO

Congenital cystic disease of the biliary tree is a known risk factor for gallbladder cancer. We here report a case of squamous cell carcinoma of the bile duct (BD) complicating a cystic dilatation of the bile ducts in a 54-year-old woman hospitalized for biliary pancreatitis. Abdominal scanner showed nodular thickening of the fundus of the gallbladder and fusiform dilation of the cystic duct and the main bile duct (VBP) with lesion of the tail of the pancreas, initially suggesting mucinous cystadenoma. Extended cholecystectomy involving the gallbladder fossa with resection of the distal biliary tract, choledocoduodenal anastomosis with caudal splenopancreatectomy + drainage were performed. Histopathological examination of the gallbladder mass revealed moderately differentiated invasive squamous cell carcinoma without infiltration of the hepatic parenchyma. The patient underwent adjuvant chemotherapy. The patient did not have the common symptoms of gallbladder cancer. Then radiology was necessary to make a diagnosis. Surgery is the best therapeutic option for early-stage gallbladder cancer, but adjuvant chemo-radiation may also be useful in treating these patients. Cholecystectomy with resection of cystic dilatation of the bile duct in high-risk patients are the most effective means of prevention.


Assuntos
Neoplasias dos Ductos Biliares/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias dos Ductos Biliares/patologia , Neoplasias dos Ductos Biliares/terapia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/terapia , Quimioterapia Adjuvante , Colecistectomia/métodos , Ducto Colédoco/patologia , Ducto Colédoco/cirurgia , Ducto Cístico/patologia , Ducto Cístico/cirurgia , Feminino , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/terapia , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Pancreatectomia/métodos , Esplenectomia/métodos
2.
BMC Cancer ; 21(1): 433, 2021 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-33879096

RESUMO

BACKGROUND: Inositol polyphosphate 4-phosphatase type II (INPP4B) is a negative regulator of the PI3K-Akt signalling pathway and plays a contradictory role in different types of cancers. However, the its biological role played by INPP4B in human gallbladder cancer (GBC) has not been elucidated. In this study, we investigated the expression, clinical significance and biological function of INPP4B in GBC patients and cell lines. METHODS: The INPP4B protein expression levels in gallbladder cancer tissues and normal gallbladder tissues were detected by immunohistochemistry, and the clinical significance of INPP4B was analysed. Knockdown and overexpression of INPP4B in GBC-SD and SGC-996 cells followed by cell proliferation, clonogenic, apoptosis detection, scratch wound-healing and transwell assays were used to identify INPP4B function in vitro. RESULTS: INPP4B was up-regulated in human GBC tissues compared with normal gallbladder tissues and was related to histopathological differentiation (p = 0.026). Here, we observed that INPP4B was highly expressed in high-moderately differentiated tumours compared with low-undifferentiated tumours (p = 0.022). Additionally, we found that INPP4B expression was not associated with overall survival of GBC patients (p = 0.071) and was not an independent prognostic factor. Furthermore, when we stratified the relationship between INPP4B expression and the prognosis of GBC based on histopathological differentiation, we found that INPP4B played a contradictory role in GBC progression depending on the degree of differentiation. In addition, INPP4B knockdown inhibited the proliferation, colony formation, migration and invasion in GBC cells, while INPP4B overexpression had the opposite effects in vitro, which indicates its role as an oncoprotein. CONCLUSIONS: These findings suggested that INPP4B may play a dual role in the prognosis of GBC depending on the degree of differentiation and that INPP4B might act as an oncogene in gallbladder cancer cells.


