Gallbladder carcinoma in the elderly: a report of 48 patients / 中华肝胆外科杂志

Objective To review the diagnosis and treatment of primary gallbladder carcinoma in patients older than 70 years.Method The clinical data of 48 patients older than 70 years with primary gallbladder carcinoma treated in our hospital from 2003 to 2010 were retrospectively analyzed.Results The preoperative diagnostic rate was 60.4％.Of 48 patients with primary gallbladder carcinoma,9 received cholecystectomy,18 radical resection,7 extended radical resection,8 palliative operation,while the remaining 6 received biopsy because of metastasis. The 3-year survival rate was 20.8％ and the 5-year survival rate was 8.3％.Conclusions Regular B-ultrasonography,CT-scan and MRI are suggested for elderly patients with chronic diseases of the gallbladder.Radical resection is recommended if clinically possible. Chinese traditional medicine given postoperatively improved the prognosis.

The tumorigenic property of side population cells in a human gallbladder carcinoma cell line GBC-SD / 中华肝胆外科杂志

ObjectiveTo explore the tumor igenic property of side population cells (SP) from human gallbladder carcinoma cell line GBC-SD. Methods SP and non-SP cells were isolated from GBC-SD staining with Hoechst33342 dye by fluorescence-activated cell sorting (FACS). The soft agar clonal assay and xenograft assay were performed to characterize tumorigenic property of side population cells in vitro and in vivo, respectively. The percentage of SP cells was analyzed by FACS in 5 hu man gallbladder carcinoma specimens. ResultsThe percentage of SP cells accounted for approximately 0.87 ％ of GBC-SD cells. The clone-formed rates of SP was more frequent than that of non-SP cells (14.74％ ± 3.53％ vs 5.17％ ± 1.05％), there was statistically significant difference (t =2.75,P＜0. 05). SP cells could generate tumors with as few as 5 × 103 cells (four of seven animals), whereas at least 1 × 105 non-SP cells were needed to form a tumor (one of seven animals). Re-analysis of SPderived tumors by FACS showed that SP cells under in vivo conditions also have the capacity to regenerate the SP and non-SP fractions. Besides, analysis of Hoechst33342 revealed s small fraction of SP cells, ranging from 0. 27％ to 2.3％ in gallbladder carcinoma specimens. ConclusionSP cells from GBC-SD are highly tumorigenic similar as the cancer stem cells.

MRI and MRCP Diagnosis of Primary Gallbladder Carcinoma / 实用放射学杂志

Objective To analyse MRI and MRCP features of primary gallbladder carcinoma.Methods MRI and MRCP data of 87 cases with gallbladder carcinoma confirmed by operation and pathology were studied retrospectively.Results Four patterns of gallbladder carcinomas were found by MRI:wall thickening (35 cases),papillary nodular(17 cases),mass-type (25 cases) and mixed (wall thickening and nodular) (10 cases).Pathology showed the tumors in combination with chronic cholecystitis and cholecystolithiasis in 69 cases(79.31%).In comparison with that of operations,the accurate diagnostic rates were 46/50(92%) with MR imaging,13/19(68.4%) with MRCP and 80/82(97.6%) in combination with both MR imaging and MRCP.The other features included:hepatic invasion directly by gallbladder cancer in 25/32(78.12%),liver metastases in 17/19(89.47%),lymph node metastases in 28/34(82.35%),intra-adbominal distant metastases in 13/13(100%) and invasion of bile ducts in 25/26(96.15%).Conclusion MRI combined with MRCP is of significant value in diagnosing gallbladder carcinoma.

