Histopathologic Analysis of Adenoma and Adenoma-related Lesions of the Gallbladder / 대한소화기학회지

BACKGROUND/AIMS: In order to determine the malignant potential of gallbladder adenoma for progression to carcinoma, we evaluated the histopathologic features of adenoma and adenoma-related lesions on cholecystectomized specimens. METHODS: Among 1,847 cholecystectomized specimens, 63 specimens from 26 benign adenomas, 9 carcinomas in situ (CIS), and 28 invasive carcinomas were selected. A pathologist reviewed all specimens and selected benign adenomas, CIS in the adenoma, and adenoma residue in invasive carcinomas. Adenomas and adenoma-related lesions were classified according to morphology (tubular, tubulopapillary, and papillary) and the consisting epithelium (biliary, pyloric metaplasia, and intestinal metaplasia). The age and the size of the benign adenomas and carcinomas in the adenoma were also compared. RESULTS: Adenoma and adenoma-related lesions were found in 34 out (1.8%) of all resected gallbladder. Among 9 CIS and 28 invasive carcinomas, adenoma-related lesions were detected in 7 and 1 case, respectively. All eight carcinomas arising in the adenoma were well-differentiated solitary tumors. The diameters of the carcinomas in the adenoma were, on average, larger than that of the benign adenomas (1.8 cm vs. 0.9 cm, p=0.01). The patients with carcinomas in the adenoma were, on average, older than those with benign adenomas, although the difference was insignificant (57 years vs. 47 years, p=0.09). The morphology and consisting epithelium did not differ between the benign adenomas and carcinomas in the adenoma. The malignant transformation occurred in 23.5% of adenomas. CONCLUSIONS: Gallbladder adenoma is a rare disease, although malignant transformation occurs frequently. Adenoma is a precancerous lesion and the adenoma-carcinoma sequence is one of the gallbladder cancer carcinogenesis.

Papillary Cholangiocarcinoma Arising from Biliary Papillomatosis / 대한간학회지

No abstract available.

Double Primary Cancer of the Gallbladder and the Ampulla of Vater in Association with Adenoma-Carcinoma Sequence

An adenoma is a rare benign tumor arising in the extra-hepatic biliary duct. Adenocarcinomatous changes are often observed in the background of an adenoma. Double or triple cancer with an adenoma and adenocarcinoma in the biliary tract can be the crucial evidence of the adenoma-carcinoma sequence. We first performed laparoscopic surgery on a 63-year old male patient complaining of pain in the right upper quadrant of the abdomen and jaundice a week earlier, which was initially diagnosed by a radiologist as a sessile polyp of the gallbladder along with stones in the gallbladder and the common bile duct. A mass was found in the distal common bile duct and ampullary area during intraoperative choledochoscopy. The frozen sections taken during surgery indicated a cancer or dysplasia in the gallbladder and the distal common bile duct. The patient underwent a pylorus-preserving pancrea-toduodenectomy. The final diagnosis was a double primary can-cer originating in the gallbladder and the ampulla of Vater with an adnocarcinoma in an adenoma. We report this case with review of the relevant literature.

Clinicopathologic Features of Flat Elevations in the Colon and Their Significance / 대한소화기내시경학회지