Assuntos
Neoplasias da Vesícula Biliar/genética , Regulação Neoplásica da Expressão Gênica , Monoéster Fosfórico Hidrolases/genética , Idoso , Idoso de 80 Anos ou mais , Apoptose/genética , Biomarcadores , Linhagem Celular Tumoral , Proliferação de Células , Feminino , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/metabolismo , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Gradação de Tumores , Metástase Neoplásica , Estadiamento de Neoplasias , Monoéster Fosfórico Hidrolases/metabolismo , Carga Tumoral
3.
Medicine (Baltimore) ; 100(14): e25449, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832150

RESUMO

BACKGROUND: Gallbladder neuroendocrine carcinoma (GB-NEC) is rare and there are few reports at present. We sought to review the current knowledge of GB-NEC and provide recommendations for clinical management. METHODS: A systemic literature research was conducted in the websites of Pubmed, Medline, Web of Science, CNKI, Wanfang Data using the keywords including gallbladder combined with neuroendocrine carcinoma or neuroendocrine tumor or neuroendocrine neoplasm. Two reviewers independently screened the articles by reading the title, abstract and full-text. RESULTS: In computed tomography (CT) and magnetic resonance imaging (MRI) examination, a well-defined margin, gallbladder replacing type with larger hepatic and lymphatic metastases could be helpful for differential diagnosis of GB-NEC and gallbladder adenocarcinoma (GB-ADC). Older age, unmarried status, large tumor size (>5 cm), positive margins, and distant Surveillance, Epidemiology and End result (SEER) stage are independently associated with poor survival. Surgical resection remains as the preferred and primary treatment. The potential survival benefit of lymphadenectomy for patients remains controversial. Platinum-based postoperative adjuvant chemotherapy may improve the survival. The efficacy of other treatments including immunotherapy, targeted therapy and somatostatin analogue needs further investigation. CONCLUSION: Typical imaging features could be helpful for preoperative diagnosis. Age, margin status, tumor size, marital status, histopathologic subtype and SEER stage may be independent predictors for the survival. Remarkable advances regarding the treatment for GB-NEC have been achieved in recent years. Further studies are needed to investigate the survival benefit of lymphadenectomy for patients with GB-NEC.


Assuntos
Carcinoma Neuroendócrino/diagnóstico , Carcinoma Neuroendócrino/terapia , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/terapia , Carcinoma Neuroendócrino/mortalidade , Terapia Combinada , Neoplasias da Vesícula Biliar/mortalidade , Humanos , Prognóstico , Taxa de Sobrevida
4.
Anticancer Res ; 41(4): 2147-2155, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33813426

RESUMO

BACKGROUND/AIM: Inflammation-based prognostic scores are proven prognostic biomarkers in various cancers. This study aimed to identify a useful prognostic score for patients with biliary tract cancer (BTC) after surgical resection. PATIENTS AND METHODS: This retrospective study recruited 115 patients with BTC during 2010-2020. The relationship between clinicopathological variables, including various prognostic scores and overall survival (OS), was investigated using univariate and multivariate analyses. RESULTS: BTC included 58 cholangiocarcinoma, 29 gallbladder carcinoma, 16 ampullary carcinoma, and 12 perihilar cholangiocarcinoma cases. A significant difference was detected in OS of patients with a Japanese modified Glasgow prognostic score (JmGPS) 0 (n=62) and JmGPS 1 or 2 (high JmGPS) (n=53). In the multivariate analysis, tumour differentiation (p=0.014) and a high JmGPS (p=0.047) were independent prognostic factors. CONCLUSION: The high JmGPS was an independent prognostic predictor after surgical resection and was superior to other prognostic scores.


