Primary Peritoneal Carcinoma with Long Term Survival-A Case Report

Fetched: June 18th, 2021, 5:01am GMT by Takayuki Higashi

Gan To Kagaku Ryoho. 2021 Jun;48(6):829-832.

ABSTRACT

A 62-year-old woman underwent upper endoscopy in January 2009 to reveal the presence of an extrinsic compression measuring approximately 3 cm in the anterior wall of the gastric antrum. Further examinations suggested that it was caused by peritoneal cancer of an unknown origin; thus, staging laparoscopy was performed in May 2009. Multiple white nodules of varying sizes were found scattered throughout the right upper quadrant of the abdomen and the right abdomen. Based on a biopsy of the greater omentum, the patient was diagnosed with papillary serous adenocarcinoma. As no abnormalities were observed in the uterus and ovary, it was suspected that the patient had primary peritoneal cancer. Hence, in July 2009, the patient underwent resection of the greater omentum, gastric pylorus, gall bladder, and right hemicolon where the tumors were localized, as well as bilateral adnexectomy. Based on intraoperative findings and postoperative histology, the patient was diagnosed with high-grade primary peritoneal serous adenocarcinoma and received paclitaxel and carboplatin therapy. Subsequent follow-up examinations, including positron emission tomography-computed tomography(PET-CT), indicated repeated recurrences in the mesentery, the pelvic floor, and around the remnant stomach. After identifying these recurrences, the patient was treated with platinum-based drugs, experiencing repeated response and cessation cycles. Since September 2019, the patient has received olaparib therapy. PET-CT examination performed in September 2020 indicated that the patient remained in complete remission.

PMID:34139733
Success rate of microsatellite instability examination and complete response with pembrolizumab in biliary tract cancer

Fetched: June 15th, 2021, 5:01am GMT by Yugo Kai

JGH Open. 2021 May 21;5(6):712-716. doi: 10.1002/jgh3.12576. eCollection 2021 Jun.

ABSTRACT

BACKGROUND AND AIM: The success rate of microsatellite instability (MSI) examination in biliary tract cancer (BTC) and the treatment outcomes of pembrolizumab in patients with MSI-high (MSI-H) BTC have not been fully investigated. We examined the success rate of MSI examination and the rate of MSI-H status in patients with BTC as well as the treatment outcomes of patients with MSI-H status who underwent pembrolizumab treatment.

METHODS: We retrospectively reviewed 60 consecutive patients with unresectable or postoperative recurrent BTC who underwent MSI examination in a Japanese cancer referral center between January 2019 and September 2020.

RESULTS: The study included 24 intrahepatic cholangiocarcinomas, 12 hilar cholangiocarcinomas, 4 distal cholangiocarcinomas, 16 gallbladder carcinomas, and 4 ampullary carcinomas. The methods of cancer tissue sampling were percutaneous liver tumor biopsy in 26 cases, surgery in 15 cases, endoscopic ultrasound fine-needle aspiration in 12 cases, transpapillary bile duct biopsy in 5 cases, and others in 2 cases. The success rate of MSI examination was 98.3% (59 of 60). MSI examination failed in only one case using a surgical specimen due to time-dependent degradation of DNA. The frequency of MSI-H BTC was 3.3% (2 of 60 cases). One patient with MSI-H intrahepatic cholangiocarcinoma achieved a complete response with pembrolizumab treatment.

CONCLUSIONS: MSI examinations in BTC were successful in almost all cases, regardless of tissue sampling methods. We experienced a case in which pembrolizumab resulted in a complete response to MSI-H BTC. Since pembrolizumab for MSI-H BTC could prolong survival time, MSI examination should be performed proactively to increase treatment options.

PMID:34124390 | PMC:PMC8171157 | DOI:10.1002/jgh3.12576
Neuroendocrine Neoplasms of the Gallbladder: A Clinicopathological Analysis of 13 Patients and a Review of the Literature

Fetched: June 15th, 2021, 5:01am GMT by Pengyan Wang

Gastroenterol Res Pract. 2021 May 22;2021:5592525. doi: 10.1155/2021/5592525. eCollection 2021.

ABSTRACT

OBJECTIVES: Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNENs) are rare gallbladder neuroendocrine neoplasms (GB-NENs). This study is aimed at investigating the clinicopathological features of GB-NENs and identifying prognostic factors related to overall survival (OS) of GB-MiNENs.