BACKGROUND AND AIMS: There are two main routes in the growth and development of colo-rectal carcinomas, that is to say, the adenoma-carcinoma sequence and the route described by the de novo theory. The adenoma-carcinoma sequence has been considered a principal route for colorectal carcinomas for a long time, but recently the de novo cancer theory has become a controversial issue, and many authors have claimed that their cases were de novo carcinomas. Since Muto described small "flat elevations" and emphasized their significance as precursors of colorectal carcinomas, especially of flat colorectal carci-nomas, many flat elevations have been reported. He cautioned that the reported de novo carcinomas could also be carcinomas that developed from small flat adenomas. In addition, no data are available in Korea on the subject of flat elevations. Accordingly, we attempted to analyze flat elevations in the colon and to obtain correlations between their endoscopic and histologic features and their clinical implications. METHODS: The authors performed colonoscopic removal of 146 flat elevations from January 1997 to December 1997 at Song-Do Colorectal Hospital in Seoul, Korea. We reviewed and analyzed all those lesions. During colonoscopy, the sizes of the lesions were measured by an endoscopic ruler. RESULTS: The most common age group was the sixth decade. Only one case involved a patient under 30 years old. The male-to-female ratio was 3.2 : 1. The numbers of flat adenomas and flat adenocarcinomas were 68 and 1, respectively. These 69 cases amounted to 47.3% of the flat elevations. The malignancy rate for flat adenomas was 1.4% (1/69). There were no malignancies in flat elevations with diameters below 10 mm. Hyperplasticpolyps and chronic nonspecific inflammation showed 34.9% and 15.8%, respectively. Most of the flat elevations were smaller than 10 mm (98.6%). Recognizable endoscopic features of the flat elevations were redness (47.3%) and depression (15.8%), but 50 cases (34.2%) of the flat elevations had no specific features. Flat elevations smaller than 5 mm had discolorations in 15 cases (14%). The sigmoid colon was the most common site of the flat elevations. The percentage of flat elevations found in the sigmoid colon and the rectum was 70.5%. Hot biopsy was the main treatment for lesions smaller than 5 mm (75.7%), and snare polypectomy was the main treament for lesions from 5 mm to 9 mm. CONCLUSIONS: Flat elevations were detected without difficulty through careful examination. Nearly half of the flat elevations were flat adenomas. Accordingly, flat elevations may have some clinical significance on the basis of the adenoma-carcinoma sequence, but flat elevations greater than 10 mm should be managed cautiously because of possible malignancy.

Proliferating cell nuclear antigen (PCNA) expression and its significance in adenoma-carcinoma sequence of the large bowel / 中华消化杂志

0.05). It's concluded that PCNA immunohistochemicai staining is valuable in early detection of malignant potential of adenomas, also it may be helpful in distinguishing the degree of adenomatous dysplasia.

A dynamic study of p53 gene mutations in the development of colorectal adenoma-carcinoma sequence / 中华消化杂志

p53 gene mutations and their expression in protein levels of colorectal adenomas, carcinomas and regional lymph nodes metastasis were detected by PCR-SSCP and AB-PAP immunohistochemical analysis, respectively. The results showed that p53 gene mutations were detected in 25% colorectal adenomas, 80% carcinomas and 100% regional lymph nodes metastasis. Meanwhile, p53 proteins were detected at rates of 75%, 60% and 57% in these three groups, respectively. It is suggested that p53 gene mutations occur frequently at late stage of progression to colorectal adenoma-carcinoma sequence and may relate to its metastasis, while the accumulation of p53 protein may be a specific genetic alteration initiated from adenomatous stage. Thus, the biological significances of the two genetic alterations are different. Investigations of these concomitantly would be helpful in understanding the malignant potential of adenoma and evaluation of its staging.

Gastroduodenal Adenomas and Carcinoma in Patients with Familial Polyposis Coli

Gastric lesion in familial polyposis coli is commonly presented with fundic gland hyperplastic polyps, but duodenal and gastric adenomas together with their carcinomatous transformation have been rarely described in familial polyposis coli mostly by case reports. We present three cases of gastric adenomas in familial polyposis coli with one in synchronous development of gastric adenocarcinoma in Korea. All three cases had the family history related to familial polyosis coli and received proctocolectomy because of synchronous development of colonic adenocarcinoma. One patient developed gastric polyposis and adenocarcinoma 8 years after colectomy, and the remaining two presented with multiple polyps either in the stomach or duodenum synchronously at the time of the diagnosis of familial polyposis coli with colonic adenocarcinoma. None disclosed any evidence of Gardner's syndrome. We conclude that association of gastric adenomas in familial oplyposis coli is not uncommon and gastric adenoma-carcinoma sequence is an another important participating mechanism to understand the histogenesis of gastric carcinoma in Korea.