Assuntos
Neoplasias do Sistema Biliar/diagnóstico , Neoplasias do Sistema Biliar/cirurgia , Colangiocarcinoma/diagnóstico , Colangiocarcinoma/cirurgia , Inflamação/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Ampola Hepatopancreática/metabolismo , Ampola Hepatopancreática/patologia , Ampola Hepatopancreática/cirurgia , Neoplasias dos Ductos Biliares/diagnóstico , Neoplasias dos Ductos Biliares/metabolismo , Neoplasias dos Ductos Biliares/mortalidade , Neoplasias dos Ductos Biliares/cirurgia , Ductos Biliares Intra-Hepáticos/metabolismo , Ductos Biliares Intra-Hepáticos/patologia , Ductos Biliares Intra-Hepáticos/cirurgia , Neoplasias do Sistema Biliar/metabolismo , Neoplasias do Sistema Biliar/mortalidade , Biomarcadores Tumorais/metabolismo , Proteína C-Reativa/metabolismo , Colangiocarcinoma/metabolismo , Colangiocarcinoma/mortalidade , Neoplasias do Ducto Colédoco/diagnóstico , Neoplasias do Ducto Colédoco/metabolismo , Neoplasias do Ducto Colédoco/mortalidade , Neoplasias do Ducto Colédoco/cirurgia , Feminino , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/metabolismo , Neoplasias da Vesícula Biliar/mortalidade , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Inflamação/metabolismo , Japão/epidemiologia , Tumor de Klatskin/diagnóstico , Tumor de Klatskin/metabolismo , Tumor de Klatskin/mortalidade , Tumor de Klatskin/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Valor Preditivo dos Testes , Prognóstico , Projetos de Pesquisa , Estudos Retrospectivos , Sensibilidade e Especificidade , Análise de Sobrevida , Resultado do Tratamento
5.
Ter Arkh ; 93(1): 100-107, 2021 Jan 10.
Artigo em Russo | MEDLINE | ID: mdl-33720634

RESUMO

Gallbladder polyps are an elevation of the mucous membrane that protrudes into the lumen of the gallbladder cavity. Their prevalence in the general population varies from 0.3 to 13.8%. According to the modern classification, polyps of the gallbladder are divided into benign non-tumor, benign tumor and malignant tumor polyps. A review of modern literature presents cohort and randomized controlled trials, including those summarized in meta-analyzes and systematic reviews, suggesting that the dominant form of polypoid formations of the gallbladder are cholesterol pseudo-polyps with no malignant potential associated with impaired cholesterol metabolism, often combined with gallbladder cholesterosis, metabolic syndrome and cardiovascular morbidity. Evidence is building up on the effectiveness of ursodeoxycholic acid for controlling components of the metabolic syndrome and cardiovascular risks. Ursodeoxycholic acid preparations may become promising for the management of cholesterol polyps.


Assuntos
Doenças da Vesícula Biliar , Neoplasias da Vesícula Biliar , Pólipos , Doenças da Vesícula Biliar/diagnóstico , Doenças da Vesícula Biliar/tratamento farmacológico , Doenças da Vesícula Biliar/epidemiologia , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/epidemiologia , Neoplasias da Vesícula Biliar/terapia , Humanos , Metanálise como Assunto , Pólipos/diagnóstico , Pólipos/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto , Ácido Ursodesoxicólico/uso terapêutico
7.
Ann R Coll Surg Engl ; 103(4): e116-e119, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33682446

RESUMO

We report a 48-year-old fit and healthy woman who was incidentally diagnosed to have adenocarcinoma of gallbladder after laparoscopic cholecystectomy. Subsequent imaging showed no evidence of regional or distant spread. She was scheduled for elective laparotomy and resection of gallbladder bed, but during laparotomy frozen section analysis of an incidentally discovered peritoneal deposit confirmed metastasis, so the procedure was abandoned. Thereafter, she received cisplatin and gemcitabine chemotherapy. However, surveillance computed tomography incidentally noted a urinary bladder mass which had not been present before. Transurethral resection of the bladder lesion revealed moderately differentiated adenocarcinoma of urinary bladder. The appearance and immunoprofile of the lesion confirmed metastasis from the primary gallbladder cancer, which has not been documented in the literature to the best of our knowledge. Her disease progressed and she is being challenged with gemcitabine and carboplatin as second-line palliative chemotherapy. She is still alive two years after the initial diagnosis.


