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1.
Prensa méd. argent ; 107(7): 360-365, 20210000. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1358943

ABSTRACT

El cáncer de vesícula es la neoplasia maligna más frecuente del tracto biliar. Con un mal pronóstico, su enfoque terapéutico muchas veces se centra en el tratamiento paliativo debido a que los pacientes suelen recibir un diagnóstico en estadios avanzados de la neoplasia, en los cuales ya no son candidatos para tratamientos quirúrgicos curativos. Por esta razón se utilizan stents o drenajes vesiculares, a fin de reducir el principal síntoma que se presenta: la ictericia, con sus consecuencias, por obstrucción biliar maligna. Este artículo pretende hacer una revisión de la evidencia recolectada en los últimos 5 años (período 2016 - 2021) acerca de los diferentes abordajes mínimamente invasivos en el tratamiento paliativo del cáncer de vesícula, sus resultados clínicos, y las diferencias entre ellos.


Gallbladder cancer is the most common malignancy neoplasm of the bile ducts. With a poor prognosis, its therapeutic approach is often focused on palliative treatment because patients usually receive a diagnosis in advanced stages of the neoplasm, in which they are no longer candidates for curative surgical treatments. For this reason, stents or gallbladder drains are used in order to reduce the main symptom that occurs: jaundice, with its consequences, due to malignant biliary obstruction. This article aims to review the evidence collected in the last 5 years (period 2016 - 2021) about the different minimally invasive approaches in the palliative treatment of gallbladder cancer, their clinical results, and the differences between them.


Subject(s)
Humans , Palliative Care , Epidemiologic Studies , Stents , Drainage/methods , Cholestasis/therapy , Minimally Invasive Surgical Procedures , Early Detection of Cancer , Gallbladder Neoplasms/therapy
3.
Prensa méd. argent ; 107(5): 272-275, 20210000. fig
Article in Spanish | LILACS, BINACIS | ID: biblio-1359357

ABSTRACT

Objetivos: Presentar una resección quirúrgica R0, con fines curativos de un cáncer de vesícula biliar estadio 1B. Caso Clínico: Femenina de 60 años de edad, sin antecedentes de relevancia, que presenta por estudios complementarios alta sospecha de cáncer de vesícula biliar (T2N0Mx), se realiza laparotomía exploradora con colecistectomía convencional, bisegmentectomía 4 b y 5 del hígado y vaciamiento ganglionar. Sin complicaciones con alta sanatorial al 4 día post operatorio. Conclusión: El diagnostico precoz y una cirugía temprana en el cáncer de vesicula biliar puede ser una herramienta fundamental para poder ofrecer al paciente una cirugía curativa en este tipo de patología


Objects: This paper introduces an R0 surgical resection in the treatment of stage 1B gallbladder cancer. Discussion: 60-year female patient without medical history with highly suspect gallbladder cancer (T2N0Mx), revealed by clinical exams. The patient underwent an exploratory laparotomy, a conventional cholecystectomy, a double segmentectomy for 4b-5 liver, and the lymph node was removed. Complications were not reported, and the patient was discharged four days after surgery. Conclusion: Early diagnosis and early surgery on gallbladder cancer patients may prove essential to cure such pathology


Subject(s)
Humans , Female , Middle Aged , Cholecystectomy , Ultrasonography , Cholecystectomy, Laparoscopic , Gallbladder Neoplasms/surgery , Gallbladder Neoplasms/therapy , Adjuvants, Pharmaceutic
4.
Rev. argent. cir ; 113(1): 121-124, abr. 2021. graf
Article in Spanish | LILACS, BINACIS | ID: biblio-1288182

ABSTRACT

RESUMEN La neoplasia papilar intracolecística con carcinoma mucinoso invasor y células en anillo de sello es una variedad de cáncer de vesícula, una patología agresiva y con mal pronóstico, la cual puede presentarse en forma similar a una colecistitis y, a pesar del tratamiento operatorio y quimioterapia posterior, la supervivencia y pronóstico son peores en relación con los otros cánceres de vesícula. Este artículo tie ne por objetivo describir un tipo histológico muy específico, de baja frecuencia, de cáncer de vesícula y el tratamiento realizado.


