Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0001430 (adenoma)
 21,222 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A 35-year-old woman with minute gallbladder cancer is presented. Cholecystectomy for gallstones resulted in recurrent colic lasting for a few years. Examination of the resected bladder under a dissection microscope disclosed a minute polypoid tumor with cylindroid appearance measuring 2.0 X 0.5 mm; it was located on a thin membraneous stalk in the neck region. Histologically, the tumor consisted chiefly of well-differentiated adenocarcinoma, in its periphery there were adenomatous residues; the stalk was free of neoplastic change. Blood group substances were completely absent in the cancerous tissues, they were present in adenomatous tissues. We hypothesize that the present cancer derived from the minute gallbladder adenoma via malignant change at an early stage development, suggesting a unique mode for an adenoma-carcinoma sequence in the gallbladder. The present case is believed to be the smallest cancer among reported cases and we propose to define minute gallbladder cancer as that less than 5 mm in maximum diameter.
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PMID:[Minute gallbladder cancer--case report with suggestions regarding a possibly unique histogenesis]. 608 81

We report herein two cases of carcinoma in situ of the gallbladder associated with cholesterosis. The patient in case 1 was an 81-year-old man who underwent a cholecystectomy for cholelithiasis. The resected specimens revealed gallbladder cancer in the fundus which was diagnosed histologically as mucinous carcinoma. Other findings included 13-mm, 12-mm, and 5-mm polypoid lesions in the neck of the gallbladder which macroscopically appeared to be cholesterol polyps, but histologically demonstrated carcinoma in situ with cholesterosis. The patient in case 2 was a 76-year-old man in whom ultrasonography revealed a highly echogenic, elevated lesion in the gallbladder. Cholecystectomy was performed, and a 33 x 28-mm papillary, elevated lesion with cholesterosis was resected from the neck of the gallbladder. Histologically, this was demonstrated to be papillary adenocarcinoma in situ with cholesterosis surrounded by glandular dysplasia. The distribution of the carcinomas and cholesterosis in both of these patients suggests that the adenoma or carcinoma of the gallbladder had occurred first. Then, the tumor epithelium absorbed cholesterol from the bile, and foamy cells were produced. Thus, when treating cholesterol polyps, it should be remembered that it is often difficult to distinguish between cholesterol polyp and gallbladder cancer with cholesterosis.
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PMID:Gallbladder cancer associated with cholesterosis. 872 45

We report a patient with symptomatic biliary disease and who was diagnosed by ultrasound to have a large polypoid gallbladder lesion. Histopathology revealed adenoma in combination with carcinoma in situ. The evidence for the adenoma-carcinoma sequence in gallbladder cancer and diagnostic and therapeutic implications are discussed.
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PMID:Evidence for the polyp-cancer sequence in gallbladder cancer. 918 89

Laparoscopy with lesser sac endoscopy (LSE) were used in combination from 1987 to 1992 in 103 patients for differentiation between pancreatic carcinoma and other peripancreatic pathology, staging, and palliation. LSE identified pancreatic carcinoma in 38 patients; pancreatic cystadenocarcinoma in 2 patients; pancreatic cystadenoma in 3 patients; pancreatic adenoma in 1 patient; pancreatic metastases from liver in 2 patients; and pancreatic cysts in 5 patients. False negative diagnosis of pancreatic carcinoma occurred in two cases. Nontumor pancreatic pathology was revealed in 10 patients. Specifically, acute pancreatitis was found in four patients, and chronic pancreatitis was found in six patients. Extrapancreatic cancers were identified in 15 patients: retroperitoneal extraorgan tumors were found in 2 patients; extrahepatic biliary tract cancer in 6 patients; gallbladder cancer in 1 patient; liver cancer in 3 patients; and stomach cancer in 1 patient. In five cases no pathology was found. Overall correct definitive diagnosis was established in 101 patients. Sensitivity of laparoscopy with LSE for pancreatic carcinoma diagnosis proved to be 95 per cent (38 of 40 patients), for pancreatic tumors diagnosis 96.22 per cent (51 of 53 patients); specificity of the method 100 per cent; and accuracy of diagnosis 98 per cent (101 of 103 patients). Thus, the accuracy of the method was as high as the accuracy of combination of all known modalities. Criteria of unresectability were revealed with the combination of LSE and laparoscopy in 75 per cent (30 of 40 cases) of pancreatic carcinoma. Moreover, laparoscopy allowed palliation of pancreatic carcinoma. Laparoscopic cholecystostomy was performed in 10 patients, and laparoscopic cholecystojejunostomy with enteroenterostomy was performed in 6 patients.
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PMID:Lesser sac endoscopy and laparoscopy in pancreatic carcinoma definitive diagnosis, staging and palliation. 973 5