Assuntos
Adenocarcinoma/secundário , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Bexiga Urinária/secundário , Adenocarcinoma/diagnóstico , Feminino , Neoplasias da Vesícula Biliar/diagnóstico , Humanos , Achados Incidentais , Pessoa de Meia-Idade , Neoplasias da Bexiga Urinária/diagnóstico
8.
BMC Cancer ; 21(1): 288, 2021 Mar 17.
Artigo em Inglês | MEDLINE | ID: mdl-33731052

RESUMO

BACKGROUND: If the depth of gallbladder malignant tumor (GBMT) invasion is deeper than the subserosa (ss), cholecystectomy is insufficient. In past reports that used endoscopic ultrasonography (EUS) to diagnose the depth of tumor invasion, it was difficult to diagnose GMBT invasion in the ss without a narrow or disrupted lateral hyperechoic layer (LHEL). Therefore, we developed a simple preoperative method to diagnose GBMTs with ss invasion. METHODS: Forty-nine GBMT patients who underwent both EUS and surgery were enrolled: 15 patients whose tumors invaded the mucosa (m) or muscularis propria (mp) were classified as the "shallow group", and 34 patients whose tumors invaded the ss were classified as the "deep group". The EUS findings were compared between the two groups. RESULTS: An irregular (narrow or thickened) LHEL was significantly more frequently observed on EUS in the deep group than in the shallow group. The diagnosis of ss invasion based on an irregular LHEL had the highest sensitivity and accuracy among the EUS imaging parameters (sensitivity 97.1% (33/34), specificity 86.7% (13/15), accuracy 93.8% (46/49)). When the deep group was limited to patients with a tumor depth of ss, the results were similar. When an irregular LHEL was used, the diagnostic accuracy of GBMTs with ss invasion was not significantly different between EUS specialists and beginners. CONCLUSIONS: The observation of an irregular (thickened or narrow) LHEL observed on EUS could be a reliable and simple method of diagnosing GBMTs with ss invasion and could contribute to choosing an appropriate surgical method.


Assuntos
Endossonografia , Neoplasias da Vesícula Biliar/diagnóstico , Vesícula Biliar/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Colecistectomia , Feminino , Vesícula Biliar/patologia , Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Reprodutibilidade dos Testes , Estudos Retrospectivos
9.
BMJ Case Rep ; 13(12)2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33370977

RESUMO

Neuroendocrine neoplasms of the gallbladder occur infrequently, with the diagnosis being incidental in most cases. We present a case of an 81-year-old African American woman who initially presented with acute suppurative cholecystitis, found on pathology to have a moderately differentiated infiltrating adenocarcinoma. A partial hepatic resection with periportal lymph node dissection was planned which was subsequently aborted intraoperatively due to the presence of diffuse carcinomatosis. Pathology of the cancerous lesions revealed neuroendocrine carcinoma. Gallbladder neuroendocrine tumours demonstrate no specific clinical features. Given its often late presentation, neuroendocrine tumours of the gallbladder pose a therapeutic and prognostic challenge.


Assuntos
Carcinoma Neuroendócrino/diagnóstico , Colecistite Aguda/etiologia , Neoplasias da Vesícula Biliar/diagnóstico , Vesícula Biliar/patologia , Neoplasias Peritoneais/diagnóstico , Idoso de 80 Anos ou mais , Carcinoma Neuroendócrino/secundário , Carcinoma Neuroendócrino/terapia , Colecistectomia Laparoscópica , Colecistite Aguda/cirurgia , Evolução Fatal , Feminino , Vesícula Biliar/diagnóstico por imagem , Vesícula Biliar/cirurgia , Neoplasias da Vesícula Biliar/complicações , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/terapia , Cuidados Paliativos na Terminalidade da Vida , Humanos , Diagnóstico Ausente , Estadiamento de Neoplasias , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/terapia , Tomografia Computadorizada por Raios X
10.
PLoS One ; 15(9): e0239178, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32946469