METHODS: The clinical data and pathological features of 13 patients with GB-NENs in our hospital were retrospectively reviewed. Additionally, 41 GB-MiNENs cases reported in English literature were reviewed and survival analysis was performed.

RESULTS: The mean age of thirteen patients (6 males and 7 females) with GB-NENs was 57.2 years (range: 35-75 years). Two patients were diagnosed with NET grade 1 (G1), two patients with NEC (large cell/small cell = 1/1), and nine patients with MiNENs. Of these 9 patients with MiNENs, 8 had composite tumors and 1 had amphicrine carcinoma. Microscopically, the adenocarcinoma component was located in the surface mucosa, and the neuroendocrine component was in the area of deep invasion, liver infiltration, and lymph node metastasis. Total analysis of 41 GB-MiNENs showed that patients were mainly elderly women (female/male ratio, 2.4 : 1.0; median age, 60 years). Kaplan-Meier's analysis demonstrated that liver metastasis and TNM stage III-IV were associated with decreased OS (P < 0.05), whereas age, sex, tumor size, grade of the neuroendocrine component, lymph node metastasis, and adjuvant chemotherapy were not significantly prognostic indicators of OS. Multivariate analysis identified liver metastasis (hazard ratio = 4.262, 95%confidence interval = 1.066-17.044, P = 0.040) as an independent unfavorable prognostic factor.

CONCLUSIONS: GB-MiNENs were the most common type of GB-NENs in our case series, and neuroendocrine components exhibited more aggressive lymph node metastasis and local invasion than adenocarcinoma. Liver metastasis was a poor prognostic indicator in GB-MiNENs patients.

PMID:34122537 | PMC:PMC8166508 | DOI:10.1155/2021/5592525
Role of Bacteria in the Incidence of Common GIT Cancers: The Dialectical Role of Integrated Bacterial DNA in Human Carcinogenesis

Fetched: June 10th, 2021, 5:01am GMT by Sayed K Elagan

Infect Drug Resist. 2021 Jun 1;14:2003-2014. doi: 10.2147/IDR.S309051. eCollection 2021.

ABSTRACT

Despite the wide medical knowledge about the direct role of many viruses in the pathogenesis of certain cancers, there is still ambiguity and hazy vision about the direct role of bacteria in cancer incidence. Understanding the role of bacteria in carcinogenesis is no longer a scientific luxury, but it has become an urgent and extremely important necessity to realize the pathogenesis of cancer caused by oncogenic bacteria as an attempt to overcome the oncogenic mechanisms exhibited by these oncogenic bacteria. This review shed the light on the indirect role of the host's inflammatory and immunological responses in the pathogenesis of bacteria-induced cancer. Also, this review discussed the indirect role of the bacterial toxins and virulence factors in the induction of common gastrointestinal cancers, such as gallbladder cancer (GBC), colorectal cancer (CRC), and gastric cancer (GC). Finally, this review dealt with the debate about the possibility of bacterial DNA integration into the human genome and cancer incidence.

PMID:34103947 | PMC:PMC8179827 | DOI:10.2147/IDR.S309051
Diagnosis and staging of hepatobiliary malignancies: Potential incremental value of (18)F-FDG-PET/MRI compared to MRI of the liver

Fetched: June 10th, 2021, 5:01am GMT by Verena Carola Obmann

Nuklearmedizin. 2021 Jun 8. doi: 10.1055/a-1486-3671. Online ahead of print.

ABSTRACT

OBJECTIVE: The purpose of the study was to investigate the potential added value of ¹⁸F-FDG-PET/MRI (functional information derived from PET) over standard diagnostic liver MRI (excellent soft tissue characterization) in diagnosing and staging suspected primary hepatobiliary malignancies including extrahepatic cholangiocarcinoma (ECC), intrahepatic cholangiocellular carcinoma (ICC) and gallbladder cancer (GBCA).

METHODS: Twenty consecutive patients with suspected hepatobiliary malignancy were included in this retrospective study. All patients underwent combined whole-body (WB) ¹⁸F-FDG-PET/MRI including contrast-enhanced MRI of the liver, contrast-enhanced WB-MRI and WB ¹⁸F-FDG-PET. Two experienced readers staged hepatobiliary disease using TNM criteria: first based on MRI alone and then based on combined ¹⁸F-FDG-PET/MRI. Subsequently, the impact of FDG-PET/MRI on clinical management compared to MRI alone was recorded. Histopathologic proof served as the reference standard.

