Modified Book Binding Technique (MBBT) for Intracorporeal Gastroduodenostomy in Totally Laparoscopic Distal Gastrectomy: Initial Experience

Totally laparoscopic distal gastrectomy (TLDG) frequently involves the use of delta shaped gastroduodenostomy (DSG) for intracorporeal anastomosis. However, DSG has some drawbacks, and the book binding technique (BBT) was developed as a new technique to overcome these drawbacks. Subsequently, this technique was further improved with the development of modified book binding technique (MBBT). This study evaluated the safety and feasibility of MBBT in patients undergoing TLDG. Thirty-three patients who underwent TLDG with MBBT were retrospectively evaluated. The mean operation time was 277.6±37.1 minutes, including 51.9±15.7 minutes for reconstruction. Two patients had anastomosis-related complications, one patient with stricture after leakage and 1 patient with stenosis. The former patient was treated with endoscopic balloon dilatation, and the latter was managed conservatively; neither required re-operation. MBBT is a safe and feasible technique, with acceptable surgical outcomes. It may be a good alternative option for the treatment of intracorporeal anastomosis in patients undergoing TLDG.

Totally Laparoscopic Distal Gastrectomy in Post Liver Transplant Patient

The risk of malignancy after transplantation is higher than that of general population. Laparoscopic surgery has become a standard treatment of gastric cancer. However, there are no case reports evaluating totally laparoscopic gastrectomy in patients with previous liver transplantation. Herein we report our experience with a liver transplant recipient who underwent totally laparoscopic distal gastrectomy (TLDG) for gastric cancer. A 63 year-old man underwent orthotopic liver transplantation (OLT) for cryptogenic liver cirrhosis. 8 years later, gastric cancer was diagnosed during the follow-up. Endoscopic submucosal dissection was performed and additional surgical resection was needed. TLDG and D1+ lymph node dissection was performed, and the patient was discharged on the 8th post-operative day without any complications. To the best of our knowledge, this is the first case of de novo gastric cancer treated with TLDG after OLT. This suggests that TLDG is a feasible for patients after OLT.

Silent invasion of Hem-O-Lok clip

A 58-year-old man underwent laparoscopy-assisted distal gastrectomy (LADG) with Billroth I gastroduodenostomy due to early gastric cancer. During surgery, the perigastric vessels were ligated with Hem-o-Lok clips. Esophagogastroduodenoscopy (EGD) 6 months later showed a fungating mass at the anastomosis site. Repeat EGD 1 year after LADG showed a Hem-o-Lok clip at the fungating mass lesion. Because the patient was asymptomatic, with no major abnormalities on clinical examination, and endoscopic removal of the clip would have been difficult due to the presence of adhesions and inflammation, no attempt was made to remove the clip. The patient remained well after the exposed Hem-o-Lok clip was identified. A third EGD 6 months later showed that the clip had disappeared from the anastomosis site, and that this site was covered with normal mucosa surrounding the scar.

Erratum to: Therapeutic Consideration of Periappendiceal Abscess: an Evaluation of Non-surgical Treatment Followed by Minimally Invasive Interval Appendectomy

Authors requested to change the name of the hospital to proper name.

Therapeutic Consideration of Periappendiceal Abscess: an Evaluation of Non-surgical Treatment Followed by Minimally Invasive Interval Appendectomy

PURPOSE: Periappendiceal abscess (PAA) is a severe complicated appendicitis with high morbidity. Non-surgical treatment followed by interval appendectomy (IA) is associated with lower complication rate compared with emergency surgery (ES) and minimally invasive surgery (MIS) can be done more often. The purpose of this study is to assess the incidence and factors predictive of complications of surgery for PAA and to evaluate the clinical effectiveness of IA as a treatment policy to increase MIS. METHODS: Retrospectively, we reviewed 171 patients undergoing surgery for PAA between 2011 and 2016 at Ulsan University Hospital. The incidence and influence of different factors were assessed by univariate and multivariate analyses. RESULTS: In 171 patients, 28 (16.4%) developed postoperative complications, which included; wound complications (7.6%), intra-abdominal abscess (4.1%) and ileus (2.9%). In both analyses, only ES was independently associated with postoperative complications; (Relative risk, 15.0; 95% Confidence interval, 2.4~92.5). Comparing the IA and ES groups revealed that operative time, complication rate, laparoscopic approach, postoperative hospitalization, postoperative antibiotic use and bowel resection rate were significantly different. The postoperative complication rate of patients with PAA in ES group was 28.7%, which was statistically higher than that of IA group (3.6%). Especially, MIS rate was more than 9-times greater in the IA group (98.8% vs. 10.3%, p<0.001). Although the IA group required additional hospitalization, there was no statistical difference between the two groups in total length of hospital stay. CONCLUSION: Morbidity was high for patients who had emergency surgery for PAA. ES was the only factor associated with postoperative morbidity. IA can reduce the postoperative complication rate and allowed MIS to be used more often as a useful treatment policy for PAA.