To diagnose early gallbladder carcinoma is difficult but essential to improve the survival of the patients with this cancer. Fifty-three early gallbladder cancers were macroscopically divided into protruding and flat types. The diagnostic devises [ultrasonography (US), computed tomography (CT), and drip infusion cholangiography (DIC)] were compared for their ability of early detection. The specimens were examined cytologically for diagnosis during operation and the p53 protein was investigated. Thirty-three cases were of the protruding type, eighteen of the flat type, and two unclassified. Carcinoma tended to be missed when gallstones were present. Preoperative diagnosis of the flat type was difficult. Tumor location did not always correlate with the preoperative diagnosis. Of the misdiagnosed cases of the protruding type, half were missed with US and CT and were not visualized clearly by DIC. Among the flat type cancers, only three had no abnormal findings by diagnostic imaging. Cytologic examination was effective, and p53 was expressed only in early carcinoma, not in adenoma or dysplasia. Even in the presence of gallstones or cholecystitis, any abnormal findings should make one suspicious of gallbladder cancer. Cytology and p53 expression may be useful for the intraoperative diagnosis, and a combination of diagnostic methods is important.
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PMID:Diagnostic imaging of early gallbladder cancer: retrospective study of 53 cases. 1039 May 91

The size and number of gallbladder polyps are used to differentiate between benign and malignant lesions before surgery and to determine whether surgery is necessary for the lesion. Since 1987, laparoscopic cholecystectomy has been widely used as the management method of choice for gallbladder lesions. The results of a clinicopathologic study of polypoid lesions of the gallbladder, based completely on laparoscopically resected gallbladder tissue, have not yet been evaluated fully. Data from 123 patients with polypoid lesions of the gallbladder treated by laparoscopic cholecystectomy were reviewed retrospectively. The gallbladders were classified into four histologic groups. Clinical features, maximal diameter, and the number of lesions were compared among the groups. The mean age of patients with adenoma and cancer was significantly greater than that of patients with cholesterol polyps and other lesions. More women than men had a neoplasm (adenoma and cancer). Patients in the neoplasm group tended to have a single lesion. The mean maximal diameter of neoplasms was significantly larger than that of lesions in the nonneoplasm group. All seven malignant lesions that were detected measured at least 1.5 cm. Univariate analysis showed that polypoid lesions of the gallbladder with neoplastic lesions correlated significantly with age, sex, size, and number of the lesions. Univariate analysis also showed that malignancy in polypoid lesions of the gallbladder correlated significantly with age, size, and number of the lesions. Multivariate logistic regression analysis showed that the age of the patient and the size of the lesion (> or = 1.0 cm) are two independent factors in predicting neoplastic lesions in polypoid lesions of the gallbladder. The size of the lesion (> or = 1.5 cm) is the only independent factor in predicting malignancy in the polypoid lesions of the gallbladder as shown by multivariate logistic regression analysis. Laparoscopic cholecystectomy is a safe and feasible method for gallbladder polypoid lesions. Neoplastic change in polypoid lesions of the gallbladder should be considered when a patient older than 50 years of age has a polypoid lesion larger than 1.0 cm. Cancer should be suspected when a polypoid lesion of the gallbladder is larger than 1.5 cm, and an aggressive surgical approach is warranted so that early gallbladder cancer can be detected and patients can have an increased chance of cure.
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PMID:Laparoscopic cholecystectomy for polypoid lesions of the gallbladder: a clinicopathologic study. 1144 47

Carcinoma of the biliary tree are rare tumours of the gastrointestinal tract with a rising incidence during the last years. Biliary neoplasms are classified into intra- and extrahepatic cholangiocarcinoma (Klatskin tumour, middle and distal extrahepatic tumours), gallbladder cancer, and ampullary carcinoma. Transformation of normal into malignant bile duct tissue requires a chain of consecutive gene mutations, similar to the adenoma-dysplasia-carcinoma-sequence in colon cancer. Abdominal ultrasound, combined non-invasive magnetic resonance cholangiography/tomography (MRC/MRT), and facultatively endoscopic retrograde cholangiography (ERC) for unclear diagnosis, represent the gold standard for primary diagnosis. For ampullary carcinoma, endosonography and endoscopic biopsy are the diagnostic tools of choice. Cure is attainable only by formal curative radical surgical resection. Increasing surgical radicality within the last years enabled clearly improved 5-year survival rates. In contrast, there has been no clinical benefit for adjuvant and neoadjuvant therapies. For palliation, bile duct stenting and photodynamic therapy are established methods. Radio- and chemotherapy should be reserved for clinical studies. New therapeutic approaches include brachytherapy, the use of modern chemotherapeutics, COX-2- and tyrosine kinase-receptor-inhibitors.
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PMID:[Current diagnostics and therapy for carcinomas of the biliary tree and gallbladder]. 1587 Oct 71