ABSTRACT Intracholecystic papillary neoplasm with invasive mucinous adenocarcinoma and signet ring cells is a rare, aggressive variety of gallbladder cancer, with symptoms mimicking cholecystitis. Survival and prognosis are worse that other types of gallbladder cancer despite surgery and chemotherapy. The aim of this article is to describe a case of a rare gallbladder cancer with specific histology and the treatment performed


Subject(s)
Humans , Male , Aged , Gallbladder Neoplasms , Pathology , Survival , Therapeutics , Grief , Cells , Baja , Blister , Drug Therapy , Gallbladder , Histology , Neoplasms
5.
Autops. Case Rep ; 11: e2021338, 2021. tab, graf
Article in English | LILACS | ID: biblio-1345357

ABSTRACT

Mucosal Schwann cell hamartoma (MSCH) is a rare benign neurogenic tumor characterized by pure S100p positive spindle cell proliferation. Most cases occur in the distal colon. Involvement of the gall bladder is exceedingly rare. There have been no reports of recurrence or a syndromic association with MSCH. Herein, we describe a case of MSCH of the gallbladder in a 55-year-old female patient with prior history of gastrointestinal neurofibromas who presented with abdominal pain. MR imaging revealed choledocholithiasis, gallbladder thickening, and marked biliary and pancreatic ductal dilation. The patient subsequently underwent cholecystectomy with choledochoduodenostomy. Histologic evaluation of the gallbladder showed diffuse expansion of the mucosa with S100p positive cells with spindly nuclei and indistinct cytoplasmic borders and diagnosis of MSCH of the gallbladder was rendered.


Subject(s)
Humans , Female , Middle Aged , Schwann Cells/pathology , Gallbladder Neoplasms/pathology , Hamartoma/pathology , Neurofibroma/pathology , Neuroma
7.
Rev. colomb. gastroenterol ; 35(4): 430-435, dic. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1156325

ABSTRACT

Resumen Introducción: la endoscopia es una de las herramientas necesarias para el manejo de las enfermedades biliares y pancreáticas. La colangiopancreatografía retrógrada endoscópica (CPRE) es uno de los procedimientos técnicamente más demandantes y de mayor riesgo de complicaciones realizados en el tratamiento de los desórdenes hepatopancreatobiliares. Objetivo: caracterizar los resultados clínicos de los pacientes llevados a CPRE en un centro de pacientes con cáncer exclusivamente. Métodos: estudio de serie de casos observacional, retrospectivo, descriptivo con base en datos clínicos de pacientes llevados a CPRE en una población diagnosticada con cáncer de distintos orígenes primarios y en diferentes estadios de enfermedad desde enero de 2010 hasta enero de 2017. Resultados: se analizaron 255 procedimientos en los que predominó el sexo femenino con 140 casos (54,9 %), el promedio de edad fue 62,9 años (desviación estándar [DE]: 12,9 años). Todos los procedimientos se hicieron con intención terapéutica. La indicación más frecuente fue cáncer de páncreas (n = 47; 18,43 %), compresión extrínseca de la vía biliar (n = 42; 16,47 %), disfunción de prótesis (n = 36; 14,12%), colecistocoledocolitiasis (n = 32; 12,55 %), otras causas (n = 32; 12,55 %), cáncer de vesícula (n = 24; 9,41 %), colangiocarcinoma extrahepático (n = 21; 8,24 %), coledocolitiasis recidivante (n = 9; 3,53%), coledocolitiasis residual (n = 6; 2,35 %) y tumor de Klatskin (n = 6; 2,35 %). La canalización exitosa se presentó en 222 casos (87,06 %). Durante el procedimiento, 10 pacientes presentaron complicaciones (4,3 %), de las cuales la pancreatitis y las perforaciones fueron las más frecuentes (n = 3; 1,18 %), seguidas por sangrado, colangitis (n = 2; 0,78 %) y dolor post-CPRE 1 (0,39 %). Conclusiones: en la población evaluada, la causa predominante para realizar el procedimiento está relacionada con cáncer y la frecuencia tanto de canalización exitosa como de complicaciones es similar a la de los reportes en las poblaciones generales.


Abstract Introduction: Endoscopy is one of the tools necessary to treat biliary and pancreatic diseases. Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most technically demanding procedures with the highest risk of complications when treating hepato-pancreato-biliary disorders. Objective: To characterize the clinical outcomes of ERCP patients in a cancer patient center. Methodology: Observational, retrospective, descriptive case series study based on clinical data of patients brought to ERCP in a population diagnosed with cancer of different primary origins and in different stages of the disease from January 2010 to January 2017. Results: A total of 255 procedures were analyzed. The female sex was predominant with 140 cases (54.9%), and the average age was 62.9 years (SD 12.9 years). All procedures were done with therapeutic intent. The most frequent indication was pancreatic cancer (N=47; 18.43%), extrinsic compression of the common bile duct (N=42; 16.47%), biliary prosthesis dysfunction (N=36; 14.12%), cholecystocholedocholithiasis (N=32; 12. 55%), other causes (N=32; 12.55%), gallbladder cancer (N=24; 9.41%), extrahepatic cholangiocarcinoma (N=21; 8.24%), recurrent choledocholithiasis (N=9; 3.53%), residual choledocholithiasis (N=6; 2.35%), and Klatskin tumor (N=6; 2.35%). Successful cannulation was reported in 222 cases (87.06%). During the procedure, 10 patients presented complications (4.3%), with pancreatitis and perforations being the most frequent (N=3; 1.18%), followed by bleeding, cholangitis (N=2; 0.78%), and post-ERCP pain (N=1; 0.39%). Conclusions: In the population studied, the principal reasons for performing the procedure were related to cancer. The frequency of successful cannulation and complications reported here are similar to other results in the general population.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Cholangiopancreatography, Endoscopic Retrograde , Neoplasms , Pancreatic Neoplasms , Gallbladder Neoplasms
8.
Rev. cir. (Impr.) ; 72(4): 287-292, ago. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138713