RESUMO

BACKGROUND: Unexpected gallbladder cancer (UGBC) is sometimes found in the resected gallbladder of patients during or after surgery. Some reports have indicated UGBC identification rates for all gallbladder surgeries, but scarce data are available for the UGBC identification rates for specific gallbladder diseases. The present study was performed to clarify UGBC rates and the factors suspicious for UGBC categorized according to preoperative diagnoses, in patients undergoing laparoscopic cholecystectomy (LSC). METHODS: We recorded data for all LSC surgeries performed in the Department of Surgery, Sada Hospital, Japan since 1991, and analyzed the 28-year data. We used the chi-square test and Kaplan-Meier analysis for this retrospective case-control study. RESULTS: The UGBC identification rate was 0.69% (63/9186 patients). The UGBC identification rates categorized according to the preoperative diagnoses were 1.3% (13/969) for acute cholecystitis, 2.4% (16/655) for benign tumor, 2.0% (28/1383) for chronic cholecystitis or cholecystitis, and 0.054% (3/5585) for cholecystolithiasis. The percentage of older patients (≥ 60 years) was significantly higher in UGBCs compared with cases finally diagnosed as benign in each group categorized according to the preoperative diagnoses (p≤0.0014), except for cholecystolithiasis. In cases pre-diagnosed as benign tumor, UGBCs were associated with higher rates of thickened gallbladder wall compared with benign tumor (69.2% vs. 27.9%, respectively; p = 0.0011). UGBCs pre-diagnosed as acute cholecystitis had higher T2-T4 rates (100% vs. 64.3%, respectively; p<0.05) and lower survival rates (p = 0.0149) than UGBCs pre-diagnosed with chronic cholecystitis. CONCLUSIONS: UGBC identification rates depend on the preoperative diagnosis and range from 0.054% to 2.4%. Older age (≥ 60 years) could be related to UGBC, and a pre-diagnosis of acute cholecystitis might indicate more advanced cancer compared with a pre-diagnosis of chronic cholecystitis.


Assuntos
Colecistectomia , Colecistite Aguda/diagnóstico , Colecistolitíase/diagnóstico , Neoplasias da Vesícula Biliar/epidemiologia , Achados Incidentais , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Criança , Pré-Escolar , Colecistite Aguda/patologia , Colecistite Aguda/cirurgia , Colecistolitíase/patologia , Colecistolitíase/cirurgia , Doença Crônica , Feminino , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/patologia , Humanos , Japão/epidemiologia , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Período Pré-Operatório , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
12.
Medicine (Baltimore) ; 99(31): e21021, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756087

RESUMO

The purpose of this study was to investigate the potential prognostic value of preoperative lymphocyte-to-monocyte ratio (LMR) and establishment of a prognostic nomogram in post surgical patients with gallbladder carcinoma (GBC).Receiver operating characteristic curve analysis was performed to determine the optimal cut-off value of LMR. The correlation between preoperative LMR and overall survival (OS) was analyzed using univariate and multivariate Cox regression analyses. A relevant prognostic nomogram was established.Three hundred fifteen GBC patients were retrospectively enrolled. Based on receiver operating characteristic curve analysis, the optimal cutoff value of LMR was 2.685. Patients were categorized into high-LMR group (n = 143) or low-LMR group (n = 172). Low-LMR value was significantly associated with elderly age, advanced tumor, and the performance of a palliative cholecystectomy. The results of the univariate and multivariate analyses eliminated the degree of tumor differentiation, tumor-node-metastasis stages, surgery types, and LMR as independent predictors of OS. Based on those independent predictors, a predictive nomogram for OS was generated with an accuracy of 0.848.Based on our findings, the predictive nomogram should be included in the routine assessment of GBC patients.


Assuntos
Neoplasias da Vesícula Biliar/diagnóstico , Contagem de Leucócitos , Contagem de Linfócitos , Monócitos , Nomogramas , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Vesícula Biliar/mortalidade , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Curva ROC , Reprodutibilidade dos Testes , Estudos Retrospectivos , Análise de Sobrevida
13.
Nat Commun ; 11(1): 4225, 2020 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-32839463

RESUMO

Gallbladder cancer (GBC) is an aggressive gastrointestinal malignancy with no approved targeted therapy. Here, we analyze exomes (n = 160), transcriptomes (n = 115), and low pass whole genomes (n = 146) from 167 gallbladder cancers (GBCs) from patients in Korea, India and Chile. In addition, we also sequence samples from 39 GBC high-risk patients and detect evidence of early cancer-related genomic lesions. Among the several significantly mutated genes not previously linked to GBC are ETS domain genes ELF3 and EHF, CTNNB1, APC, NSD1, KAT8, STK11 and NFE2L2. A majority of ELF3 alterations are frame-shift mutations that result in several cancer-specific neoantigens that activate T-cells indicating that they are cancer vaccine candidates. In addition, we identify recurrent alterations in KEAP1/NFE2L2 and WNT pathway in GBC. Taken together, these define multiple targetable therapeutic interventions opportunities for GBC treatment and management.


