Concordancia de la sobrevida global, evaluando el tejido adiposo intra-abdominal en cancer de vesicula biliar / Concordance of overall survival, evaluating intra-abdominal adipose tissue in gallbladder cancer

El uso del rol predictor del tejido adiposo intra-abdominal puede ser un criterio útil para estimar la concordancia del tiempo de supervivencia, comparándolo al sistema de estadiaje TNM, en cáncer primario de vesícula biliar. Su beneficio es no requerir de métodos invasivos para su evaluación. Se realizó un estudio prospectivo, de cohortes, con un grupo conformado por pacientes con obesidad según el valor del tejido adiposo intra-abdominal, evaluado por tomografía, así como otro grupo sin obesidad. El estudio incluyó 19 pacientes, con seguimiento desde diciembre de 2009 hasta febrero de 2013, divididos en el primer grupo 8 y en el grupo sin obesidad a 11 pacientes. La estadística usada para evaluar su concordancia fue el método Kaplan-Meier y la prueba Logrank (Mantel-Haezel). El tiempo de supervivencia global en el grupo de obesidad fue 13,6 meses y del grupo sin obesidad 11,7 meses. El valor del tejido adiposo intra-abdominal no muestra concordancia para pronosticar sobrevida, comparado a la estadificación de eoplasias TNM(AU)

The use of the predicting roll of intraabdominal fat can be a useful to consider the agreement of the time of survival, being compared it the characters of the system of TNM stage. Its benefit is not to require of invasive methods for its evaluation. A cohorts prospective study was made, with a group conformed by patients to obesity according to the value of the intraabdominal fat, evaluated by tomografía, and another group without obesity. The group I include population of patients from December of the 2009 to February of the 2013, being 19 cases, divided in first group 8 and the group without obesity to 11 patients. The used statistic to evaluate its agreement was the Kaplan-Meier method and the Logrank test (Mantel-Haezel).The overall survival in group I (Obesity) was 13.6 months and of group without obesity was 11.7 months. The value of the intra-abdominal fat does not show agreement to forecast of survivor, compared to neoplasm staging TNM(AU)

Role of C-erbB2 expression in gallbladder cancer.

Background: Gallbladder cancer (GBC) is a lethal malignancy presenting at an advanced stage. The pathogenesis is not well categorized, and surgery is the only treatment available at the early stage of the disease. There have been few reports on role of growth factor receptors in GBC. C-erbB2 is one such receptor whose over-expression is being explored in GBC as one of the factors involved in carcinogenesis and possible target for therapy. Materials and Methods: One hundred and four consecutive cases of GBC were retrospectively studied with regard to clinical features, histological type, grade and stage of tumor. Immunohistochemistry for C-erbB2 was done and expression was correlated with different clinic-pathological parameters and survival. Results: C-erbB2 overexpression was seen in 9.4% cases with complete staining and both complete and incomplete staining (2+ and 3+) was seen in 13.4% cases. Eighty percent of the C-erbB2 over-expressed cases were well differentiated and in stage II to stage IV disease. Dysplasia adjacent to carcinoma did not show any expression. No correlation was found with tumor grade, stage, gall stones, and patient survival. Xanthogranulomatous inflammation was inversely correlated with C-erbB2 over-expression. Median survival was 30 months in C-erbB2 over-expressed cases, and 12 months in C-erbB2 negative cases. Conclusion: We found complete membranous staining of C-erbB2 in 9.4% of GBC which was frequent in well differentiated and stage II to stage IV tumors. C-erbB2 tumors had longer median survival than C-erbB2 negative tumors. C-erbB2 is not involved early in the carcinogenetic process as none of the dysplasia showed expression. C-erbB2 over-expression may be considered as target for therapy in advanced stage of GBC.

Gastroduodenal dysmotility in patients with gallbladder carcinoma: frequency of occurrence and clinical importance.

BACKGROUND: Gastric stasis, common in patients with gall-bladder carcinoma (GBC), results from anatomical obstruction or motor abnormalities. We studied patients with GBC for antroduodenal motor dysfunction using manometry. METHODS: Forty-one patients with GBC without endoscopic gastric outlet obstruction and 10 healthy controls were evaluated using a symptom scoring system for gastric stasis, saline load test and water perfusion antroduodenal manometry. Fasting, post-prandial and post-octreotide motility were recorded and analysed on a computer using GiPC manometry software. RESULTS: Sixteen of 41 patients (39%) with GBC reported recurrent vomiting; patients with vomiting had a higher symptom score (13 [11-17] v. 6 [4-10], p<0.0001] and higher volume of aspirate on the saline load test (460 ml [210-650] v. 160 ml [70-260], p<0.0001) as compared with those without vomiting. Healthy subjects more often had spontaneous fasting migratory motor complex than patients with GBC (9/10 v. 13/41, p=0.002). The amplitudes of contractions in the antrum and duodenum were significantly lower in patients with GBC than in healthy subjects. Patients with GBC had lower fasting (157 [68-284] v. 190.5 [150-284], p=0.01) and post-prandial (200 [96-395] v. 284 [178-395], p<0.0001) antral motor indices than healthy subjects. Patients with GBC and vomiting had significantly lower contraction amplitude and motility indices than those without vomiting. Motility indices correlated inversely with the symptom score and volume of aspirate on the saline load test (Spearman correlation, p = 0.01 for all). CONCLUSION: Antroduodenal motor abnormalities are common in patients with GBC. These may explain the symptoms of gastric stasis and abnormal results of the saline load test in the absence of anatomical obstruction in such patients.