ABSTRACT

Resumen Introducción: En algunas áreas el cáncer de la vesícula biliar se detecta en hasta el 3,5% de los pacientes intervenidos por colelitiasis. Con el objetivo de evaluar el rol de la ruptura de la vesícula y la consiguiente contaminación por bilis, se evaluó una serie de pacientes portadores de cáncer de vesícula diagnosticado posterior a la colecistectomía. Materiales y Método: El estudio se efectuó en 109 pacientes en quienes se diagnosticó un cáncer de vesícula posterior a la colecistectomía. El grupo a estudiar se dividió de acuerdo a la ocurrencia o no de contaminación por bilis al momento de la colecistectomía, como también de acuerdo a la magnitud de ésta. Resultados: De los pacientes estudiados, en 32 se documentó la ocurrencia de contaminación por bilis al momento de la colecistectomía. De estos, en 13 la contaminación fue considerada mayor. El tiempo promedio de seguimiento fue de 33 meses, 35 pacientes (32,1%) fallecieron durante el seguimiento. La sobrevida media de la totalidad de la serie que tuvo contaminación por bilis no se diferenció de los pacientes sin contaminación. Sin embargo, el grupo que tuvo una contaminación catalogada como mayor, presentó una sobrevida estadísticamente inferior al resto de los pacientes. Finalmente, se realizó un análisis mediante el modelo de regresión de COX que incluyó edad, género, nivel de invasión y tipo de contaminación, resultando la existencia de contaminación mayor por bilis un factor independientemente asociado al pronóstico. Conclusión: La presencia de ruptura vesicular y contaminación mayor por bilis debiera considerarse un factor pronóstico.


Background: Incidental gallbladder cancer is observed in up to 3.5% of patients undergoing laparoscopic cholecystectomy. To study the role of wall perforation on the prognosis, we evaluated a series of patients in whom perforation occurred during the cholecystectomy. Materials and Method: 109 patients who underwent a laparoscopic cholecystectomy in whom final diagnosis was gallbladder cancer were the focus of the study. We divided the patients according the occurrence of spillage. Furthermore, patients with spillage were divided into two categories according the spillage magnitude. Results: Of the patients, spillage was documented in 32 (29.3%). In 13 patients spillage was considered major. The median follow-up of patients was 36 months, while 35 (32.1%) patients died during the follow-up. Five-year survival of all patients with spillage was not statistically different from the group without spillage. However, the group with major spillage had a statistically worse survival than the rest. A Cox regression analysis including age, gender, level of invasion and spillage category showed that major spillage was independently associated with a worse prognosis.


Subject(s)
Humans , Male , Female , Middle Aged , Surgical Wound Infection/microbiology , Bile/microbiology , Cholecystectomy, Laparoscopic/adverse effects , Gallbladder Neoplasms/mortality , Surgical Wound Infection/mortality , Cholecystectomy/mortality , Survival Rate , Retrospective Studies , Aftercare
9.
Gac. méd. boliv ; 43(1): 23-27, ago. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1124815

ABSTRACT

El cáncer de vesícula biliar es una enfermedad poco frecuente en el mundo y altamente letal. Objetivo: caracterizar histopatológicamente el cáncer de vesícula biliar en el Hospital Clínico Quirúrgico Docente "Joaquín Albarrán" de La Habana-Cuba, en el periodo 2010 al 2019. Método: se realizó un estudio retrospectivo, descriptivo y observacional, en el cual se revisaron los registros de biopsias y necropsias para identificar los casos con diagnóstico histológico de cáncer de vesícula biliar, se revisaron además tejidos fijados en parafina del archivo. Resultados: fueron diagnosticados 10 casos de cáncer de vesícula, 9 femenino y 1 masculino, todos mayores de 60 años. Histológicamente la variedad predominante fue el adenocarcinoma moderadamente diferenciado, siendo 2 de ellos mucoproductores, de los cuales 1 infiltrante y con permeación linfática. Conclusión: el cáncer de vesícula biliar es una enfermedad con muy baja frecuencia y su diagnóstico, continua siendo un hecho incidental, es decir, que el diagnóstico se establece en el examen histopatológico luego de la colecistectomía o en la necropsia. La variedad más frecuente es el adenocarcinoma moderadamente diferenciado.