RESULTS: Hepatobiliary neoplasms were present in 16/20 patients (ECC n = 3, ICC n = 8, GBCA n = 5), two patients revealed benign disease, two were excluded. TNM staging with ¹⁸F-FDG-PET/MRI was identical to MRI alone in 11/18 (61.1 %) patients and correctly changed the stage in 4/18 (22.2 %), resulting in a change in management for 2/4 patients (11.1 %). ¹⁸F-FDG-PET/MRI was false-positive in 3/18 cases (16.7 %). Both MRI and ¹⁸F-FDG-PET/MRI were falsely positive in 1 case without malignancy.

CONCLUSIONS: A small incremental benefit of ¹⁸F-FDG-PET/MRI over standard MRI of the liver was observed. However, in some cases ¹⁸F-FDG-PET/MRI may lead to false-positive findings. Overall there is seemingly limited role of ¹⁸F-FDG-PET/MRI in patients with suspected hepatobiliary malignancy.

PMID:34102690 | DOI:10.1055/a-1486-3671
LncRNA TTN-AS1 acts as a tumor promoter in gallbladder carcinoma by regulating miR-107/HMGA1 axis

Fetched: June 9th, 2021, 5:01am GMT by Zhaoxia Lin

World J Surg Oncol. 2021 Jun 5;19(1):163. doi: 10.1186/s12957-021-02279-2.

ABSTRACT

BACKGROUND: The incidence of gallbladder carcinoma (GBM) in China has increased in recent years. Here, the functional mechanism of lncRNA TTN-AS1 in GBC was preliminary elucidated.

METHODS: The expression levels of lncRNA TTN-AS1, miR-107, and HMGA1 in tissues and cell lines were assessed by RT-qPCR. Cell proliferation was measured by MTT assays. Cell invasion and migration abilities were evaluated by Transwell assays. The relationship between miR-107 and lncRNA TTN-AS1 or HMGA1 was confirmed by luciferase reporter assay.

RESULTS: Upregulation of lncRNA TTN-AS1 and downregulation of miR-107 were detected in GBC. Furthermore, the expressions between TTN-AS1 and miR-107 were mutually inhibited in GBC. Functionally, lncRNA TTN-AS1 promoted cell viability and motility in GBC by sponging miR-107. In addition, miR-107 directly targets HMGA1. And HMGA1 can be positively regulated by lncRNA TTN-AS1 in GBC. Furthermore, HMGA1 promoted GBC progression by interacting with lncRNA TTN-AS1/miR-107 axis.

CONCLUSION: LncRNA TTN-AS1 acted as a tumor promoter in GBC by sponging miR-107 and upregulating HMGA1.

PMID:34090483 | PMC:PMC8180155 | DOI:10.1186/s12957-021-02279-2
Clinicopathological characteristics and prognosis of signet ring cell carcinoma of the gallbladder

Fetched: June 9th, 2021, 5:01am GMT by Shijie Wang

BMC Gastroenterol. 2021 Jun 6;21(1):248. doi: 10.1186/s12876-021-01831-4.

ABSTRACT

BACKGROUND: Signet ring cell carcinoma (SRC) is a rare histological subtype of gallbladder adenocarcinoma. The current study evaluates the clinicopathologic features and prognosis of SRC.

METHODS: Patients with adenocarcinoma of the gallbladder were identified in the Surveillance, Epidemiology, and End Results database from 1973 to 2016. Overall survival (OS) and cancer-specific survival (CSS) of patients who had SRC were compared with those of patients who had non-SRC using Cox regression and propensity score methods.

RESULTS: Of 22,781 gallbladder adenocarcinomas retrieved, 377 (1.7%) were SRC and the other 22,404 were non-SRC. SRC was more significantly associated with older age, female gender, poor differentiation, advanced tumor stage, lymph node metastasis, distant metastasis, and advanced AJCC stage. The 5-year OS and CSS in the SRC group were 7.2 and 6.5%, respectively, both of which were significantly worse than the 13.2 and 13.3% seen in the SRC group (P = 0.002 and P = 0.012, respectively). This survival disadvantage persisted in multivariable analyses [hazard ratio (HR) = 1.256, P = 0.021 and HR = 1.211, P = 0.036] and after propensity score matching (OS: HR = 1.341, P = 0.012 and CSS: HR = 1.625, P = 0.005). Surgery in combination with chemotherapy improved OS of gallbladder SRC patients compared with surgery alone (HR = 0.726, P = 0.036) or chemotherapy alone (HR = 0.433, P < 0.001).

