ABSTRACT
This case report describes an unusual paraneoplastic leukemoid response presenting in a rare instance of gallbladder (GB) adenosquamous carcinoma (ASC). Adenocarcinoma is the most prevalent histological subtype of GB carcinoma, which is most frequently diagnosed in people in their sixth and seventh decades of life. Adenosquamous and squamous variations are uncommon. Rarely have reports of paraneoplastic leukemoid reaction (PLR) in GB carcinoma been made; this reaction is characterized by a white cell count exceeding 50,000/mm3 in combination with solid malignancy. PLR has most commonly been found in association with lung carcinoma. In this instance, a 40-year-old man presented with right upper abdominal pain and a total leukocyte count of 26 x 109/L. The patient was initially treated on the lines of acute cholecystitis. But when the abdominal symptoms and leukocytosis did not settle, open cholecystectomy was performed. The results of the histopathological analysis showed that the GB had adenosquamous cancer. The white cell count increased even after surgery. Leukocytosis in the patient was looked into further to rule out hematological malignancy and other possible reasons. Sadly, the patient expired before any treatment could be started. The cancer GB carcinoma is uncommon and aggressive. Despite its rarity, ASC should be included in the differential diagnosis. PLR is an unusual manifestation associated with GB carcinoma. A thorough investigation, including a complete blood count, can help identify this paraneoplastic syndrome in patients with elevated white cell counts.
ABSTRACT
Adenosquamous carcinoma (ASC) of the gallbladder is an incredibly rare malignancy. It is much less common than adenocarcinoma of the gallbladder and also has a much poorer prognosis. The case presented here is that of a patient diagnosed with ASC of the gallbladder after undergoing cholecystectomy for symptomatic cholelithiasis. Her disease progressed despite four cycles of chemotherapy. Her course was complicated by recurrent obstructive jaundice requiring biliary duct stent placement and percutaneous biliary drain placement over several admissions. She was discharged home with hospice service seven months after diagnosis, where she died a few weeks later. Knowledge pertaining to gallbladder ASC is limited, as prevalence is low and information is mostly derived from case reports such as this.
ABSTRACT
BACKGROUND: Situs inversus totalis (SIT) is a rare genetic congenital disease, characterized with complete right-to-left inversion of all the internal organs. We herein describe a meaningful case which was diagnosed as gallbladder adenosquamous carcinoma, a rare histology type of gallbladder cancer, with SIT. CASE PRESENTATION: A 59-year-old Chinese woman was admitted for persistent epigastric distention and intermittent abdominal pain. The abdominal CT scan revealed a huge mass at the gallbladder bottom, involving the adjacent transverse colon and liver. En-bloc radical resection of the gallbladder cancer, including partial colectomy and hepatectomy with regional node dissection, followed by colocolostomy and Roux-en-Y choledochojejunostomy, was successfully performed. Pathology analysis indicated an adenosquamous carcinoma with positive adenocarcinoma markers (CK7, CK19) and squamous carcinoma markers (CK5/6, P63). CONCLUSION: The SIT anomaly might increase the risk of malignancies by sharing genome mutations, suggesting the importance of surveillance in the SIT settings.
