Detección de micrometástasis en médula ósea de pacientes con cáncer de vesícula biliar / Detection of bone marrow micrometastases in patients with gallbladder cancer

Background: There is a very strong documented correlation between the appearance of cancer cells in blood and occurrence of metastasis in gastrointestinal cancer. Aim: To determine MUC1, CK19, CK20 and CEA mRNA expression in bone marrow of patients with gallbladder cancer and evaluate its clinical significance. Material and methods: Sixty eight samples were analyzed, 38 bone marrow samples of gallbladder cancer patients, 20 healthy donors, and 10 frozen samples of gallbladder cancer. Nested reverse transcriptase-polymerase chain reaction (nested RT-PCR) was used to analyze mRNA expression. Results: All frozen tumors were positive for CEA, CK19, and MUC1 mRNA and 70 percent were positive for CK20. Seventeen of 20 donor samples were positive for MUC1 and only one sample from donors was positive for both CK20 and CK19 mRNA. Among the 38 blood and bone marrow samples of gallbladder cancer patients, the expression of MUC1, CK19, CK20, and CEA, mRNA was 60.5 percent (23/38), 31.6 percent (12/38), 7.9 percent (3/38), and 7.9 percent (3/38), respectively. Disregarding the MUC1 results. 37 percent (14/38), 13 percent (5/38) and 5 percent (2/38) were positive for one, two and three markers respectively. Not significant differences were found in survival with a follow up to 12 months. Conclusion: Our results indicate that the molecular detection of tumor cells in bone marrow in patients with gallbladder carcinoma is technically possible, being CEA, CK19 and CK20 gene expression the best markers. The MUC1 gene expression marker was highly unspecific and it should not been considered. The detection of bone marrow micrometastasis might be helpful in prognosis and the selection of clinical treatment but a larger series with a longer follow-up should be studied.

Contenido de ADN y sobrevida en el carcinoma subseroso de la vesícula biliar / DNA content and survival in subserous gallbladder carcinoma

Background: The clinical and morphological characterization of the subserous gallbladder carcinomas is controversial. Aim: To study the prognostic importance of DNA content of subserous gallbladder carcinoma. Material and methods: We studied 104 females aged 60±12 years old and 16 men aged 70±13 years old. In all of them diagnosis was established after mapping of cholecystectomy sample and had a complete clinical follow up. DNA content was measured by flow cytometry. Results: All tumors were adenocarcinoma, and only 16 percent were well differentiated. Aneuploidy was observed in 29 cases (26 perceeeent) with DNA index fluctuating between 1.1 and 1.8. Lymphatic vessel tumor involvement was present in 16 of 22 cases with aneuploidy and in 22 of 46 diploid tumors (p= 0.05). Eighty nine percent of aneuploid tumors were detected macroscopically and 11 percent were unapparent. Five years survival was non significantly better among patients with diploid tumors than in patients with aneuploid tumors (45 and 28 percent, respectively, p= 0.2). The histological differentiation was the only variable significantly associated with survival. Conclusions: Aneuploidy is present in 26 percent of subserous gallbladder carcinoma. It is not related with any of the morphological or clinical variables studied in this series of patients.

Pólipos y adenomas de la vesícula biliar: consideraciones clínico-patológicas / Clinicopathological features of gallbladder polyps and adenomas

Background: Chile has a high frequency of gallbladder cancer. Polyps are common lesions of gallbladder mucosa but there is little information about their morphological features. Aim: To report the clinical and pathological features of 219 gallbladder polyps. Material and methods: Cholecystectomies samples in which a polypoid lesion was diagnosed microscopically. In all cases, complete clinical information and digitalized images of the complete surgical specimens was reviewed. Results: In a period of 10 years, 21.412 gallbladders were processed. Among these, 884 carcinomas were diagnosed and in 219 cases (1 percent) a polyp was found. One hundred and eighty three patients were females (mean age 49.3 years) and 36 males (mean age 53.4 years). The preoperative diagnosis of gallbladder polyp was done only in 26 cases (12 percent). Eighty five percent of polyps were non-neoplastic (metaplastic in 32 percent, cholesterol in 29 percent, hyperplastic in 22 percent and inflammatory in 2 percent). The remaining 15 percent were adenomas. Seventy five percent of non-neoplastic polyps were located in the proximal half of the gallbladder and 88 percent of adenomas in the distal half. Ninety five percent of non-neoplastic polyps measured less than 10 mm. Among adenomas, 47 percent measured less than 5 mm and 28 percent more than 10 mm. Smaller polyps were of cholesterol and larger polyps were adenomas. Eight adenomas were associated with an adenocarcinoma, two had less than 5 mm lenght. Mean age of patients with adenomas associated to cancer was higher than patients with pure adenomas (64.6 and 44.3 years respectively, p >0.001). Conclusions: There are size and location differences between non neoplastic polyps and adenomas. Adenomas associated to cancer may measure less than 5 mm. Therefore the polyp size criteria to decide surgical behavior in symptomatic gallstone patients may be misleading (Rev Méd Chile 2004; 132: 673-9).