CONCLUSION: Patients with SRC of the gallbladder have distinct clinicopathological features with poor prognosis. Surgery in combination with chemotherapy can improve survival.

PMID:34090347 | PMC:PMC8180115 | DOI:10.1186/s12876-021-01831-4
Black versus Clear (f.k.a. White) Bile

Fetched: June 9th, 2021, 5:01am GMT by Vincent Zimmer

Am J Med Sci. 2021 May;361(5):e47-e48. doi: 10.1016/j.amjms.2020.10.022. Epub 2020 Oct 26.

NO ABSTRACT

PMID:33773761 | DOI:10.1016/j.amjms.2020.10.022
Receptor-interacting protein in malignant digestive neoplasms

Fetched: June 8th, 2021, 5:01am GMT by Lilong Zhang

J Cancer. 2021 May 19;12(14):4362-4371. doi: 10.7150/jca.57076. eCollection 2021.

ABSTRACT

A deep and comprehensive understanding of factors that contribute to cancer initiation, progression, and evolution is of essential importance. Among them, the serine/threonine and tyrosine kinase-like kinases, also known as receptor interacting proteins (RIPs) or receptor interacting protein kinases (RIPKs), is emerging as important tumor-related proteins due to its complex regulation of cell survival, apoptosis, and necrosis. In this review, we mainly review the relevance of RIP to various malignant digestive neoplasms, including esophageal cancer, gastric cancer, colorectal cancer, hepatocellular carcinoma, gallbladder cancer, cholangiocarcinoma, and pancreatic cancer. Consecutive research on RIPs and its relationship with malignant digestive neoplasms is required, as it ultimately conduces to the etiology and treatment of cancer.

PMID:34093836 | PMC:PMC8176420 | DOI:10.7150/jca.57076
Simultaneous occurrence of autoimmune pancreatitis and sclerosing cholangitis as immune-related adverse events of pembrolizumab

Fetched: June 6th, 2021, 5:01am GMT by Tsuyoshi Suda

BMJ Case Rep. 2021 Jun 4;14(6):e243360. doi: 10.1136/bcr-2021-243360.

ABSTRACT

A 57-year-old man with lung cancer, previously treated with the programmed death-1 inhibitor pembrolizumab, was evaluated for liver injury and acute pancreatitis. Serum IgG4 levels were not elevated. Contrast-enhanced CT showed pancreatic swelling, contrast unevenness in the liver and thickening of the common bile duct and gall bladder. Magnetic resonance cholangial pancreatography revealed beads in the left intrahepatic bile duct and localised narrowing of the head and body of the central pancreatic duct. Endoscopic ultrasound-guided fine-needle and liver needle biopsy showed CD8+ and CD4+ T lymphocyte aggregates, whereas immunostaining revealed greater infiltration by CD8+ cells than CD4+ cells. IgG4-related disease was ruled out based on serum and pathological findings. The patient simultaneously presented with immune-related adverse events, autoimmune pancreatitis-like features and sclerosing cholangitis, which were ameliorated by steroid therapy. CD8+ lymphocytes were the dominant infiltrating cells in autoimmune pancreatitis and sclerosing cholangitis.

PMID:34088696 | PMC:PMC8183231 | DOI:10.1136/bcr-2021-243360
Multidisciplinary management of the primary liver cancers

Fetched: June 5th, 2021, 5:01am GMT by O Detry

Rev Med Liege. 2021 May;76(5-6):519-524.

ABSTRACT

In Belgium and around the world, the incidence of primary malignant liver tumours is increasing, both for hepatocarcinoma and cholangiocarcinoma. Their curative treatment is based on multidisciplinary and specialized care, of which surgery (including liver transplantation) remains the cornerstone, often associated with other logoregional treatments, as radioembolisation, radiofrequency ablation, and chemoembolisation. For advanced cases, the prognosis remains poor, in particular due to a certain chemoresistance of these tumours. New treatments include targeted therapies (including various tyrosine kinase inhibitors) and immunotherapy. A specialized multidisciplinary discussion is therefore necessary to define the best therapeutic management, individualized to each patient. In this article, the authors review the most recent data relating to the treatment of hepatocarcinoma and cholangiocarcinoma.

PMID:34080390
Programmed Death Ligand 1 Expression as a Prognostic Marker in Patients with Advanced Biliary Tract Cancer

Fetched: June 3rd, 2021, 5:01am GMT by Hyera Kim

Oncology. 2021;99(6):365-372. doi: 10.1159/000514404. Epub 2021 Mar 17.