Sonographic and colour doppler morphology in carcinoma gallbladder.

Conventional radiography has limitations in accurate diagnosis of gallbladder cancer (GBC). Ultrasonography (USG) allows correct diagnosis in 70-80% advanced and 23% early GBC. Present study was initiated to identify morphology and flow characteristics in GBC using conventional USG and Colour Doppler USG (CD-USG). In 100 patients, USG assessed morphology of mass lesion/wall thickening together with associated features. Of these, 60 cases were studied using CD-USG for intralesional/perilesional vascularity, peak systolic flow velocity (V max), resistive index (RI) and pulsatility index (PI). USG identified GB with mass lesion in 44% cases (Group-I) and only mass in GB fossa in 56% cases (Group-II). Findings identified calculi (73%), liver infiltration (74%), intrahepatic ductal dilatation (IHDD) (52%), lymphadenopathy (19%) and ascites (5%). CD-USG revealed vascularity, mainly pulsatile flow, in 78.3% cases (in 91.3% Group-I cases). Mean Vmax was 0.3037 m/sec (0.109 - 0.646 m/sec.), mean RI was 0.6621 (0.526 - 1.000) and PI was 1.282 (0.772 -2.140), Mean Vmax and PI were higher in Group-I compared to Group-II. Presence of calculus in 73% cases suggests a high association between calculus and malignancy. As flow signals were seen in 78% of all cases and 91.3% Group-I cases undergoing CD-USG, USG and CD-USG together can improve pickup rate of GBC.

Carcinoma primario de la vesícula biliar / Cancer of the gallbladder

Objetivo. Determinar las características generales del carcinoma primario de la vesícula biliar (CVB), los procedimientos diagnósticos más frecuentes y la forma de manejo contemporánea así como analizar la experiencia en el Instituto Nacional de Cancerología (INCan). Introducción. El CVB es una neoplasia rara, frecuentemente letal ya que la mayoría de los casos se descubren en etapas avanzadas. En años recientes se ha demostrado que cirugías radicales incrementan la sobrevida. Material y métodos. Se realizó una revisión de artículos relevantes sobre características epidemiológicas, estudios de laboratorio y gabinete y formas de manejo de acuerdo a la etapa clínica. Se revisaron los expedientes clínicos de pacientes tratados en el INCan en los últimos 10 años y se analizaron los resultados. Resultados. El CVB es una neoplasia rara, pero es la más frecuente de las originadas en el árbol biliar. Su pronóstico depende de la etapa clínica cuando se diagnostique, neoplasias ubicadas a la pared vesicular (Nevin I-III) tienen mejor pronóstico que las que presentan invasión ganglionar o hepática. La cirugía radical más aceptada es la resección en cuña del lecho vesicular asociada a la linfadenectomía la cual en lesiones tempranas incrementa el periodo libre de enfermedad y la sobrevida. En el INCan se estudiaron 100 pacientes en los últimos 10 años, los que tuvieron neoplasias tempranas Nevin I se encuentran vivos con seguimiento promedio de 33 meses, en lesiones Nevin II de 13, cinco se encuentran vivos o colecistectomía más radioterapia al lecho vesicular, en lesiones Nevin III, cuatro que recibieron RT adyubante se encuentran vivos y todos los Nevin IV-V tuvieron pronóstico malo. Conclusiones. El CVB es altamente letal. El diagnóstico temprano permite ralizar un procedimiento oncológico adecuado lo que ha demostrado incrementar la sobrevida

Rabdomiossarcoma primário da vesícula biliar em paciente adulta. A propósito de um caso / Adult rhabdomiosarcoma of the gallbladder. The purpose of a case

Os autores descrevem um caso de rabdomiossarcoma embrionário primário da vesícula biliar, em uma paciente feminina de 62 anos, que deu entrada no Serviço de Emergência do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro, com quadro clínico de colecistite aguda associada à colelitíase. O diagnóstico operatório foi de câncer da vesícula biliar com metástases hepáticas. Foi realizada laparotomia + colecistostomia + exérese de massa intraluminal na vesícula biliar + retirada de cálculos biliares. A paciente sobreviveu dois meses. Fazem uma revisão da literatura médica.

Adenoma tubulo-papilar y displasia severa de la vesícula biliar / Tubulo-papillary adenoma and severe dysplasia o fthe gall bladder

Se presenta un caso de adenoma túbulo-papilar y displasis severa de la vesícula biliar en una mujer de 65 años de edad con colecistitis litiasica. La lesión adenomatosa túbulo-papilar estaba localizada en el cuello vesicular y midió 15 x 16 mm. Histológicamente las glándulas tubulares del adenoma erab similares a las glándulas pilóricas y mostraron metaplasia intestinal con células columnares, células de Paneth y células endócrinas que contenían serotonina. Las células columnares mostraron cambios displásicos severos. En algunas areoas las atipias nucleares fueron similares a las descritas en carcinoma in situ. La inmunohistoquímica fué negativa para antígeno carcinoembrionario y otras hormonas peptídicas. Se discute la relación entre adenoma y carcinoma de la vesícula biliar.