Expresión inmunohistoquímica del antígeno carcinoembrionario en el cáncer de la vesícula biliar / Immunohistochemical expression of the carcinoembryonic antigen in gallbladder cancer

Immunohistochemical techniques using monoclonal antibodies were used to investigate the carcinoembryonic antigen (CEA) in gallbladders from 26 patients with gallbladdeer cancer and 26 patients without cacer, including normal mucosa, areas of pyloric metaplasia and areas identified by the presence of "clear cells". All carcinomas were strongly positive for CEA but 61% of noncancerous samples were also positive. However, only 1 of the last samples was strongly positive. According to hystologic type the positivity for CEA in noncancerous samples was 6/11 in normal mucosa, 6/8 in samples with intestinal metaplasia and 1/8 in samples with pyloric metaplasia (p < 0.05). Thus a negative reaction for CEA is 100% specific for absence of cancer. If mild reactions are disregarded, strong reaction for CEA is 81% specific for cancer

Duodenopancreatectomía más linfadenectomía regional en cáncer periampular / Duodenopancreatectomy plus regional lymphadenectomy in periampullar carcinoma

Entre marzo y septiembre de 1988 se operaron 7 enfermos con cáncer periampular realizando duodenopancreatectomía más linfadenectomía regional. En todos los casos se tuvo la confirmación histológica preoperatoria de cáncer, por biopsia endoscópica y en el curso de operaciones previas por biopsia intracoledociana o mediante citología positiva después de punción transduodenal. Se abordó el retroperitoneo de derecha a izquierda con la finalidad de facilitar el control de los pedículos vasculares, la linfadenectomía regional y la resección duodenopancreática. La reconstrucción del tránsito digestivo se realizó siguiendo la técnica descrita por Imanaga. De acuerdo al diámetro del Wirsung se emplearon dos variantes de anastomosis Wirsung-yeyunal. La morbilidad próxima estuvo representada por bacteremias e infección de herida operatoria. No hubo ni fístulas pancreáticas ni significativa disfución pancreática exo o endocrina. Esta serie no presentó mortalidad perioperatoria

Cáncer de la vesícula biliar en la IX región de Chile / Gall Bladder cancer in the ninth region of Chile

El cáncer de la vesícula biliar ha cobrado gran importancia en la población chilena. La tasa actual de mortalidad es de 10 x 100,000 habitantes. Las proyecciones del aumento hacen pensar que en las próximas décadas será el tumor más frecuente en nuestro país, sobrepasando al cáncer gástrico. Durante 1987-1988 en la IX Región de Chile, fueron diagnosticados 96 carcinomas de la vesícula biliar. El 85%de los pacientes eran mujeres. El promedio de edad fue de 62.4 años. El 25%de los pacientes tenian por lo menos un apellido de origen Mapuche. En este grupo el 91%eran mujeres. En 52 casos el diagnóstico se realizó en la pieza de la colecistectomía y los casos restantes fueron metástasis. El 52%de los tumores fueron inaparentes durante el exámen macroscópico de la pieza quirúrgica de colecistectomía. La litiasis estuvo presente en el 67%de los casos. EL 96%de los tumores eran paco o moderadamente diferenciados. En el 54%el tumor comprometía el espesor de la pared vesicular y en 7 estaba confinado a la mucosa. Las metástasis e infiltración tumoral fue principalmente hepático en el 64%y en segundo lugar el peritoneo y ganglios linfáticos .