ABSTRACT

BACKGROUND: Biliary tract cancer (BTC) is associated with poor prognosis because of its aggressive and heterogeneous nature. Programmed death ligand 1 (PD-L1) has been considered a novel biomarker for prognosis and response of immune checkpoint inhibitors in various tumors. However, there are limited data reporting on the role of PD-L1 in advanced BTC patients.

PATIENTS AND METHODS: We analyzed 186 patients with advanced BTC who received palliative gemcitabine and platinum between May 2010 and December 2019. All patients were evaluated for PD-L1 expression by combined positive score positivity.

RESULTS: Of the 186 patients, the primary tumor location was intrahepatic cholangiocarcinoma (IHCC) in 72 (38.7%), extrahepatic cholangiocarcinoma (EHCC) in 90 (48.4%), and gallbladder (GB) cancer in 24 (12.9%). Among all the patients, 53 (28.5%) had PD-L1 positivity. The median overall survival (OS) of patients with PD-L1 positivity or negativity was 12.1 and 15.4 months, respectively. The median progression-free survival (PFS) in patients with PD-L1 positivity or negativity was 5.7 and 7.1 months, respectively. OS and PFS were not statistically different between groups. In subgroup analysis, EHCC patients with PD-L1 negativity had more favorable OS (17.2 vs. 11.6 months, p = 0.002) and PFS (7.8 vs. 5.4 months, p = 0.005) than those who were PD-L1-positive. However, this finding was not reproduced in patients with IHCC or GB cancer.

CONCLUSION: This study demonstrated that PD-L1 expression might be a novel prognostic biomarker in patients with EHCC but not in patients with IHCC or GB cancer.

PMID:33730723 | DOI:10.1159/000514404
Prognostic Nomograms to Predict Survival of Patients with Resectable Gallbladder Cancer: A Surveillance, Epidemiology, and End Results (SEER)-Based Analysis

Fetched: June 2nd, 2021, 5:01am GMT by Yan Lin

Med Sci Monit. 2021 Mar 30;27:e929106. doi: 10.12659/MSM.929106.

ABSTRACT

BACKGROUND Gallbladder adenocarcinoma (GBAC) is globally acknowledged as one of the most common malignancies among all gastrointestinal cancers. Despite prognosis of GBAC patients remains poor, patients with early-stage disease can be observed with long-term survival. MATERIAL AND METHODS In this study, 2556 patients with pathological GBAC between 2010 and 2015 were derived from the Surveillance, Epidemiology, and End Results (SEER) database. The prognostic nomograms containing all independent prognostic factors for predicting overall survival (OS) and cancer-specific survival (CSS) were constructed to achieve superior prognostic discriminatory ability. RESULTS Based on the AJCC 7th TNM staging system, we found the TNM substaging was not accurate enough to predict the survival and stratify the risk. Based on the results of univariate and multivariate analyses, a more precise prognostic nomogram was constructed containing all significant independent prognostic factors (age, grade, TNM stage, bone metastasis, and chemotherapy) for OS, while age, grade, TNM stage, bone metastasis and radiotherapy significant independent prognostic factors for CSS. The C-index of the constructed nomogram for predicting OS and CSS was 0.740 and 0.737 higher than that of TNM staging alone (0.667 for OS and 0.689 for CSS), respectively. In addition, the calibration curves and decision curve analysis further showed its robust power in survival prediction. CONCLUSIONS The constructed nomograms showed better discrimination abilities to predict OS and CSS rates at 1, 3, and 5 years. In the future, these constructed models for this disease will assist in risk stratification to guide GBAC treatment.

PMID:33784268 | PMC:PMC8019267 | DOI:10.12659/MSM.929106
The optimal extent of surgery in T2 gallbladder cancer and the need for hepatectomy: A meta-analysis

Fetched: May 31st, 2021, 5:01am GMT by Pipit Burasakarn

Asian J Surg. 2021 May 26:S1015-9584(21)00262-1. doi: 10.1016/j.asjsur.2021.05.005. Online ahead of print.