Assuntos
Proteínas de Ligação a DNA/genética , Mutação da Fase de Leitura , Neoplasias da Vesícula Biliar/genética , Predisposição Genética para Doença/genética , Proteínas Proto-Oncogênicas c-ets/genética , Fatores de Transcrição/genética , Vacinas Anticâncer/genética , Vacinas Anticâncer/imunologia , Chile , Proteínas de Ligação a DNA/imunologia , Proteínas de Ligação a DNA/metabolismo , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/metabolismo , Perfilação da Expressão Gênica/métodos , Regulação Neoplásica da Expressão Gênica , Genômica/métodos , Humanos , Índia , Proteína 1 Associada a ECH Semelhante a Kelch/genética , Proteína 1 Associada a ECH Semelhante a Kelch/metabolismo , Fator 2 Relacionado a NF-E2/genética , Fator 2 Relacionado a NF-E2/metabolismo , Proteínas Proto-Oncogênicas c-ets/imunologia , Proteínas Proto-Oncogênicas c-ets/metabolismo , República da Coreia , Fatores de Transcrição/imunologia , Fatores de Transcrição/metabolismo , Via de Sinalização Wnt/genética , beta Catenina/genética , beta Catenina/metabolismo
14.
Zhonghua Wai Ke Za Zhi ; 58(7): 490-493, 2020 Jul 01.
Artigo em Chinês | MEDLINE | ID: mdl-32610416

RESUMO

Incidental gallbladder cancer(IGBC) originated in the West more than half a century ago.IGBC was translated and introduced into China afterwards with widespread clinical application.With the popularization of laparoscopic cholecystectomy, the trend of "abuse" of IGBC has become increasingly apparent worldwide.Many advanced gallbladder cancers have been categorized as IGBC which actually become the synonym of "missed diagnosis" . From the point of the pathology, the diagnosis of IGBC may cause delays in treatment and adversely affect the patient's prognosis.For country like China with relatively high incidences of chronic cholecystitis, cholelithiasis, and gallbladder cancer, the concept of IGBC, however, is no longer applicable to our diagnosis treat model.For improving the prognosis of gallbladder patients, it is necessary to update and rename the concept of IGBC and more attention should be paid to improve the diagnostic level of early stage tumor.


Assuntos
Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/cirurgia , Diagnóstico Ausente , Terminologia como Assunto , China , Colecistectomia Laparoscópica , Colecistite/cirurgia , Colelitíase/cirurgia , Neoplasias da Vesícula Biliar/patologia , Humanos , Achados Incidentais , Estadiamento de Neoplasias , Prognóstico , Tempo para o Tratamento
15.
Sci Rep ; 10(1): 7700, 2020 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-32382062

RESUMO

Ultrasonography (US) has been considered image of choice for gallbladder (GB) polyp, however, it had limitations in differentiating between nonneoplastic polyps and neoplastic polyps. We developed and investigated the usefulness of a deep learning-based decision support system (DL-DSS) for the differential diagnosis of GB polyps on US. We retrospectively collected 535 patients, and they were divided into the development dataset (n = 437) and test dataset (n = 98). The binary classification convolutional neural network model was developed by transfer learning. Using the test dataset, three radiologists with different experience levels retrospectively graded the possibility of a neoplastic polyp using a 5-point confidence scale. The reviewers were requested to re-evaluate their grades using the DL-DSS assistant. The areas under the curve (AUCs) of three reviewers were 0.94, 0.78, and 0.87. The DL-DSS alone showed an AUC of 0.92. With the DL-DSS assistant, the AUCs of the reviewer's improved to 0.95, 0.91, and 0.91. Also, the specificity of the reviewers was improved (65.1-85.7 to 71.4-93.7). The intraclass correlation coefficient (ICC) improved from 0.87 to 0.93. In conclusion, DL-DSS could be used as an assistant tool to decrease the gap between reviewers and to reduce the false positive rate.