Impact of the Endoscopic Submucosal Dissection on Early Postoperative Outcome after Additional Gastric Resections for Early Gastric Cancer

PURPOSE: The aim of this study was to compare ESD only and subsequent Laparoscopy-assisted gastrectomy (LAG) patients for EGC through propensity score matching analysis. METHODS: This study was a retrospective review of the records of 46 consecutive patients with gastric cancer who underwent LAG after ESD from 2009, September to 2014, September, and propensity matching analysis was performed with 92 patients who underwent LAG without ESD as a control group. Subgroup analysis was performed with the interval of subsequent laparoscopic gastrectomy and endoscopic resection (within 2 weeks, 2~4 weeks, above 4 weeks). RESULTS: There were no significant differences in age, gender, body mass index, comorbidity, previous abdominal surgery, and location of the lesion or clinical stage between the two groups. Early postoperative outcomes including postoperative complications and postoperative hospital stay were not significantly different between the two groups. According to subgroup analysis with the interval of laparoscopic gastrectomy and endoscopic resection, there were no significant differences in early outcomes in three groups. However, only early postoperative complication rate was significantly higher in patients who received LAG more than 4 weeks after ESD (0 versus 4.76 versus 40 per cent; p=0.0032). CONCLUSION: We analyzed the influence of ESD on subsequent LAG using propensity score matching to reduce the bias. However, we found that ESD might induce inflammation for a significant duration, but ESD had little influence on early postoperative outcome of LAG.

Mesh Encircling Total Extraperitoneal (TEP) Repair of Inguinal Hernia without a Fixation Material or Preformed Mesh: Overlay Closure of Slit Without Additional Mesh

PURPOSE: Mesh non-fixation in TEP is associated with lower cost and shorter operative time, and it is safe and recommended when performed by an experienced surgeon. In performance of TEP surgery using a non-fixation mesh, particularly by a non-experienced surgeon, prevention of mesh migration is an important issue for mesh application. The aim of this study was to report on a fixation method using a non-preformed mesh encircling a cord structure without the use of tacks, staples, or fibrin sealants in TEP surgery. METHODS: A total of 41 patients who had undergone mesh-encircling TEP without fixation from December 2008 (first case of surgery) to June 2012 were analyzed. RESULTS: The mean follow-up period was 23.2 months (12~35 months). Three patients complained of scrotal discomfort, and one patient complained of scrotal edema, but they were resolved with conservative management. There was no recurrence during the follow up period. CONCLUSION: The method of mesh-encircling TEP without fixation material and no additional mesh in which the slit of the mesh is wrapped around the cord structure using an overlay suture is a simple and safe technique without compromising recurrence or chronic pain.

Successful Reuse of a Kidney Allograft from a Brain-Dead Donor into a Second Recipient: A Case Report / 대한이식학회지

The limited donor organ supply is a main problem for transplant surgeons in Korea, and forces them to use organs from extended sources. In one such case, we reused a transplanted kidney allograft in August 2012. This was the first successful case involving the reuse of a transplanted kidney allograft in Korea. The kidney donor was a 44-year-old man brain-dead due to spontaneous subdural hemorrhage. He received a kidney transplant from his sister in 2006. The second recipient was a 59-year-old man who had been receiving hemodialysis for 11 years. There were full human leukocyte antigen (HLA) matches between the first donor and the first recipient, and two HLA mismatches between the first donor and the second recipient. Fortunately, we were able to perform a crossmatch test between the first donor and the second recipient as well as the first recipient and the second recipient (with the first donor's agreement). We used the left iliac artery for perfusion instead of the aorta during organ procurement. The cold ischemic time was 4 hours and the initial kidney function was excellent. The patient has been doing well, without any significant complications or rejections, for 3 weeks. His last serum creatinine level was 0.91 mg/dL. Our case shows that the reuse of kidney allografts could be a possible solution for the shortage of donor kidneys. However, this method requires careful consideration and an agreement among participants before its performance.