ABSTRACT

Extensive surgery is the mainstay treatment for gallbladder cancer and offers a long-term survival benefits to the patients. However, the optimal extent of surgery remains debatable. We aimed to perform a meta-analysis of hepatectomy and no hepatectomy approaches in patients with T2 gallbladder cancer. We searched the following electronic databases for systematic literature: PubMed, Google Scholar, and the Cochrane Library. We selected studies that compared patients with T2 gallbladder cancer who underwent hepatectomy with those who did not. While the long-term overall survival (OS) and disease-free survival (DFS) were the primary outcomes, perioperative morbidity and mortality were the secondary outcome. We analysed over 18 studies with 4,587 patients. Of the total patients, 1,683 and 1,303 patients underwent hepatectomy and no hepatectomy, respectively. The meta-analysis revealed no significant difference between the hepatectomy and no hepatectomy groups, in terms of the overall morbidity (risk ratio [RR] = 1.85, 95% confidence interval [CI] = 0.66-5.20) and 30-day mortality (RR = 0.9, 95% CI = 0.1-8.2). The results were comparable in terms of the OS (RR = 0.76, 95% CI = 0.57-1.01), (HR = 0.74, 95% CI = 0.49-1.12), and DFS (RR = 0.99, 95% CI = 0.88-1.11). In conclusion, the perioperative and long-term outcomes of hepatectomy and no hepatectomy approaches were comparable. Hepatectomy may not be required in T2 gall bladder cancer if the preoperative evaluation confirms the depth of the tumour in the perimuscular connective tissue and the intraoperative frozen sections confirm microscopic negative margins. Likewise, for those whom gall bladder cancer was diagnosed from the pathological report after simple cholecystectomy, further hepatectomy may not necessary.

PMID:34052085 | DOI:10.1016/j.asjsur.2021.05.005
Retrospective sequential trend analysis of neoplasms reported in a tertiary care hospital of district Etawah, Uttar Pradesh

Fetched: May 28th, 2021, 5:01am GMT by Sushil K Shukla

J Family Med Prim Care. 2021 Mar;10(3):1419-1424. doi: 10.4103/jfmpc.jfmpc_1468_20. Epub 2021 Apr 8.

ABSTRACT

INTRODUCTION: An estimated 2.25 million new cancer cases with 7 lakh cancer deaths were reported, according to GLOBOCAN 2018 in India. There is a steady rise in cancer cases, but trends and patterns vary within the state depending on the geographic region.

OBJECTIVES: To study the proportion and site-wise distribution of neoplasm reported at a tertiary care hospital in district Etawah, Uttar Pradesh, India.

MATERIAL AND METHODS: A record based retrospective study was conducted at a tertiary care hospital in district Etawah, Uttar Pradesh. Total four years (from 2015 to 2018) hospital-based retrospective data were collected from the Medical Record Department. Identification and distribution of malignant neoplasm were done according to the WHO ICD-10 classification.

RESULTS: Total cases diagnosed with malignancy from January 2015 to December 2018 were 3614. Cancer cases reported over the years was 932 (25.8%) in 2015, 1031 (28.5%) cases in 2016, 897 (24.8%) in 2017 and 754 (20.9%) in 2018. It was found that breast carcinoma (24.0%) accounted for the maximum number of cases diagnosed, followed by lung carcinoma (10.9%), cervical cancer (8.7%), gall bladder carcinoma (8%), and oral cavity cancer (7.9%).

CONCLUSION: The present study reveals that the malignancy of the breast is most common, followed by malignancies of lung, cervix, and gall bladder among the patients who were seeking care in a tertiary care hospital of the district Etawah Uttar Pradesh, India.

PMID:34041188 | PMC:PMC8140243 | DOI:10.4103/jfmpc.jfmpc_1468_20
Unraveling Neuroendocrine Gallbladder Cancer: Comprehensive Clinicopathologic and Molecular Characterization

Fetched: May 27th, 2021, 5:01am GMT by Tessa J J de Bitter

JCO Precis Oncol. 2021 Mar 8;5:PO.20.00487. doi: 10.1200/PO.20.00487. eCollection 2021.

ABSTRACT

PURPOSE: Neuroendocrine carcinomas and mixed neuroendocrine non-neuroendocrine neoplasms of the gallbladder (NE GBC) are rare and highly aggressive entities. The cell of origin of NE GBC has been a matter of controversy. Here, we performed a comparative histopathologic and molecular analysis of NE GBC cases and, if present, associated precancerous lesions.

PATIENTS AND METHODS: We selected cases diagnosed between 2000 and 2019 in the Netherlands. Precursors and carcinomas were immunohistochemically compared and analyzed for mutations, gene amplifications, microsatellite instability, and tumor mutational burden using an next-generation sequencing panel containing 523 cancer-related genes. In addition, presence of fusion genes was analyzed using a panel of 55 genes.

