Pancreatobiliary Maljunction-associated Gallbladder Cancer Is as Common in the West, Shows Distinct Clinicopathologic Characteristics and Offers an Invaluable Model for Anatomy-induced Reflux-associated Physio-chemical Carcinogenesis

被引：13

作者：

Muraki, Takashi ^{[1
]}

Pehlivanoglu, Burcin ^{[2
]}

Memis, Bahar ^{[2
]}

Reid, Michelle D. ^{[2
]}

Uehara, Takeshi ^{[3
]}

Basturk, Olca ^{[4
]}

Pernicka, Jennifer Golia ^{[5
]}

Klimstra, David S. ^{[4
]}

Jarnagin, William R. ^{[6
]}

Ito, Tetsuya ^{[1
]}

Hasebe, Osamu ^{[7
]}

Okaniwa, Shinji ^{[8
]}

Horigome, Naoto ^{[8
]}

Hisa, Takeshi ^{[9
]}

Mittal, Pardeep ^{[10
]}

Sarmiento, Juan M. ^{[11
]}

Maithel, Shishir K. ^{[11
]}

Koshiol, Jill ^{[12
]}

Tsai, Susan ^{[13
]}

Evans, Douglas ^{[13
]}

Erkan, Mert ^{[14
]}

Adsay, Volkan ^{[15
,16
]}

机构：

[1] Shinshu Univ Hosp, Dept Gastroenterol, Nagano, Japan

[2] Emory Univ Hosp, Dept Pathol, 1364 Clifton Rd NE, Atlanta, GA 30322 USA

[3] Shinsu Univ Hosp, Dept Pathol, Nagano, Japan

[4] Mem Sloan Kettering Canc Ctr, Dept Pathol, 1275 York Ave, New York, NY 10021 USA

[5] Mem Sloan Kettering Canc Ctr, Dept Radiol, 1275 York Ave, New York, NY 10021 USA

[6] Mem Sloan Kettering Canc Ctr, Dept Surg, 1275 York Ave, New York, NY 10021 USA

[7] Nagano Municipal Hosp, Dept Gastroenterol, Nagano, Japan

[8] Iida Municipal Hosp, Dept Digest Surg, Iida, Japan

[9] Saku Ctr Hosp, Dept Gastroenterol, Nagano, Japan

[10] Emory Univ Hosp, Dept Radiol, Atlanta, GA 30322 USA

[11] Emory Univ Hosp, Dept Surg, 1364 Clifton Rd NE, Atlanta, GA 30322 USA

[12] NIH, Canc Epidemiol & Genet, Bldg 10, Bethesda, MD 20892 USA

[13] Med Coll Wisconsin, Dept Surg, 8700 W Wisconsin Ave, Milwaukee, WI 53226 USA

[14] Koc Univ, Dept Surg, Istanbul, Turkey

[15] Koc Univ, Dept Pathol, Istanbul, Turkey

[16] Koc Univ, Res Ctr Translat Med KUTTA, Istanbul, Turkey

来源：

ANNALS OF SURGERY | 2022年 / 276卷 / 01期

关键词：

anomalous; anomaly; bile duct; carcinogenesis; carcinoma; gallbladder; hyperplasia; junction; maljunction; reflux; union; BILE-DUCT; MR CHOLANGIOPANCREATOGRAPHY; SQUAMOUS-CELL; DIAGNOSTIC-CRITERIA; CHOLEDOCHAL CYSTS; CARCINOMA; JUNCTION; BILIARY; DILATATION; MULTICENTER;

D O I：

10.1097/SLA.0000000000004482

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Objective: To determine the associations of pancreatobiliary maljunction (PBM) in the West. Background: PBM (anomalous union of common bile duct and pancreatic duct) is mostly regarded as an Asian-only disorder, with 200X risk of gallbladder cancer (GBc), attributed to reflux of pancreatic enzymes. Methods: Radiologic images of 840 patients in the US who underwent pancreatobiliary resections were reviewed for PBM and contrasted with 171 GBC cases from Japan. Results: Eight % of the US GBCs (24/300) had PBM (similar to Japan; 15/171, 8.8%), in addition to 1/42 bile duct carcinomas and 5/33 choledochal cysts. None of the 30 PBM cases from the US had been diagnosed as PBM in the original work-up. PBM was not found in other pancreatobiliary disorders. Clinicopathologic features of the 39 PBM-associated GBCs (US:24, Japan:15) were similar; however, comparison with non-PBM GBCs revealed that they occurred predominantly in females (F/M = 3); at younger (<50-year-old) age (21% vs 6.5% in non-PBM GBCs; P = 0.01); were uncommonly associated with gallstones (14% vs 58%; P < 0.001); had higher rate of tumor-infiltrating lymphocytes (69% vs 44%; P = 0.04); arose more often through adenoma-carcinoma sequence (31% vs 12%; P = 0.02); and had a higher proportion of nonconventional carcinomas (21% vs 7%; P = 0.03). Conclusions: PBM accounts for 8% of GBCs also in the West but is typically undiagnosed. PBM-GBCs tend to manifest in younger age and often through adenoma-carcinoma sequence, leading to unusual carcinoma types. If PBM is encountered, cholecystectomy and surveillance of bile ducts is warranted. PBM-associated GBCs offer an invaluable model for variant anatomy-induced chemical (reflux-related) carcinogenesis.

引用

页码：E32 / E39

页数：8