Bacteriology, Antibiotic Susceptibility and Empirical Antibiotics of Community-acquired Perforated Appendicitis / 감염과화학요법

BACKGROUND: The aim of this study was to study bacteriology and antibiotic susceptibility in patients with community-acquired perforated appendicitis over a five-year-period. MATERIALS AND METHODS: We conducted a retrospective review of the records of adult patients (age > or =18 years) who were diagnosed as having perforated appendicitis at Ulsan University Hospital between January 2007 and December 2011. Patients who had healthcare-associated or hospital-acquired appendicitis were excluded. Intraoperative specimens submitted to the microbiology laboratory were obtained either by aspiration of pus into a syringe or by use of a swab. Anaerobic bacterial cultures were not performed. RESULTS: Among 216 adult patients with perforated appendicitis, we analyzed 163 culture-positive cases. The overall mortality rate of patients was 0.6% (1/163). Escherichia coli was the most common pathogen (93/163, 57.0%), followed by Streptococcus spp. (45/163, 27.6%), Pseudomonas aeroginosa (13/163, 7.9%), and Enterococcus spp. (17/163, 10.4%). The susceptibility of E. coli to quinolones (ciprofloxacin or levofloxacin) was 74.1%. The susceptibility of E. coli to amoxicillin/clavulanate, cefoxitin, ceftriaxone, piperacillin/tazobactam, and carbapenem reached 75%, 86%, 90%, 98%, and 100%, respectively. Isolated E. coli, including ESBL producing organism and P. aeroginosa, were highly susceptible to piperacillin/tazobactam. Empirical antibiotics used most commonly were a combination of third generation cephalosporin and metronidazole. CONCLUSION: E. coli was the most common pathogen of community-acquired perforated appendicitis, and resistance to quinolone was greater than 25%. We cannot recommend quinolones for use as empirical therapy for treatment of perforated appendicitis.

The Influence of Operative Approach on Food Retention after Open and Laparoscopy-Assisted Distal Gastrectomy (LADG) for Gastric Cancer

PURPOSE: Laparoscopy-assisted distal gastrectomy (LADG) has gained wide acceptance for minimally invasive treatment of early gastric cancer (EGC). The aim of this study was to see the relationship between the operative approach of a distal subtotal gastrectomy and food retention of the remnant stomach. METHODS: A retrospective review of the records of 321 consecutive patients with gastric cancer who underwent a distal subtotal gastrectomy between 2001 and 2008 was conducted. A total of 233 patients who revisited the same surgeon's outpatient clinic and received regular endoscopic examination using the same protocol were finally included in this study. Reconstruction was performed using the Billroth I procedure. Mechanical-stapled anastomosis (MSA) was performed in 112 patients and conventional hand-sutured anastomosis (HA) was performed in 121 patients. RESULTS: According to results of multivariate analysis, the anastomosis method (MSA) was the only independent risk factor for accumulation of food residue. At six and 12 months after surgery, the incidence of food retention was higher in patients who had undergone MSA (22.3%, 13.4%) than in those who had undergone HA (9.1%, 2.5%) (p=0.006, p=0.002, respectively). However, the incidence of food residue at 24 months after surgery did not differ statistically between MSA and HA (p=0.266). CONCLUSION: Our results showed that the laparoscopic approach was not influenced on the accumulation of food residue. Mechanical-stapled anastomosis was the only independent risk factor for food retention. During the early postoperative period, although more food retention was observed in patients who underwent MSA than in those who underwent HA, in the long term, this anastomosis method did not influence food retention after a distal gastrectomy.

The presence of high level soluble herpes virus entry mediator in sera of gastric cancer patients