Gallbladder cancer is a rare and highly lethal disease in the world. Objective: To characterize histopathologically gallbladder cancer at the "Joaquín Albarrán" Clinical Teaching Surgical Hospital of Havana-Cuba, in the period 2010 to 2019. Methods: A retrospective, descriptive and observational study was conducted, in which biopsy and necropsy records were reviewed to identify cases with a histological diagnosis of gallbladder cancer. Paraffin-embedded tissues from the archive were also reviewed. Results: Ten cases of gallbladder cancer were diagnosed, nine female and one male, all over 60 years old. Histologically the predominant variety was moderately differentiated adenocarcinoma, being 2 of them mucoproducers, of which 1 was infiltrating and with lymphatic permeation. Conclusion: Gallbladder cancer is a very low frequency disease and its diagnosis continues to be an incidental fact, that is, the diagnosis is established in the histopathological examination after cholecystectomy or in the necropsy. The most frequent variety is moderately differentiated adenocarcinoma.


Subject(s)
Gallbladder Neoplasms
10.
Arq. bras. med. vet. zootec. (Online) ; 72(3): 1063-1066, May-June, 2020. ilus
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1129774

ABSTRACT

Carcinoid is a neoplasia that arises from dispersed cells of the neuroendocrine system. This tumor is uncommon in animals, and its occurrence in the gallbladder is rare. A male Basset Hound dog's corpse was taken to the Univerdade Federal de Minas Gerais to be analyzed by the Veterinary Pathology sector, without a description of its previous history. Necropsy revealed the presence of pale oral, ocular and penile mucous membranes. The gallbladder had a thickened wall and a dilated lumen, which was filled with dark and lumpy bile. Its mucosa had a whitish-red nodule, with solid and friable areas. Microscopically, there was a focal neoplastic proliferation, which wasn't encapsulated and had imprecise limits, which cells were distributed in a solid pattern and separated by a delicate fibrovascular stroma. The neoplastic cells presented oval or round shaped nucleus, which had a chromatin predominantly loose, and one or two nucleoli. Their cytoplasm was moderately abundant, and in most of the cells it was eosinophilic, granular, and had well-defined limits. Using the Grimelius coloration, neoplastic cells' cytoplasmic granules stained brownish or black, confirming the neuroendocrine origin of the neoplasia. Based on the macroscopic and microscopic findings, the diagnosis of a gallbladder carcinoid was established.(AU)


Subject(s)
Animals , Male , Dogs , Carcinoid Tumor/veterinary , Carcinoma, Neuroendocrine/veterinary , Gallbladder/pathology , Gallbladder Neoplasms/veterinary
11.
Rev. cir. (Impr.) ; 72(3): 262-266, jun. 2020. ilus
Article in Spanish | LILACS | ID: biblio-1115553

ABSTRACT

Resumen El cáncer de vesícula es infrecuente a nivel mundial, a diferencia de su alta incidencia en Chile. Su pronóstico es malo en general, y dependerá de su forma de presentación, siendo mejor en los casos diagnosticados después de una colecistectomía laparoscópica por patología benigna. La reintervención, que incluye la resección hepática y linfadenectomía, es el pilar de la terapia curativa en esta neoplasia. Presentamos la descripción de la técnica quirúrgica realizada en los pacientes con cáncer de vesícula de diagnóstico incidental, en el Servicio de Cirugía de Clínica Alemana de Santiago y en el Hospital de la Fuerza Aérea de Chile. El abordaje laparoscópico representa una alternativa quirúrgica válida en el tratamiento de pacientes con cáncer de vesícula biliar diagnosticados después de la colecistectomía. La estandarización de la técnica debiera contribuir a su mayor empleo y a la obtención de buenos resultados desde un punto de vista oncológico.


Gallbladder cancer is considered an infrequent disease but in Chile has a higher incidence. Prognostic is considered dismal except in those patients in whom the diagnosis is performed after the cholecystectomy specimen study. Reoperation with gallbladder bed resection and lymphadenectomy is considered the treatment in patients with incidental cases. We show the way this operation is performed in Clinica Alemana of Santiago and in the Air Force Hospital. The laparoscopic approach is an alternative to those patients in whom the diagnosis was done after the cholecystectomy. Laparoscopy allows to accomplish same objectives and to obtain identical results that the open approach. The technical standardization should contribute to spread its employment and to improve the results.