Assuntos
Neoplasias da Vesícula Biliar/diagnóstico , Vesícula Biliar/diagnóstico por imagem , Pólipos/diagnóstico , Ultrassonografia , Aprendizado Profundo , Feminino , Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos/diagnóstico por imagem , Pólipos/patologia , Lesões Pré-Cancerosas/diagnóstico , Lesões Pré-Cancerosas/diagnóstico por imagem , Lesões Pré-Cancerosas/patologia , Estudos Retrospectivos
16.
Trop Doct ; 50(3): 243-245, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32290760

RESUMO

A haemocholecyst is a clot-filled gallbladder caused by bleeding into its lumen. It is a rare entity with fewer than 50 cases reported in the English literature. Preoperative diagnosis is often not possible even with good quality cross-sectional imaging. Here, we present a case of a gallbladder mass, whose nature was only made clear at operation, where a hugely enlarged gallbladder was found filled with blood clots. There was neither liver infiltration nor regional lymphadenopathy. The clinical status of the patient demanded simple cholecystectomy. Histopathological examination, however, revealed a gallbladder adenocarcinoma, infiltrating the perimuscular connective tissue. Thus, more radical surgery was performed eight weeks later. At the 21-month follow-up, the patient was found to be well.


Assuntos
Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/patologia , Adenocarcinoma/cirurgia , Colecistectomia , Feminino , Neoplasias da Vesícula Biliar/cirurgia , Hematoma/diagnóstico , Hematoma/patologia , Hematoma/cirurgia , Humanos , Pessoa de Meia-Idade , Resultado do Tratamento
17.
Zhonghua Wai Ke Za Zhi ; 58(4): 243-251, 2020 Apr 01.
Artigo em Chinês | MEDLINE | ID: mdl-32241052

RESUMO

In order to improve the overall therapeutic effect of gallbladder cancer in China, Branch of Biliary Surgery, Chinese Surgical Society and Chinese Committee of Biliary Surgeons have formulated the guideline for the diagnosis and treatment of gallbladder carcinoma (2019 edition) . The guideline provided an overview of the evidence on epidemiological risk factors, treatment and follow-up strategies for patients with gallbladder cancer.It also updated the new TNM stage and proposed the clinical classification of gallbladder cancer for the first time. The guideline highlighted the importance of accurate prediction of TNM stage and type of gallbladder cancer based on modern high-quality imaging technology and endoscopic techniques.The idea of comprehensive treatment should be established as the fundamental principle for patients with advanced gallbladder cancer, and a multidisciplinary approach is recommended to make optimal clinical decisions. Standard radical surgical treatment should be delivered by a team of experienced hepato-pancreato-biliary surgeons and pathologists.The combination regimens of chemotherapy, radiotherapy, targeted therapy and immunotherapy for gallbladder cancer have shown promise in improving prognosis. Further research is still needed to confer greater survival benefits to patients with gallbladder cancer.


Assuntos
Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/terapia , China , Humanos , Estadiamento de Neoplasias , Guias de Prática Clínica como Assunto , Prognóstico , Fatores de Risco
18.
Zhonghua Wai Ke Za Zhi ; 58(4): 303-309, 2020 Apr 01.
Artigo em Chinês | MEDLINE | ID: mdl-32241061