ABSTRACT
Objective@#To investigate the clinical efficacy of radical resection for stage T3 gallbladder cancer and prognostic factors.@*Methods@#The retrospective case-control study was conducted. The clinico-pathological data of 87 patients with T3 gallbladder cancer who were admitted to Tianjin Medical University Cancer Institute and Hospital from January 2005 to June 2016 were collected. There were 44 males and 43 females, aged 29-79 years, with a median age of 61 years. According to the different preoperative pathological classification and intraoperative exploration of gallbladder cancer, corresponding surgeries were performed. Observation indicators: (1) surgical and postoperative conditions; (2) clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis; (3) clinical efficacy of stage T3 gallbladder adenocarcinoma and prognostic factors analysis; (4) clinical efficacy of stage T3 gallbladder adenosquamous carcinoma and prognostic factors analysis. Follow-up by outpatient examination or telephone interview was performed to detect the postoperative survival of patients up to June 2018. Measurement data with skewed distribution were represented as M (range), and count data were described as absolute numbers. Survival curve, survival time and survival rate were drawn and calculated by the Kaplan-Meier method. Survival analysis was performed by the Log-rank test. Univariate analysis was performed using the Log-rank test and multivariate analysis using the COX proportional hazard model.@*Results@#(1) Surgical and postoperative conditions: all the 87 patients underwent radical resection of gallbladder cancer, including 29 cases of hepatic wedge resection and 58 cases of extended hepatectomy. Of the 87 patients, 42 underwent standard lymph node dissection and 45 underwent enlarged lymph node dissection. There were 27 cases receiving extrahepatic bile duct reconstruction. The postoperative pathological results of 87 patients showed that 64 were diagnosed with gallbladder adenocarcinoma and 23 were diagnosed with gallbladder adenosquamous carcinoma. There were 59 cases comorbid with liver invasion and 3 cases comorbid with vascular invasion. The marginal histopathological examination showed negative margin in 63 cases and positive margin in 24 cases. The degree of tumor differentiation: there were 23 patients with highly differentiated tumor and 64 with poorly differentiated tumor. Of the 87 patients, 43 received postoperative adjuvant therapy and 44 didn′t receive adjuvant therapy. (2) Clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis. ① All the 87 patients were followed up for 1.8-128.0 months, with a median follow-up time of 26.3 months. All the 87 patients had survived for 1.1-82.7 months, with a median time of 20.1 months. The 2-year overall survival rate of patients was 59.8%, and the 2-year disease-free survival rate was 49.4%. ② Univariate analysis showed that preoperative alkaline phosphatase (ALP) level, tumor diameter, pathological type of tumor, lymph node metastasis, and range of hepatectomy were associated factors for the postoperative 2-year overall survival rate of patients (χ2=5.451, 4.900, 8.256, 4.419, 5.858, P<0.05), and pathological type of tumor, lymph node metastasis, and range of hepatectomy were associated factors for the postoperative 2-year disease-free survival rate of patients (χ2=5.828, 6.968, 4.077, P<0.05). Multivariate analysis showed that preoperative ALP level, tumor diameter, and lymph node metastasis were independent factors influencing the postoperative 2-year overall survival rate of patients [hazard ratio (HR)=2.539, 2.619, 2.201, 95% confidence interval (CI) : 1.174-5.491, 1.209-5.673, 1.104-4.391, P<0.05)]; pathological type of tumor and lymph node metastasis were independent factors influencing the postoperative 2-year disease-free survival rate of patients (HR=2.254, 2.296, 95%CI: 1.170-4.344, 1.206-4.374, P<0.05). ③ Survival analysis: pathological type of tumor was an associated factor for the postoperative 2-year overall survival rate and 2-year disease-free survival rate of patients. Of the 87 patients with T3 gallbladder cancer, there was no significant difference in the postoperative 2-year overall survival rate between the 64 patients with gallbladder adenocarcinoma and 23 with gallbladder adenosquamous carcinoma (68.8% vs. 34.8%, χ2=8.256, P>0.05), but a significant difference in the postoperative 2-year disease-free survival rate between them (56.3% vs. 30.4%, χ2=5.828, P<0.05). (3) Clinical efficacy of