The expanding use of ultrasound in general practice is leading to an ever increasing rate of detection of true hepatic incidentaloma. The correct diagnosis of hepatic incidentaloma may be made in over 90% with non-invasive means. The questionable diagnosis of "symptomatic" incidentaloma should undergo close scrutiny prior to a decision in favour of surgery. With regard to more recent literature, the former "absolute" requirement for surgical resection in all cases of liver cell adenoma may have to be reappraised. Final inability to rule out malignancy represents an unquestionable indication for surgery in the light of low rates of morbidity and lack of mortality in this otherwise healthy patient group. Percutaneous biopsies should not be performed due to oncological hazards, indeterminate results and potential for acute complications.The stage-oriented radical re-resection following diagnosis of an incidentally detected gallbladder cancer may lead to significantly improved long-term survival, especially in the early tumour stages T1b and T2, which represents the most common stage of gallbladder cancer in incidentaloma. Patients at elevated risk for incidental gallbladder cancer should undergo thorough instruction with regard to the potential hazards of laparoscopic cholecystectomy. Multimodal therapeutic strategies directed at advanced stages of incidentally detected gallbladder cancer should be evaluated in prospective multicentre studies.
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PMID:[Incidentalomas of the liver and gallbladder. Evaluation and therapeutic procedure]. 1766 Oct

Curative resection is the only treatment for biliary tract cancer that achieves long-term survival. However, patients with advanced biliary tract cancer have only a limited prognosis even after radical surgical resection. Thus, to improve the longterm results, the early detection of biliary tract cancer and subsequent cure seem to be essential. The purpose of this study was to review the literature concerning the risk factors for cancerous and precancerous lesions of the biliary tract, and prophylactic surgery for these factors. It has been reported that pancreaticobiliary maljunction (PBM) with bile duct dilatation is a risk factor for gallbladder cancer and bile duct cancer, while PBM without bile duct dilatation is a risk factor for gallbladder cancer. Thus, in the former group, a prophylactic excision of the common bile duct and gallbladder should be recommended, while in the later group, a prophylactic cholecystectomy without bile duct resection may be the appropriate surgical procedure. It has also been reported that primary sclerosing cholangitis (PSC) is a risk factor for cholangiocarcinoma. Patients with PSC often develop advanced cholangiocarcinoma with a poor prognosis. In patients with PSC, therefore, strict follow-up should be recommended. Adenoma and dysplasia have been regarded as precancerous lesions of gallbladder cancer. A polypoid lesion of the gallbladder that is sessile, has a diameter greater than 10 mm, and /or grows rapidly, is highly likely to be cancerous and should be resected. Although gallstones seem to be closely associated with gallbladder cancer, there is no evidence of a direct causal relationship between gallstones and gallbladder cancer. Thus, a cholecystectomy is not advised for asymptomatic cholecystolithiasis. Controversy remains as to whether adenomyomatosis of the gallbladder and porcelain gallbladder are associated with gallbladder cancer. With respect to ampullary carcinoma, adenoma of the ampulla is considered to be a precancerous lesion. This article discusses the risk factors for cancerous and precancerous lesions of the biliary tract and prophylactic treatment for these factors.
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PMID:Risk factors for biliary tract and ampullary carcinomas and prophylactic surgery for these factors. 1827 40

The only curative treatment in biliary tract cancer is surgical treatment. Therefore, the suitability of curative resection should be investigated in the first place. In the presence of metastasis to the liver, lung, peritoneum, or distant lymph nodes, curative resection is not suitable. No definite consensus has been reached on local extension factors and curability. Measures of hepatic functional reserve in the jaundiced liver include future liver remnant volume and the indocyanine green (ICG) clearance test. Preoperative portal vein embolization may be considered in patients in whom right hepatectomy or more, or hepatectomy with a resection rate exceeding 50%-60% is planned. Postoperative complications and surgery-related mortality may be reduced with the use of portal vein embolization. Although hepatectomy and/or pancreaticoduodenectomy are preferable for the curative resection of bile duct cancer, extrahepatic bile duct resection alone is also considered in patients for whom it is judged that curative resection would be achieved after a strict diagnosis of its local extension. Also, combined caudate lobe resection is recommended for hilar cholangiocarcinoma. Because the prognosis of patients treated with combined portal vein resection is significantly better than that of unresected patients, combined portal vein resection may be carried out. Prognostic factors after resection for bile duct cancer include positive surgical margins, especially in the ductal stump; lymph node metastasis; perineural invasion; and combined vascular resection due to portal vein and/or hepatic artery invasion. For patients with suspected gallbladder cancer, laparoscopic cholecystectomy is not recommended, and open cholecystectomy should be performed as a rule. When gallbladder cancer invading the subserosal layer or deeper has been detected after simple cholecystectomy, additional resection should be considered. Prognostic factors after resection for gallbladder cancer include the depth of mural invasion; lymph node metastasis; extramural extension, especially into the hepatoduodenal ligament; perineural invasion; and the degree of curability. Pancreaticoduodenectomy is indicated for ampullary carcinoma, and limited operation is also indicated for carcinoma in adenoma. The prognostic factors after resection for ampullary carcinoma include lymph node metastasis, pancreatic invasion, and perineural invasion.
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PMID:Guidelines for the management of biliary tract and ampullary carcinomas: surgical treatment. 1827 43


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