The development of gastric cancer (GC) is closely related to chronic inflammation caused by Helicobacter pylori infection, and herpes virus entry mediator (HVEM) is a receptor expressed on the surface of leukocytes that mediates potent inflammatory responses in animal models. However, the role of HVEM in human GC has not been studied. Previously, we showed that the interaction of HVEM on human leukocytes with its ligand LIGHT induces intracellular calcium mobilization, which results in inflammatory responses including induction of proinflammatory cytokine production and anti-bacterial activities. In this study, we report that leukocytes from GC patients express lower levels of membrane HVEM (mHVEM) and have lower LIGHT-induced bactericidal activities than those from healthy controls (HC). In contrast, levels of soluble HVEM (sHVEM) in the sera of GC patients were significantly higher than in those of HC. We found that monocyte membrane-bound HVEM is released into the medium when cells are activated by proinflammatory cytokines such as TNF-alpha and IL-8, which are elevated in the sera of GC patients. mHVEM level dropped in parallel with the release of sHVEM, and release was completely blocked by the metalloprotease inhibitor, GM6001. We also found that the low level of mHVEM on GC patient leukocytes was correlated with low LIGHT-induced bactericidal activities against H. pylori and S. aureus and production of reactive oxygen species. Our results indicate that mHVEM on leukocytes and sHVEM in sera may contribute to the development and/or progression of GC.

Retroperitoneal Mucinous Cystadenoma

We present a case of a primary retroperitoneal mucinous cystadenoma, which is a relatively rare tumor found exclusively in women. This tumor is difficult to correctly diagnose preoperatively. Although there is little published information regarding the CEA levels in the cystic fluid of cystic tumors arising in the retroperitoneum, a high CEA level in the cystic fluid is a useful diagnostic marker for a primary retroperitoneal mucinous tumor. The appropriate management of retroperitoneal mucinous cystadenomas is the total removal of the cyst. The retroperitoneal approach for retroperitoneal cystic tumors is useful, has a lower risk of traumatizing the bowel than the intra-abdominal approach, and does not require compression of the other organs. We report the successful resection of a retroperitoneal mucinous cystadenoma through the retroperitoneal approach.

Appendiceal Mucocele

PURPOSE: An appendiceal mucocele refers to an abnormal dilatation of the appendiceal lumen by mucus. It is a rare clinical entity with a reported prevalence rate of 0.2~0.3% of all appendectomies. The purpose of our study was to identify the clinical characteristics of and the proper surgical management for appendiceal mucoceles. METHODS: The hospital records of 24 eligible patients were reviewed. We analyzed demographic data, and pathological and clinical data. RESULTS: There was a significant difference in size (P<0.009) between simple mucoceles (mean, 1.95 cm) and cystadenomas (mean, 3.6 cm). While ultrasonography was the most commonly used test to establish the diagnosis (14 patients), computed tomography and colonoscopy also provided fundamental information in 5 and 2 patients, respectively. An appendectomy was performed in most cases (20 cases, 83%). A cecectomy was performed in 3 cases, and an ileocecal resection was performed in only one case. Among the cases requiring a cecectomy, a laparoscopic cecectomy was performed in one case. A synchronous tumor was present in 5 cases. Three patients had gastric cancer, 1 patient had gallbladder cancer, the other one had endometriosis. CONCLUSIONS: Our study shows that appendiceal mucoceles most frequently present as acute appendicitis and that preoperative diagnosis is difficult to make. All mucoceles should probably be removed to eliminate the chance of progression to malignancy. Also of note was the elevated incidence of associated neoplasms, especially gastrointestinal carcinomas. Some recommend surveillance colonoscopy in patients with a diagnosis of an appendiceal mucocele. We had three cases accompanied by gastric malignancy. Therefore, we suggest that surveillance gastrofiberscopy may be indicated.

Combination Chemotherapy with 5-Fluorouracil and Heptaplatin as First-line Treatment in Patients with Advanced Gastric Cancer

Heptaplatin is a recently developed platinum derivative. This agent has been reported to have a response rate of 17% as a single agent, and tolerable toxicity in the treatment of advanced gastric cancer. The aim of this study was to evaluate the efficacy and toxicity of a combination of 5-fluorouracil (5-FU) and heptaplatin in patients with advanced gastric cancer. Forty-seven chemotherapy-naive patients with advanced or recurred gastric cancer were recruited. 5-FU was administered over 120 hr by continuous intravenous infusion from day 1 to 5, at a daily dose of 1,000 mg/m2 and heptaplatin was administered over 1 hr by intravenous infusion on day 1 at 400 mg/m2, and this cycle was repeated every 4 weeks. The response rate was 21%, median progression-free survival was 1.9 months (95% CI, 1.6 to 2.2 months). Median overall survival was 6.2 months (95% CI, 4 to 8.4 months) and the 1-yr survival rate was 29% for all patients. The most frequent toxicity was proteinuria. Toxicities were generally mild and reversible. This study demonstrates that the combination of 5-FU/heptaplatin combination is less active but tolerated in patients with advance gastric cancer.