stage T3 gallbladder adenocarcinoma and prognostic factors analysis. ① Sixty-four patients with gallbladder adenocarcinoma had the median survival time of 23.1 months, with a range from 3.2 to 82.7 months. The postoperative 2-year overall survival rate was 68.8%, and the postoperative 2-year disease-free survival rate was 56.3%. ② For the 64 patients with T3 stage gallbladder adenocarcinoma, univariate analysis showed that preoperative CA19-9 level and range of lymph node dissection were associated factors for the postoperative 2-year overall survival rate (χ2=4.012, 8.837, P<0.05). The range of lymph node dissection was an associated factor for the postoperative 2-year disease-free survival rate (χ2=6.361, P<0.05). Multivariate analysis showed that range of lymph node dissection was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate (HR=0.244, 0.382, 95%CI: 0.088-0.674, 0.176-0.831, P<0.05). ③ Survival analysis: range of lymph node dissection was an associated factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients. Of the 64 patients with T3 stage gallbladder adenocarcinoma, the postoperative 2-year overall survival rate and disease-free survival rate of patients undergoing enlarged lymph node dissection were 84.8% and 69.7%, versus 51.6% and 41.9% of the patients undergoing standard lymph node dissection (χ2=8.837, 6.361, P<0.05). (4)Clinical efficacy of stage T3 gallbladder adenosquamous carcinoma and prognostic factors analysis. ① Twenty-three patients with gallbladder adenosquamous carcinoma had the median survival time of 13.2 months, with a range from 1.1 to 70.3 months. The postoperative 2-year overall survival rate was 34.8%, and the postoperative 2-year disease-free survival rate was 30.4%. ② For the 23 patients with T3 stage gallbladder adenosquamous carcinoma, univariate analysis showed that preoperative ALP level, lymph node metastasis, range of hepatectomy, and extrahepatic bile duct reconstruction were associated factors for the postoperative 2-year overall survival rate of patients (χ2=5.288, 4.574, 12.960, 4.106, P<0.05). The lymph node metastasis and range of hepatectomy were associated factors for the postoperative 2-year disease-free survival rate of patients (χ2=7.364, 10.582, P<0.05). Multivariate analysis showed that range of hepatectomy was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate (HR=0.102, 0.153, 95%CI: 0.012-0.880, 0.033-0.718, P<0.05). ③ Survival analysis: range of hepatectomy was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients. Of the 23 patients with T3 stage gallbladder adenosquamous carcinoma, the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients undergoing extended hepatectomy were 87.5% and 75.0%, versus 6.7% and 6.7% of the patients undergoing hepatic wedge resection (χ2=12.960, 10.528, P<0.05).@*Conclusions@#Lymph node metastasis is an independent factor influencing the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with T3 stage gallbladder cancer. The range of lymph node dissection is an independent factor for the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with stage T3 gallbladder adenocarcinoma. Range of hepatectomy is an independent factor for the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with stage T3 gallbladder adenosquamous carcinoma. Patients with gallbladder adenocarcinoma should undergo enlarged lymph node dissection, and patients with gallbladder adenosquamous carcinoma need to undergo extended hepatectomy.
ABSTRACT
Objective To investigate the clinical efficacy of radical resection for stage T3 gallbladder cancer and prognostic factors.Methods The retrospective case-control study was conducted.The clinicopathological data of 87 patients with T3 gallbladder cancer who were admitted to Tianjin Medical University Cancer Institute and Hospital from January 2005 to June 2016 were collected.There were 44 males and 43 females,aged 29-79 years,with a median age of 61 years.According to the different preoperative pathological classification and intraoperative exploration of gallbladder cancer,corresponding surgeries were performed.Observation indicators:(1) surgical and postoperative conditions;(2) clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis;(3) clinical efficacy of stage T3 gallbladder adenocarcinoma and prognostic factors analysis;(4) clinical efficacy of stage T3 gallbladder adenosquamous carcinoma and prognostic factors analysis.Follow-up by outpatient examination or telephone interview was performed to detect the postoperative