RESULTS: Sixty percent of neuroendocrine cases (6/10) presented with a precursor lesion, either intracholecystic papillary neoplasm (n = 3) or biliary intraepithelial neoplasia (n = 3). Immunohistochemically, neuroendocrine components were different from the epithelial precursor lesions. Molecular profiling, however, revealed TP53 mutations shared between different components in five of six cases, indicating a clonal relation. Furthermore, 40% of cases (4/10) harbored at least one potentially actionable alteration. This included (likely) pathogenic mutations in RAD54L, ATM, and BRCA2; amplifications of ERBB2 and MDM2; and a gene fusion involving FGFR3-TACC3. All cases were microsatellite-stable and had a tumor mutational burden of < 10 mutations/Mb.

CONCLUSION: Our data provide insight into the development of NE GBC and suggest a common origin of precancerous epithelial lesions and invasive neuroendocrine components, favoring the hypothesis of lineage transformation. Moreover, nearly half of the NE GBCs carried at least one potentially actionable molecular alteration, highlighting the importance of molecular testing in this highly lethal cancer.

PMID:34036234 | PMC:PMC8140808 | DOI:10.1200/PO.20.00487
Professor SHAO Ming-xi's experience in differentiation and treatment of arthralgia in breast cancer with acupuncture, moxibustion and tuina

Fetched: May 20th, 2021, 5:01am GMT by Xiao-Meng Liu

Zhongguo Zhen Jiu. 2021 May 12;41(5):541-4. doi: 10.13703/j.0255-2930.20200326-k0003.

ABSTRACT

Professor SHAO Ming-xi 's experience in treatment of arthralgia in breast cancer is summarized. Professor SHAO believes that the dysfunction of liver, spleen and kidney is the primary and the invasion of the exogenous wind, cold and damp is the secondary in arthralgia in breast cancer. Emphasized on syndrome/pattern differentiation, this disorder is identified as 4 patterns, i.e. liver qi stagnation, blockage by phlegm and stasis, qi and blood deficiency and obstruction by wind, cold and damp. Acupuncture-moxibustion is applied to Hegu (LI 4), Taichong (LR 3) and Waiguan (TE 5). The supplementary acupoints are selected on the base of syndrome/pattern differentiation. Tuina is combined with acupuncture-moxibustion and the reinforcing and reducing techniques are used appropriately. Shaoyang meridian is specially considered, due to which, Waiguan (TE 5) and Zhongzhu (TE 3) of triple energizer meridian of hand-shaoyang and Yanglingquan (GB 34) and Zulinqi (GB 41) of gallbladder meridian of foot-shaoyang are combined. Additionally, it stresses the combination of the local and distal acupoints and the coordination of various therapies of TCM to achieve the better effect.

PMID:34002570 | DOI:10.13703/j.0255-2930.20200326-k0003
Molecular Oncology of Gall Bladder Cancer

Fetched: May 18th, 2021, 5:01am GMT by Arun Chaturvedi

Indian J Surg Oncol. 2021 Apr;12(Suppl 1):57-64. doi: 10.1007/s13193-019-01008-2. Epub 2019 Nov 16.

ABSTRACT

Gall bladder carcinoma (GBC) is a worldwide problem, with a higher incidence in areas of the world where cholelithiasis is common. As GBC is usually diagnosed in an advanced stage, the mortality is high. An understanding of the molecular pathways of carcinogenesis and the mutations involved in the development and progression of GBC could be useful in early diagnosis. Understanding molecular markers of prognosis as well as predictors of outcome could also potentially benefit patients undergoing treatment. New therapies targeting major molecular pathways and immunotherapy are exciting novel therapeutic options. This review focuses on the current understanding of the molecular oncology of GBC.

PMID:33994729 | PMC:PMC8119519 | DOI:10.1007/s13193-019-01008-2
Second-line FOLFOX chemotherapy versus active symptom control for advanced biliary tract cancer (ABC-06): a phase 3, open-label, randomised, controlled trial

Fetched: May 18th, 2021, 5:01am GMT by Angela Lamarca

Lancet Oncol. 2021 May;22(5):690-701. doi: 10.1016/S1470-2045(21)00027-9. Epub 2021 Mar 30.