Expression of a Novel 90 kDa Heat Shock Protein in Colorectal Tumor

PURPOSE: When cells are subjected to a wide variety of stressful stimuli, they respond by increasing the synthesis of specific stress proteins. Stresses include heat shock, nutrient deprivation, oxygen radicals, toxic metal and viral infection. Major stress proteins are Hsp 27, Hsp 60, Hsp 70 (9), Hsp 90 (3) and Hsp 100 (1). Previously a novel 90 kDa stress protein has been reported to be induced in fish cells by virus infection. The novel 90 kDa stress protein is different from well-known major stress protein in size, antigenicity, cellular localization. The novel 90 kDa stress protein was found to be present in various kinds of cells including human cells and its expression was increased in human carcinomas. The purpose of this study is to evaluate the expression of the novel 90 kDa stress protein in human colonic mucosa of normal tissue, adenoma and adenocarcinoma using immunohistochemical method. METHODS: 85 colon tissues were screened for the expression of the novel 90 kDa stress protein; 85 normal colonic mucosa, 20 colonic adenoma and 65 colonic adenocarcinoma. The tissues were stained with monoclonal antibody against the novel 90 kDa stress protein. In scoring system, tissue sections with immunostained area above 10 % were decided to be positive and, among the positive, the tissue sections were divided into three score, 1, 2, and 3, based on the staining intensity and positive area proportion. The tissue sections with immunostained area below 10% were decided to be negative and grouped into 0 score. Correlation of immunohistochemical expression was analysed by using SPSS version 10.0 statistically. RESULTS: The expression of the 90 kDa stress protein was significantly different among normal colonic mucosa, colonic adenoma, and colonic adenocarcinoma and the percentage of positive samples were 14.1%, 80.5%, and 95.4% respectively. This result suggests that the expression level of the novel 90 kDa stress protein was extremely low in normal tissue but increased significantly in adenocarcinomatous tissues. CONCLUSIONS: The expression of the novel 90 kDa stress protein was increased significantly with transformation of the normal colon tissue to malignancy. This suggests the possibility that this novel 90 kDa stress protein play some role in cancerous transformation of colon tissue.

A Case of Small Bowel Obstruction Caused by Cytomegalovirus Infection

The human cytomegalovirus (CMV), a member of the herpes virus family, can cause a lifelong infection with episodes of endogenous reactivation. Almost the entire adult Korean population has been infected with CMV; they have serum CMV antibodies of IgG class. Reactivation is clinically silent in immunocompetent individuals. Symptomatic illness, such as pneumonitis, retinitis, hepatitis or gastroenteritis, is usually confined to immunocompromized patients. The colon, stomach and esophagus are the organs frequently infected with CMV in these patients. A CMV infection may also complicate an inflammatory bowel disease. CMV enteritis involving the small bowel, which makes up less than 10% of the CMV gastroenteritis cases, usually presents with diarrhea, bleeding and perforation, but rarely evokes obstruction. The authors experienced a case of CMV enteritis of the terminal ileum, presenting as an intestinal obstruction, which developed in an immunocompetent individual with no underlying disease. This appears to be a world first.

Study of Capsaicin-induced Apoptosis in Human Colon Cancer Cell Lines

PURPOSE: Numerous investigations have been conducted in order to determine the potential carcinogenic or chemopreventive activity of capsaicin. The aim of this study is to characterize the effects of capsaicin on colon cancer cells, and provide valuable information concerning the application of capsaicin in chemoprevention as well as for therapeutic purposes. METHODS: CoLo320DM and LoVo cells (human colon cancer cell line) were treated with capsaicin. In order to access cell viability and altered morphology, an MTT assay was performed and the cells were microscopically examined. Decreasing DNA staining was accessed by FACS. The cells were stained with FITC labeled annexin V and analyzed by FACS to detect cellular membrane alteration during apoptosis. The cells were stained with DiOC6(3) and Hydroethidine and analyzed by FACS in order to access ROS and dleta psi m. RESULTS: Capsaicin decreased cell viability in a dose-dependent manner. Capsaicin produced a cell morphology corresponding to the apoptotic features including cell shrinkage and chromatic condensation. Capsaicin treated cells induced a loss of nuclear DNA leading to hypoploidy in a dose-dependent manner. Cells were excluded by double staining with PI and FITC labeled annexin v and detected by FACS. We show that treatment of CoLo320DM, L0Vo cells with increasing concentrations of capsaicin parallel an increase in the percentage of red fluorescent cells (HE-->Eth) that reflect ROS hypergeneration and a decrease in the percentage of green fluorescent cells that reflect delta psi m disruption. CONCLUSION: These results clearly demonstrate that capsaicin-induced colon cancer cell death is apoptotic.