survival of patients up to June 2018.Measurement data with skewed distribution were represented as M (range),and count data were described as absolute numbers.Survival curve,survival time and survival rate were drawn and calculated by the Kaplan-Meier method.Survival analysis was performed by the Log-rank test.Univariate analysis was performed using the Log-rank test and multivariate analysis using the COX proportional hazard model.Results (1) Surgical and postoperative conditions:all the 87 patients underwent radical resection of gallbladder cancer,including 29 cases of hepatic wedge resection and 58 cases of extended hepatectomy.Of the 87 patients,42 underwent standard lymph node dissection and 45 underwent enlarged lymph node dissection.There were 27 cases receiving extrahepatic bile duct reconstruction.The postoperative pathological results of 87 patients showed that 64 were diagnosed with gallbladder adenocarcinoma and 23 were diagnosed with gallbladder adenosquamous carcinoma.There were 59 cases comorbid with liver invasion and 3 cases comorbid with vascular invasion.The marginal histopathological examination showed negative margin in 63 cases and positive margin in 24 cases.The degree of tumor differentiation:there were 23 patients with highly differentiated tumor and 64 with poorly differentiated tumor.Of the 87 patients,43 received postoperative adjuvant therapy and 44 didn't receive adjuvant therapy.(2) Clinical efficacy of stage T3 gallbladder cancer and prognostic factors analysis.① All the 87 patients were followed up for 1.8-128.0 months,with a median follow-up time of 26.3 months.All the 87 patients had survived for 1.1 -82.7 months,with a median time of 20.1 months.The 2-year overall survival rate of patients was 59.8％,and the 2-year disease-free survival rate was 49.4％.② Univariate analysis showed that preoperative alkaline phosphatase (ALP) level,tumor diameter,pathological type of tumor,lymph node metastasis,and range of hepatectomy were associated factors for the postoperative 2-year overall survival rate of patients (x2 =5.451,4.900,8.256,4.419,5.858,P ＜ 0.05),and pathological type of tumor,lymph node metastasis,and range of hepatectomy were associated factors for the postoperative 2-year disease-free survival rate of patients (x2 =5.828,6.968,4.077,P＜ 0.05).Multivariate analysis showed that preoperative ALP level,tumor diameter,and lymph node metastasis were independent factors influencing the postoperative 2-year overall survival rate of patients [hazard ratio (HR) =2.539,2.619,2.201,95％ confidence interval (CI):1.174-5.491,1.209-5.673,1.104-4.391,P＜ 0.05)];pathological type of tumor and lymph node metastasis were independent factors influencing the postoperative 2-year disease-free survival rate of patients (HR =2.254,2.296,95％CI:1.170-4.344,1.206-4.374,P＜0.05).③ Survival analysis:pathological type of tumor was an associated factor for the postoperative 2-year overall survival rate and 2-year disease-free survival rate of patients.Of the 87 patients with T3 gallbladder cancer,there was no significant difference in the postoperative 2-year overall survival rate between the 64 patients with gallbladder adenocarcinoma and 23 with gallbladder adenosquamous carcinoma (68.8％ vs.34.8％,x2 =8.256,P＞0.05),but a significant difference in the postoperative 2-year disease-free survival rate between them (56.3％ vs.30.4％,x2=5.828,P＜0.05).(3) Clinical efficacy of stage T3 gallbladder adenocarcinoma and prognostic factors analysis.① Sixty-four patients with gallbladder adenocarcinoma had the median survival time of 23.1 months,with a range from 3.2 to 82.7 months.The postoperative 2-year overall survival rate was 68.8％,and the postoperative 2-year disease-free survival rate was 56.3％.② For the 64 patients with T3 stage gallbladder adenocarcinoma,univariate analysis showed that preoperative CA19-9 level and range of lymph node dissection were associated factors for the postoperative 2-year overall survival rate (x2=4.012,8.837,P＜0.05).The range of lymph node dissection was an associated factor for the postoperative 2-year disease-free survival rate (x2 =6.361,P＜0.05).Multivariate analysis showed that range of lymph node dissection was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate (HR =0.244,0.382,95％CI:0.088-0.674,0.176-0.831,P＜0.05).