Subject(s)
Humans , Biliary Tract Surgical Procedures/methods , Gallbladder/surgery , Gallbladder Neoplasms/surgery , Lymph Node Excision/methods , Biliary Tract Surgical Procedures/adverse effects , Laparoscopy , Disease Management , Incidental Findings , Lymph Node Excision/standards
12.
Arch. argent. pediatr ; 118(1): e43-e47, 2020-02-00. ilus, tab
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1095864

ABSTRACT

La adenomiomatosis vesicular es una enfermedad degenerativa adquirida que se caracteriza por proliferación epitelial con hipertrofia de la capa muscular y formación de trayectos fistulosos, conocidos como senos de Rokitansky-Aschoff. La adenomiomatosis se diagnostica principalmente mediante ecografía. No se conocen cabalmente la patogenia, la patología ni las indicaciones para cirugía de esta afección. Es sumamente rara en niños. En este artículo, presentamos el caso de un varón de 17 años con adenomiomatosis vesicular tratado adecuadamente con una colecistectomía laparoscópica


Adenomyomatosis of the gallbladder is an acquired, degenerative disease characterized by epithelial proliferation with hypertrophy of the muscularis layer with forming of sinus tracts, termed Rokitansky-Aschoff sinuses. Adenomyomatosis is diagnosed mainly by ultrasonography. The pathogenesis, pathology, and indications for surgery in this condition are not well understood. It is an extremely rare condition in children. We present a case of a 17-year boy with adenomyomatosis of the gallbladder successfully managed with laparoscopic cholecystectomy,


Subject(s)
Humans , Male , Adolescent , Adenomyoma , Cholecystectomy, Laparoscopic , Gallbladder Diseases , Gallbladder Neoplasms
14.
Biol. Res ; 53: 13, 2020. tab, graf
Article in English | LILACS | ID: biblio-1100919

ABSTRACT

BACKGROUND: Gallbladder cancer (GBC) is the most common tumor of the biliary tract. The incidence of GBC shows a large geographic variability, being particularly frequent in Native American populations. In Chile, GBC represents the second cause of cancer-related death among women. We describe here the establishment of three novel cell lines derived from the ascitic fluid of a Chilean GBC patient, who presented 46% European, 36% Mapuche, 12% Aymara and 6% African ancestry. RESULTS: After immunocytochemical staining of the primary cell culture, we isolated and comprehensively characterized three independent clones (PUC-GBC1, PUC-GBC2 and PUC-GBC3) by short tandem repeat DNA profiling and RNA sequencing as well as karyotype, doubling time, chemosensitivity, in vitro migration capability and in vivo tumorigenicity assay. Primary culture cells showed high expression of CK7, CK19, CA 19-9, MUC1 and MUC16, and negative expression of mesothelial markers. The three isolated clones displayed an epithelial phenotype and an abnormal structure and number of chromosomes. RNA sequencing confirmed the increased expression of cytokeratin and mucin genes, and also of TP53 and ERBB2 with some differences among the three cells lines, and revealed a novel exonic mutation in NF1. The PUC-GBC3 clone was the most aggressive according to histopathological features and the tumorigenic capacity in NSG mice. CONCLUSIONS: The first cell lines established from a Chilean GBC patient represent a new model for studying GBC in patients of Native American descent.


Subject(s)
Humans , Animals , Male , Middle Aged , Antigens, Tumor-Associated, Carbohydrate/genetics , Indians, South American/genetics , Gallbladder Neoplasms/genetics , Ascitic Fluid/metabolism , Tumor Cells, Cultured , Carcinogenicity Tests , Chile , DNA Fingerprinting , Tumor Suppressor Protein p53/genetics , Cisplatin/pharmacology , Mice, Inbred NOD , Clone Cells/drug effects , Clone Cells/metabolism , Sequence Analysis, RNA , Receptor, ErbB-2/genetics , Genes, erbB-2/genetics , Gene Expression Profiling , Cell Line, Tumor/drug effects , Cell Line, Tumor/metabolism , Deoxycytidine/analogs & derivatives , Deoxycytidine/pharmacology , Epithelial Cells/metabolism , Keratin-19/genetics , Keratin-7/genetics , Carcinogenesis/genetics , Gallbladder Neoplasms/metabolism , Antineoplastic Agents/pharmacology
15.
ABCD arq. bras. cir. dig ; 33(1): e1496, 2020.
Article in English | LILACS | ID: biblio-1130518

ABSTRACT

ABSTRACT Background: Incidental gallbladder cancer is defined as a cancer discovered by histological examination after cholecystectomy. It is a potentially curable disease. However, some questions related to their management remain controversial and a defined strategy is associated with better prognosis. Aim: To develop the first evidence-based consensus for management of patients with incidental gallbladder cancer in Brazil. Methods: Sixteen questions were selected, and 36 Brazilian and International members were included to the answer them. The statements were based on current evident literature. The final report was sent to the members of the panel for agreement assessment. Results: Intraoperative evaluation of the specimen, use of retrieval bags and routine histopathology is recommended. Complete preoperative evaluation is necessary and the reoperation should be performed once final staging is available. Evaluation of the cystic duct margin and routine 16b1 lymph node biopsy is recommended. Chemotherapy should be considered and chemoradiation therapy if microscopically positive surgical margins. Port site should be resected exceptionally. Staging laparoscopy before reoperation is recommended, but minimally invasive radical approach only in specialized minimally invasive hepatopancreatobiliary centers. The extent of liver resection is acceptable if R0 resection is achieved. Standard lymph node dissection is required for T2 tumors and above, but common bile duct resection is not recommended routinely. Conclusions: It was possible to prepare safe recommendations as guidance for incidental gallbladder carcinoma, addressing the most frequent topics of everyday work of digestive and general surgeons.