Diagnosis of Gastrointestinal Invasion by Carcinoma of Gallbladder on Spiral CT(Report of 8 Cases ) / 中国普外基础与临床杂志

Objective To study the spiral CT features of gastrointestinal invasion by carcinoma of gallbladder. Methods Eight patients with surgical-pathologically documented gastrointestinal invasion by carcinoma of gallbladder were analyzed retrospectively. All patients underwent plain and contrast-enhanced dual-phase scanning of the abdomen. Oral contrast medium (1.2% Angiografin) was used to fill the gastrointestinal tract before CT scanning. Results There were 2 cases of gastric antrum invasion, 6 duodenal invasion and 3 colonic invasion according to the surgical and pathological findings. Spiral CT correctly diagnosed 2 gastric invasion and 4 duodenal invasion based on several imaging features, like blurring of fat plane, focal wall thickening and luminal narrowing of involved gastrointestinal segments, and mass formation. However CT was unable to diagnose the 3 cases of hepatic flexure of colon invasion. Conclusion CT is valuable for diagnosing upper gastrointestinal tract invasion by carcinoma of gallbladder, yet the diagnosis of hepatic flexure of colon invasion is still difficult.

Progress of Early Diagnosis in Primary Carcinoma of Gallbladder / 中国普外基础与临床杂志

Objective To introduce the methods and the advancements of early diagnosis in primary carcinoma of gallbladder (PCG),and improve the early diagnostic rate of PCG.Methods Recent relevant literatures were reviewed.Results It was difficult in early diagnosis of PCG and with a poor prognosis.Comprehending case history and careful examination and being assisted by multiple imaging methods and molecular biology technology could markedly improve the early diagnostic rate.Conclusion Comprehending the progress will contribute a lot of improving the early diagnostic rate and selecting reasonable clinical methods to be used in early diagnosis of PCG.

CT Staging of Gallbladder Carcinoma and Its Role in Evaluation of Surgical Resectability / 实用放射学杂志

Objective To investigate CT stage of carcinoma of gallbladder and its role in preoperative evaluation of surgical resectability.Methods CT staging with reference to current literature was made retrospectively in 80 cases of carcinoma of gallbladder proved pathologically and imaging studies.Surgical resectability was evaluated in combination with surgical and pathological results on different stages of this disease.Results In this group,there were stage Ⅰin 9 cases,stageⅡ in 18 cases,stage Ⅲin 42 cases and stageⅣ in 11 cases.32 cases were radically resected,among them,9 were stage Ⅰ,18 stage Ⅱ and 5 stage Ⅲ.Palliative resection was done on 31 cases;all were stage Ⅲ.Exploratory surgery were done on 9 cases(6 stage Ⅲ and 3 stage Ⅳ),by they were unresectable.8 cases (CT stage Ⅳ on CT)had no surgery,but treated otherwise.Conclusion CT studies and staging of gallbladder carcinoma are conducive to preoperative evaluation of surgical and choice of appropriate treatment planning.

Xanthogranulomatous Cholecystitis

Xanthogranulomatous cholecystitis(XGC) is a rare, benign, destructive, inflammatory process of the gallbladder that is believed to be a variant of chronic cholecystitis. The gross and microscopic appearances are characteristic with multiple intramural nodules composed of foamy histiocytes and inflammatory cells. Clinically, radiologically and morphologically, XGC sometimes is confused with a malignant neoplasm. In a retrospective twelve year study, 20 cases of XGC were found in 2007 gallbladders (0.99%) and we have been reviewed the characteristic features of it. In 8 patients(40%) XGC sufficiently resembled carcinoma of the gallbladder for the radiological study and surgeon. Gallstones were found in 14 cases(70%). Associated malignancy were 2 cases : one in distal CBD and one in head of pancreas but, there was no coexisted carcinoma of the gallbladder. Complete cholecystectomy was done in 12 cases(60%) and partial cholecystectomy was performed in 7 cases(35%). One underwent T-tube choledochostomy only for suspectd carcinoma of the gallbladder, which subsequently proved to be XGC. In conclusion, appearances often mimicked carcinoma of the gallbladder at laparotomy with xanthogranulomatous tissue extending to adjacent structures. So the possibility should be considered that an `inoperable tumor' of the gallbladder may be in fact XGC, a benign condition that frozen-section biopsy may confirm. If XGC was suspected at operation or confirmed at frozen-section biopsy, coincident carcinoma may still be present. Management of XGC should therefore include choloecystectomy and excision of adjacent xanthogranulomatous tissue and any fistula.