The Cold Preservation of Mice Hepatocytes Induces Apoptosis but Not over Expression of MHC Class I Antigen / 대한이식학회지

Hepatocyte transplantation is a potential treatment modality for liver diseased patients. Purified hepatocytes stimulates allospecific cytotoxicity by expressing the MHC class I antigen. Also, during cold preservation, hepatocytes are damaged by lipid peroxidation with oxygen free radicals, which may induce apoptosis on cold preserved hepatocyte. For measuring the degree of antigenicity on cold- preserved mice hepatocytes with UW solution, we studied the expression of MHC class I antigen in various time period by FACS and RT-PCR. For analysis of apoptotic hepatocyte death, we studied morphological changes and DNA fragmentation. We used flow cytometry techniques with rhodamine 123,3,3'-dihexiloxadicarbocyanine (DiOC6 (3)) and propidium iodide (PI). DiOC6 (3) is mitochondrial probe to measure the mitochondrial transmembrane potential that drops early in apoptosis. The percentage of cells undergoing chromatinolysis (subdiploid cells) was determined by ethanol fixation followed by RNA digestion and PI staining. The cold preserved hepatocytes expressed MHC class I constitutively, but revealed no significant differences among various preservation period. However, apoptosis of hepatocytes occured progressively during cold preservation. These results provides that the cold preservation of mice hepatocyte induces apoptosis with involvement of an oxidative process, but does not stimulate over expression of MHC class I antigen.

The Expression of a Novel 90 kDa Stress Protein in Human Malignant Neoplasms / 대한암학회지

PURPOSE: When cells are subjected to stressful stimuli such as, heat shock, toxic metal, nutrient deprivation, and metabolic disruption, they increase production of specific stress proteins that buffer them from harm. We reported that the expression of a navel 90 kDa cellular protein was increased by the infection of a fish rhabdovirus and heat shock in a fish cell. This new 90 kDa protein is not expressed in normal animal tissues but is highly induced in progressively transforming tissues or cells. That gives us some ideas tl at it is possible for this stress protein to be expressed in specific human cancer tissues. MATERIALS AND METHODS: Commercialized checkerboard multi-tumor block (DAKO Co. Carpinteria, CA) was used for immunohistochemical analysis. The samples of human gastric cancer, colon cancer and breast cancer tissues were evaluated by Western blot and Northern blot for overexpression of the novel 90 kDa stress protein. Sera of those patients were analyzed by ELISA for the presence of antibody against the novel 90 kDa stress protein. RESULTS: Immunohistochemical staining of human tumor tissue blocks showed significant immunostaining of novel 90 kDa stress protein in carcinomas such as colon cancer, breast cancer and stomach cancer but no apparent immunostaining in sarcomas. Coinciding with the immunohistochemical result, Western blotting and Northern blotting analyses indicate that the expression of the novel 90 kDa stress protein was increased in carcinomas. In addition, the antibody titer against the novel 90 kDa stress protein was found to be elevated in the sera of cancer patients. CONCLUSIONS: The novel 90 kDa stress protein gene expression was elevated in carcinomas such as gastric cancer, breast cancer and colon cancer. These findings suggest that this new stress protein can be used as a tumor marker and may function as a chaperone in tumor growth.

Biliary Cystadenocarcinoma with Early Gallbladder Cancer: A Case Report / 한국간담췌외과학회지

The biliary cystadenocarcinomas are very rare malignant tumor. The etiology is unclear, this tumor may be develop from malignant transformation of begin cystadenoma. The tumor appears typically as a cystic mass which contains papillary projections or internal septations. Papillary projections are seen on the inner surface of the cyst which present numerous papillary protrusion typical to this rare tumor. Excessive mucin secretion produced by the tumor cells and its retention in the common bile duct may cause bile stasis leading to obstructive jaundice. Common presenting symptoms are abdominal fullness, pain, nausea, palpable mass and asymptomatic. The available diagnostic tools are CT and sonography, but histologic examination can be made diagnostic confirm. Surgical resection yields excellent results. We were experienced a cystadecarcinoma with early gallbladder cancer, then report with reference.