RESUMO Racional: Carcinoma incidental da vesícula biliar é definido como uma neoplasia descoberta por exame histológico após colecistectomia videolaparoscópica. É potencialmente uma doença curável. Entretanto algumas questões relacionadas ao seu manuseio permanecem controversas e uma estratégia definida está associada com melhor prognóstico. Objetivo: Desenvolver o primeiro consenso baseado em evidências para o manuseio de pacientes com carcinoma incidental da vesícula biliar no Brasil. Métodos: Dezesseis questões foram selecionadas e para responder as questões e 36 membros das sociedades brasileiras e internacionais foram incluídos. As recomendações foram baseadas em evidências da literatura atual. Um relatório final foi enviado para os membros do painel para avaliação de concordância. Resultados: Avaliação intraoperatória da peça cirúrgica, uso de bolsas para retirar a peça cirúrgica e exame histopatológico de rotina, foram recomendados. Avaliação pré-operatória completa é necessária e deve ser realizada assim que o estadiamento final esteja disponível. Avaliação da margem do ducto cístico e biópsia de rotina do linfonodo 16b1 são recomendadas. Quimioterapia deve ser considerada e quimioradioterapia indicada se a margem cirúrgica microscópica seja positiva. Os portais devem ser ressecados excepcionalmente. O estadiamento laparoscópico antes da operação é recomendado, mas o tratamento radical por abordagem minimamente invasiva deve ser realizado apenas em centros especializados em cirurgia hepatopancreatobiliar minimamente invasiva. A extensão da ressecção hepática é aceitável até que seja alcançada a ressecção R0. A linfadenectomia padrão é indicada para tumores iguais ou superiores a T2, mas a ressecção da via biliar não é recomendada de rotina. Conclusões: Recomendações seguras foram preparadas para carcinoma incidental da vesícula biliar, destacando os mais frequentes tópicos do trabalho diário do cirurgião do aparelho digestivo e hepatopancreatobiliar.


Subject(s)
Humans , Female , Gallbladder Neoplasms , Brazil , Carcinoma , Retrospective Studies , Incidental Findings , Consensus , Positron Emission Tomography Computed Tomography , Lymph Node Excision , Neoplasm Staging
16.
Rev. méd. Chile ; 147(7): 860-869, jul. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1058615

ABSTRACT

Background: Gallbladder cancer is a relevant public health problem in Chile. Aim: To analyze the mortality trend due to gallbladder cancer and hospital discharges due to biliary disease between 2002 and 2014. To analyze the effect on these parameters of the new health system called explicit guaranties in health whose acronym in Spanish is GES. Material and Methods: Mortality and hospital discharge databases available at the website of the Ministry of Health were analyzed. Changes in crude and adjusted rates were evaluated, analyzing data by geographical regions, sex and age. The standardization was carried out using the direct method and using as reference the Chilean population in 2002. The trends were evaluated through the Poisson regression method. Results: There is a 4.5% trend towards a decreasing mortality at a national level, as compared with the figures before GES came into force. Mortality among people aged 35 to 49 decreased by 4% before GES, and by 8% after GES. The trend of hospital discharges varied from −1% before GES, to a 2% increase after GES. Discharges among people aged 35-49 years increased from 0.1% to 2.9%. Conclusions: The discharge rate increase after GES, does not yet show a break in the reduction of mortality at the national level, although it does benefit the group of 35 to 49 years.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Patient Discharge/statistics & numerical data , Gallbladder Neoplasms/mortality , Cholecystectomy , Chile/epidemiology , Regression Analysis , Retrospective Studies , Gallbladder Neoplasms/surgery
17.
Rev. argent. cir ; 111(2): 90-94, jun. 2019.
Article in English, Spanish | LILACS | ID: biblio-1013350