RESUMO

Objective: To examine the role of the number of lymph nodes examined(NLNE) on the prognosis of patients with curatively resected gallbladder carcinoma(GBC). Methods: The clinicopathological data and prognosis of 401 patients with GBC who underwent radical surgery from six institutions of China from January 2013 to December 2017 were analyzed retrospectively. There were 153 males(38.2%) and 248 females(61.8%), with age of (62.0±10.5) years (range: 30-88 years). Fifty-three patients(22.2%) were accompanied by jaundice. All patients underwent radical resection+regional lymphadenectomy.R0 or R1 resection was confirmed by postoperative pathological examination.The different cut-off values of NLNE were determined by the X-tile software, the optimal cut-off values were identified by analyzing the relationship between different cut-off values of NLNE with survival rate. Kaplan-Meier method was used for survival analysis. Univariate and multivariate analysis were implemented respectively using the Log-rank test and Cox proportional hazard model. Results: Among the 401 patients enrolled, 135 cases (33.6%) had lymphatic metastasis, of which 98 cases were in N1 stage(24.4%) and 37 cases were in N2 stage(9.2%).A total of 2 794 NLNE were retrieved, with a median count of 6 (5).The median positive lymph nodes count was 0 (1), and the median positive lymph nodes ratio was 0 (IQR, 0-0.2). Since the 12 and 15 were determined as the cut-off values by X-tile, all patients were divided into three groups of 1-11, 12-15 and ≥16.The 3-year survival rate of the three groups was 45.2%, 74.5%, 12.0% respectively, with statistically significant difference between three groups (χ(2)=10.94, P<0.01). The results of multivariate analysis showed that NLNE was an independent prognostic factor for overall survival (P<0.05). Further analysis was performed specifically for subgroup of T stages. For T1b patients, the prognosis of the NLNE with 1-7 group was significantly better than that of the ≥8 group(χ(2)=4.610, P<0.05). For T2 patients, the prognosis of the TLNE ≥7 group was significantly better than that of 1 -6 group (χ(2)=4.287, P<0.05). For T3 and T4 patients, the prognosis of the TLNE with 12 - 15 group was significantly better than that of 1 -11 group (χ(2)=5.007, P<0.01) and ≥16 group (χ(2)=10.158, P<0.01). Conclusions: The NLNE is an independent factor affecting the prognosis of patients with GBC.For patients with stage T1b,8 lymph nodes should be retrieved; for patients with stage T2,extensive dissection of more than 6 lymph nodes can significantly improve the prognosis.For advanced patients (stages T3 and T4), extensive dissection with 12-15 lymph nodes is recommended. However, it fails to get more survival benefits by dissecting more than 16 lymph nodes.


Assuntos
Neoplasias da Vesícula Biliar/diagnóstico , Excisão de Linfonodo , Adulto , Idoso , Idoso de 80 Anos ou mais , China , Feminino , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Linfonodos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
20.
Am J Surg ; 220(3): 741-744, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32037044

RESUMO

BACKGROUND: Gallbladder cancer (GBC) has a poor prognosis. The aim was to develop and validate a preoperative risk score for incidental gallbladder cancer (IGBC) in patients scheduled for cholecystectomy. METHODS: Data registered in the nationwide Swedish Registry for Gallstone Surgery (GallRiks) was analyzed, including the derivation cohort (n = 28915, 2007-2014) and the validation cohort (n = 7851, 2014-2016). An additive risk score model based on odds ratio was created. RESULTS: The scoring model to predict IGBC includes age, female gender, previous cholecystitis, and either jaundice or acute cholecystitis. The calibration by HL test and discrimination by AUROC was 8.27 (P = 0.291) and 0.76 in the derivation cohort (214 IGBC) and 14.28 (P = 0.027) and 0.79 in the validation cohort (35 IGBC). The scoring system was applied to three risk-groups, based on the risk of having IGBC, eg. the high-risk group (>8 points) included 7878 patients, with 154 observed and 148 expected IGBC cases. CONCLUSION: We present the first risk score model to predict IGBC. The model estimates the expected risk for the individual patient and may help to optimize treatment strategies.


Assuntos
Colecistectomia , Colecistite/cirurgia , Neoplasias da Vesícula Biliar/diagnóstico , Achados Incidentais , Modelos Estatísticos , Idoso , Estudos de Coortes , Feminino , Previsões , Neoplasias da Vesícula Biliar/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco
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