Carcinoma gallbladder: atypical presentations and unusual associations.

Patients with carcinoma of the gall bladder (CaGB) may have atypical presentations and unusual associations. Out of 324 patients with CaGB seen at a tertiary referral center in northern India, 26 (8%) had atypical clinical presentations and 34 (10%) had unusual associations. The atypical presentations were empyema (5), acute cholecystitis (3), post-cholecystectomy benign biliary stricture (3), carcinoma of the head of pancreas (3), gastric outlet obstructions (2) and liver abscess (1). Unusual associations were common bile duct stones (18), left supraclavicular lymph node metastasis (11), Mirizzi's syndrome (3), inguinal lymph node metastasis (1) and umbilical metastasis (1). Majority of these patients had advanced disease and curative resection was not possible; a worthwhile palliation was however possible in the majority.

Extended cholecystectomy for carcinoma of the gall bladder.

Resection was performed in 158 (70%) out of 227 patients with carcinoma of the gall bladder treated over 22 years between 1971 and 1993; 59 had simple cholecystectomy, 66 extended cholecystectomy (including 2 cm wedge resection of the liver at the gall bladder bed and regional lymphadenectomy in the hepatoduodenal ligament, behind the superior part of the pancreatic head and in the common hepatic artery region) and 33 had a more extended operation. Staging as proposed by the Japanese Society of Biliary Surgery (JSBS) was followed. Simple cholecystectomy was performed in 35 patients with stage I, 6 with stage II, 6 with stage III and 11 with stage IV disease while extended cholecystectomy was performed in 28 patients with stage I, 11 with stage II, 12 with stage III and 14 patients with stage IV disease. Survival was calculated using Kaplan - Meier method and log rank test was used for analysis of survival rates. The cumulative 5 year survival after extended cholecystectomy was 79% in stage I, 64% in stage II, 44% in stage III and 8% in stage IV. There was no difference in survival between stage I and II but survival in stage I was significantly better than that in stage III (p = 0.05). There was no statistically significant difference in survival after extended or simple cholecystectomy in stage I disease although incidence of recurrence was less after extended than after simple cholecystectomy (7% vs 17%). Extended cholecystectomy produced better survival than simple cholecystectomy in stage II disease (p = 0.04) but there was no difference between extended and simple cholecystectomy in stage III and IV disease. Retrospective analysis was performed to identify significant prognostic indicators. The significant factors for pior survival were N2, Hinf 1, Binf 1 and invasive cancer.

Malignant retrorectal teratoma presenting as an infected perianal sinus.

Retrorectal teratomas are rare tumours arising in the presacral space. We report a case of malignant retrorectal teratoma which presented as an infected perianal sinus. The patient was treated with abdominoperineal resection.