ABSTRACT

Antecedentes: El cáncer de vesícula biliar se caracteriza por ser un tumor de mal pronóstico y diagnóstico tardío. Objetivo: Describir variables epidemiológicas del cáncer de vesícula en nuestro centro y compararlos con la bibliografía internacional. Material y métodos: En pacientes sometidos a colecistectomía entre el 1º de enero de 2006 y el 31 de diciembre de 2015, se estudiaron las siguientes variables: sexo, edad, relación mujer/varón, causa de colecistectomía, clasificación en urgencias y programadas; en los casos de cáncer de vesícula: sexo, edad, histopatología, diferenciación celular, invasión (de pared vesicular, angiolinfática, del ganglio cístico, tejidos vecinos y del hígado), estadificación (clasificaciones de Nevin y de Unión Internacional Contra el Cáncer-UICC). Resultados: Se diagnosticaron 92 neoplasias vesiculares (1,26% de todas las colecistectomías). El promedio de edad para cáncer de vesícula fue 57,9 años (rango 22-88); sexo femenino 64 (69,5%, con relación mujer/varón 2:1. La histopatología mostró 86 (93,4%) adenocarcinomas, 4 (4,4%) carcinomas escamosos y 2 (2,2%) indiferenciados con elementos de origen mesenquimático y epitelial de vesícula. Las lesiones asociadas fueron adenocarcinoma con metaplasia escamosa, 2 casos; mucosecretante, 2 casos; papilar, 1 caso; metaplasia intestinal y antral, 1 caso. En 60 (65,4%) casos fueron moderadamente diferenciados; bien diferenciados, 12 (13%); pobremente diferenciados, 11 (11,9%) e indiferenciados, 4 (4,3%). En 5 casos (5,4%), no se especificaba la diferenciación celular. Conclusión: El cáncer de vesícula diagnosticado luego de una colecistectomía es más frecuente en mujeres, con tipo histológico adenocarcinoma, llamando la atención la cantidad de pacientes jóvenes diagnosticados.


Background: Gallbladder cancer is characterized by poor prognosis and late diagnosis. Objective: The aim of our study is to describe the epidemiological variables of gallbladder cancer at our centre and to compare them with data from the worldwide literature. Material and methods: Patients undergoing cholecystectomy between January 1, 2006, and December 31, 2015. The following variables were analyzed: sex, age, male to female ratio, reason for cholecystectomy, urgent or scheduled. In case of gallbladder cancer, sex, age, histopathology, cell differentiation, gallbladder layer invasion, lymphovascular, cystic lymph node, adjacent tissues and liver invasion; and cancer staging according to Nevin staging system and the Union for International Cancer Control (UICC). Results: Ninety-two gallbladder neoplasms were found, representing 1.26% of all cholecystectomies. Mean age of patients with gallbladder cancer was 57.9 years (range, 22-88 years) of whom 69.5% (n=64) were women, with the same female to men ratio of 2:1 described for cholecystectomy. The histopathology of the 92 gallbladder cancers corresponded to adenocarcinoma, 93.4% (n= 86); squamous cell carcinoma, 4.4% (n= 4); and undifferentiated malignancy with elements of epithelial and mesenchymal origin, 2.2% (n= 2). There were two cases of adenocarcinoma with squamous metaplasia, two mucinous carcinomas, one papillary adenocarcinoma and one case of antral-type and intestinal metaplasia. Sixty tumors (65.4%) were moderately differentiated; 12 (13%) well differentiated; 11 (11.9%) poorly differentiated; and 4 (4.3%) were undifferentiated. In 5 cases (5.4%) the type of differentiation was not described. Conclusion: In gallbladder cancer diagnosed after a cholecystectomy, it is more frequent in the female sex, with adenocarcinoma being the most common histological type. Interestingly, the number of young patients with gallbladder cancer is noteworthy.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Young Adult , Cholecystectomy/methods , Adenocarcinoma/epidemiology , Gallbladder Neoplasms/epidemiology , Argentina/epidemiology , Epidemiologic Factors , Epidemiology, Descriptive , Retrospective Studies , Gallbladder Neoplasms/diagnosis , Gallbladder Neoplasms/pathology , Neoplasm Staging
18.
Gut and Liver ; : 104-113, 2019.
Article in English | WPRIM | ID: wpr-719361

ABSTRACT

BACKGROUND/AIMS: There have been no nationwide studies to investigate the trends in incidence and 5-year survival rates of intra- and extrahepatic bile duct cancers and gall-bladder cancer. Therefore, our study aimed to describe the incidence and 5-year survival rates of biliary tract cancers by subsites in South Korea. METHODS: A total of 86,134 patients with biliary tract cancers were selected from the National Health Information Database. Age-standardized incidence rates and annual percentage changes were calculated. Life-table methods and log-rank tests were used to determine the differences in survival rates. Cox-proportional hazard models were used to estimate the hazard ratio of the patients with biliary tract cancers. RESULTS: The incidence rate of intra-hepatic bile duct cancer decreased by 1.3% annually from 8.8 per 100,000 in 2006 to 7.8 per 100,000 in 2015. Extrahepatic bile duct cancer also showed a decreasing trend by 2.2% per year from 8.7 per 100,000 in 2006 to 6.7 per 100,000 in 2015. Gallbladder cancer showed the greatest decline, with an annual percentage change of 2.8% from 6.3 per 100,000 to 5.2 per 100,000 during the same period. The 5-year survival rates were 30.0% in gallbladder cancer, 27.8% in extrahepatic bile duct cancer, and 15.9% in intra-hepatic bile duct cancer. CONCLUSIONS: The overall incidence rates of intrahepatic and extrahepatic bile duct cancer and gallbladder cancer decreased from 2006 to 2015. Among biliary tract cancers, intrahepatic bile duct cancers exhibited the highest incidence rate and the worst survival rate.


