ERCC1 Can Be a Prognostic Factor in Hilar Cholangiocarcinoma and Extrahepatic Bile Duct Cancer, But Not in Intrahepatic Cholangiocarcinoma / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: There are three types of bile duct cancer, intrahepatic cholangiocarcinoma (ICC), hilar cholangiocarcinoma (HC), and extrahepatic cholangiocarcinoma (EHC). Despite different clinical presentation, the same protocol has been used in treatment of patients with these cancers. We analyzed clinicopathologic findings and protein expression in order to investigate the difference and the specific prognostic factors among these three types of cancers. MATERIALS AND METHODS: We conducted a retrospective review of 104 patients diagnosed with bile duct cancer at Seoul St. Mary's Hospital between January 1994 and May 2004. We performed immunohistochemical staining for p53, cyclin D1, thymidine phosphorylase, survivin, and excision repair cross-complementing group 1 (ERCC1). RESULTS: Of the 104 patients, EHC was most common (44.2%). In pathologic findings, perineural invasion was significantly less common in ICC. Overall survival was similar among the three types of cancer. Lymph node invasion, lymphatic, and venous invasion showed a significant association with survival outcome in ICC, however, the differentiation of histologic grade had prognostic significance in HC and EHC. No difference in protein expression was observed among these types of cancer, however, ERCC1 showed a significant association with survival outcome in HC and EHC, not in ICC. CONCLUSION: Based on our data, ICC showed different characteristics and prognostic factors, separate from the other two types of bile duct cancer. Conduct of further studies with a large sample size is required in order to confirm these data.

Three Cases of Gastritis Cystica Polyposa Following Partial Gastric Resection

Gastritis cystica polyposa was diagnosed in three patients with ages of 49, 56 and 66 years. All patients had been operated on for gastric cancer 1 to 5 years earlier, with Billroth II gastroenteric anastomose being made at that time. The lesions were diagnosed by regular follow-up endoscopic examination without any presenting symptoms. Macroscopically, all lesions were located on the gastric side of the anastomosis, with polypoid growth of 1.5x1.0, 2.0x1.5, and 0.5x0.5 cm in size respectively. The surfaces of the lesions were coarsely nodular and brittle, and one of them protruded into the anastomosis lumen. Histologic examination revealed polypoid mucosal changes associated with functionally active, hyperplastic and cystic dilatation of the glands which had infiltrated to into the underlying submucosa. An endoscopic polypectomy was performed in two patients, and all has gone well, without evidence of a recurrent tumor 6 & 18 months after polypectomy. The other patients refused a polypectomy. Gastritis cystica polyposa should be differentiated from a stump carcinoma to avoid a further unnecessary surgical intervention. Awareness of the entity will lead to better diagnosis of gastritis cystica polyposa.