③ Survival analysis:range of lymph node dissection was an associated factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients.Of the 64 patients with T3 stage gallbladder adenocarcinoma,the postoperative 2-year overall survival rate and disease-free survival rate of patients undergoing enlarged lymph node dissection were 84.8％ and 69.7％,versus 51.6％ and 41.9％ of the patients undergoing standard lymph node dissection (x2 =8.837,6.361,P＜0.05).(4)Clinical efficacy of stage T3 gallbladder adenosquamous carcinoma and prognostic factors analysis.① Twenty-three patients with gallbladder adenosquamous carcinoma had the median survival time of 13.2 months,with a range from 1.1 to 70.3 months.The postoperative 2-year overall survival rate was 34.8％,and the postoperative 2-year disease-free survival rate was 30.4％.② For the 23 patients with T3 stage gallbladder adenosquamous carcinoma,univariate analysis showed that preoperative ALP level,lymph node metastasis,range of bepatectomy,and extrahepatic bile duct reconstruction were associated factors for the postoperative 2-year overall survival rate of patients (x2 =5.288,4.574,12.960,4.106,P＜0.05).The lymph node metastasis and range of hepatectomy were associated factors for the postoperative 2-year disease-free survival rate of patients (x2 =7.364,10.582,P＜0.05).Multivariate analysis showed that range of hepatectomy was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate (HR=0.102,0.153,95％CI:0.012-0.880,0.033-0.718,P＜0.05).③ Survival analysis:range of hepatectomy was an independant factor for both the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients.Of the 23 patients with T3 stage gallbladder adenosquamous carcinoma,the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients undergoing extended hepatectomy were 87.5％ and 75.0％,versus 6.7％ and 6.7％ of the patients undergoing hepatic wedge resection (x2 =12.960,10.528,P＜0.05).Conclusions Lymph node metastasis is an independent factor influencing the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with T3 stage gallbladder cancer.The range of lymph node dissection is an independent factor for the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with stage T3 gallbladder adenocarcinoma.Range of hepatectomy is an independent factor for the postoperative 2-year overall survival rate and postoperative 2-year disease-free survival rate of patients with stage T3 gallbladder adenosquamous carcinoma.Patients with gallbladder adenocarcinoma should undergo enlarged lymph node dissection,and patients with gallbladder adenosquamous carcinoma need to undergo extended hepatectomy.
ABSTRACT
AIM: To investigate the expression and clinical pathological significance of ROR2 and WNT5a in gallbladder squamous/adenosquamous carcinoma (SC/ASC) and adenocarcinoma (AC). METHODS: EnVision immunohistochemistry was used to stain for ROR2 and WNT5a in 46 SC/ASC patients and 80 AC patients. RESULTS: Poorly differentiated AC among AC patients aged > 45 years were significantly more frequent compared with SC/ASC patients, while tumors with a maximal diameter > 3 cm in the SC/ASC group were significantly more frequent compared with the AC group. Positive ROR2 and WNT5a expression was significantly lower in SC/ASC or AC with a maximal mass diameter ≤ 3 cm, a TNM stage of I + II, no lymph node metastasis, no surrounding invasion, and radical resection than in patients with a maximal mass diameter > 3 cm, TNM stage IV, lymph node metastasis, surrounding invasion, and no resection. Positive ROR2 expression in patients with highly differentiated SC/ASC was significantly lower than in patients with poorly differentiated SC/ASC. Positive ROR2 and WNT5a expression levels in highly differentiated AC were significantly lower than in poorly differentiated AC. Kaplan-Meier survival analysis showed that differentiation degree, maximal mass diameter, TNM stage, lymph node metastasis, surrounding invasion, surgical procedure and the ROR2 and WNT5a expression levels were closely related to average survival of SC/ASC or AC. The survival of SC/ASC or AC patients with positive expression of ROR2 and WNT5a was significantly shorter than that of patients with negative expression results. Cox multivariate analysis revealed that poor differentiation, a maximal diameter of the mass ≥ 3 cm, TNM stage III or IV, lymph node metastasis, surrounding invasion, unresected surgery and positive ROR2 or WNT5a expression in the SC/ASC or AC patients were negatively correlated with the postoperative survival rate and positively correlated with mortality, which are risk factors and independent prognostic predictors. CONCLUSION: SC/ASC or AC patients with positive ROR2 or WNT5a expression generally have a poor prognosis.