Subject(s)
Bile Duct Neoplasms , Bile Ducts, Extrahepatic , Bile Ducts, Intrahepatic , Biliary Tract Neoplasms , Biliary Tract , Cholangiocarcinoma , Gallbladder Neoplasms , Humans , Incidence , Korea , Proportional Hazards Models , Survival Rate
19.
Yonsei Medical Journal ; : 223-229, 2019.
Article in English | WPRIM | ID: wpr-742515

ABSTRACT

PURPOSE: To investigate the overall cancer risk and risk for specific cancers in rheumatoid arthritis (RA) patients in Korea by comparing cancer incidence between RA patients and the general population. MATERIALS AND METHODS: Individuals diagnosed with RA between 1996 and 2009 who underwent treatment at the Daegu Catholic University Medical Center were retrospectively examined. 1885 patients with RA were included in the analyses. Occurrence of cancer and death during follow up was ascertained by linking medical records to the Korean Central Cancer Registry and national death certificates. For comparing cancer incidence between RA patients and general population, standardized incidence ratios (SIR) were calculated. The 95% confidence intervals (CIs) of SIRs were calculated using the shortcut method introduced by Vandenbroucke. RESULTS: The total follow-up time was 10218.9 person-years. During follow up, 100 patients (31 men and 69 women) were diagnosed with cancer. Both men and women had greater risks of having malignancy, although cancer risk was greater in men. Men showed increased risks of lung cancer (SIR=5.46, 95% CI: 2.60–9.36) and leukemia (SIR=16.7, 95% CI: 1.58–47.9). Women showed increased risks of thyroid cancer (SIR=1.75, 95% CI: 1.02–2.68), cervical cancer (SIR=3.65, 95% CI: 1.65–6.42), non-Hodgkin's lymphoma (SIR=6.47, 95% CI: 2.04–13.4), and gallbladder cancer (SIR=3.87, 95% CI: 1.01–8.60). Disease-modifying anti-rheumatic drugs usage and cancer were not related: the relative risks of developing malignancy were not elevated for each medicine. CONCLUSION: The overall cancer incidence was increased in Korean men and women with RA. Increased risk of specific malignancy differed according to sex.


Subject(s)
Academic Medical Centers , Antirheumatic Agents , Arthritis, Rheumatoid , Death Certificates , Female , Follow-Up Studies , Gallbladder Neoplasms , Humans , Incidence , Korea , Leukemia , Lung Neoplasms , Lymphoma, Non-Hodgkin , Male , Medical Records , Methods , Retrospective Studies , Thyroid Neoplasms , Uterine Cervical Neoplasms
20.
Clinical Endoscopy ; : 168-174, 2019.
Article in English | WPRIM | ID: wpr-763412

ABSTRACT

BACKGROUND/AIMS: Pathological diagnosis of biliary strictures with atypical or suspicious cells on endoscopic retrograde brush cytology and indeterminate strictures on imaging is challenging. The aim of this study was to identify markers for malignant strictures in such cases. METHODS: We retrospectively analyzed data collected from 146 consecutive patients with indeterminate biliary strictures on imaging who underwent endoscopic retrograde brush cytology from 2007 to 2013. Factors associated with malignant strictures in patients with atypical or suspicious cells on brush cytology were identified. RESULTS: Among the 67 patients with a malignant disease (48 cholangiocarcinoma, 6 gallbladder cancer, 5 pancreatic cancer, 5 ampulla of Vater cancer, and 3 other types), 36 (53.7%) had atypical or suspicious cells on brush cytology. Among these, the factors that independently correlated with malignant strictures were stricture length (odds ratio [OR], 5.259; 95% confidence interval [CI], 1.802– 15.294) and elevated carbohydrate antigen 19-9 (CA19-9) (OR, 3.492; 95% CI, 1.242–9.815), carcinoembryonic antigen (CEA) (OR, 4.909; 95% CI, 1.694–14.224), alkaline phosphatase (ALP) (OR, 3.362; 95% CI, 1.207–9.361), and gamma-glutamyl transpeptidase (rGT) (OR, 4.318; 95% CI, 1.512–12.262). CONCLUSIONS: Elevated levels of CA19-9, CEA, ALP, and rGT and stricture length are associated with malignant strictures in patients with indeterminate biliary strictures on imaging and atypical or suspicious cells on brush cytology.


Subject(s)
Alkaline Phosphatase , Ampulla of Vater , Carcinoembryonic Antigen , Cholangiocarcinoma , Constriction, Pathologic , Diagnosis , Gallbladder Neoplasms , gamma-Glutamyltransferase , Humans , Pancreatic Neoplasms , Retrospective Studies
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