ABSTRACT

BACKGROUND: Advanced biliary tract cancer has a poor prognosis. Cisplatin and gemcitabine is the standard first-line chemotherapy regimen, but no robust evidence is available for second-line chemotherapy. The aim of this study was to determine the benefit derived from second-line FOLFOX (folinic acid, fluorouracil, and oxaliplatin) chemotherapy in advanced biliary tract cancer.

METHODS: The ABC-06 clinical trial was a phase 3, open-label, randomised trial done in 20 sites with expertise in managing biliary tract cancer across the UK. Adult patients (aged ≥18 years) who had histologically or cytologically verified locally advanced or metastatic biliary tract cancer (including cholangiocarcinoma and gallbladder or ampullary carcinoma) with documented radiological disease progression to first-line cisplatin and gemcitabine chemotherapy and an Eastern Cooperative Oncology Group performance status of 0-1 were randomly assigned (1:1) centrally to active symptom control (ASC) and FOLFOX or ASC alone. FOLFOX chemotherapy was administered intravenously every 2 weeks for a maximum of 12 cycles (oxaliplatin 85 mg/m², L-folinic acid 175 mg [or folinic acid 350 mg], fluorouracil 400 mg/m² [bolus], and fluorouracil 2400 mg/m² as a 46-h continuous intravenous infusion). Randomisation was done following a minimisation algorithm using platinum sensitivity, serum albumin concentration, and stage as stratification factors. The primary endpoint was overall survival, assessed in the intention-to-treat population. Safety was also assessed in the intention-to-treat population. The study is complete and the final results are reported. This trial is registered with ClinicalTrials.gov, NCT01926236, and EudraCT, 2013-001812-30.

FINDINGS: Between March 27, 2014, and Jan 4, 2018, 162 patients were enrolled and randomly assigned to ASC plus FOLFOX (n=81) or ASC alone (n=81). Median follow-up was 21·7 months (IQR 17·2-30·8). Overall survival was significantly longer in the ASC plus FOLFOX group than in the ASC alone group, with a median overall survival of 6·2 months (95% CI 5·4-7·6) in the ASC plus FOLFOX group versus 5·3 months (4·1-5·8) in the ASC alone group (adjusted hazard ratio 0·69 [95% CI 0·50-0·97]; p=0·031). The overall survival rate in the ASC alone group was 35·5% (95% CI 25·2-46·0) at 6 months and 11·4% (5·6-19·5) at 12 months, compared with 50·6% (39·3-60·9) at 6 months and 25·9% (17·0-35·8) at 12 months in the ASC plus FOLFOX group. Grade 3-5 adverse events were reported in 42 (52%) of 81 patients in the ASC alone group and 56 (69%) of 81 patients in the ASC plus FOLFOX group, including three chemotherapy-related deaths (one each due to infection, acute kidney injury, and febrile neutropenia). The most frequently reported grade 3-5 FOLFOX-related adverse events were neutropenia (ten [12%] patients), fatigue or lethargy (nine [11%] patients), and infection (eight [10%] patients).

INTERPRETATION: The addition of FOLFOX to ASC improved median overall survival in patients with advanced biliary tract cancer after progression on cisplatin and gemcitabine, with a clinically meaningful increase in 6-month and 12-month overall survival rates. To our knowledge, this trial is the first prospective, randomised study providing reliable, high-quality evidence to allow an informed discussion with patients of the potential benefits and risks from second-line FOLFOX chemotherapy in advanced biliary tract cancer. Based on these findings, FOLFOX should become standard-of-care chemotherapy in second-line treatment for advanced biliary tract cancer and the reference regimen for further clinical trials.

FUNDING: Cancer Research UK, StandUpToCancer, AMMF (The UK Cholangiocarcinoma Charity), and The Christie Charity, with additional funding from The Cholangiocarcinoma Foundation and the Conquer Cancer Foundation Young Investigator Award for translational research.

PMID:33798493 | PMC:PMC8082275 | DOI:10.1016/S1470-2045(21)00027-9
Prognostic implications of the coexisting precursor lesion types in invasive gallbladder cancer

Fetched: May 16th, 2021, 5:01am GMT by Naoki Mochidome

Hum Pathol. 2021 May 11;114:44-53. doi: 10.1016/j.humpath.2021.05.001. Online ahead of print.

ABSTRACT

Invasive gallbladder carcinoma (GBC) is preceded by two main types of precursor lesions: intracholecystic papillary-tubular neoplasms (ICPNs) and biliary intraepithelial neoplasias (BilINs). Invasive GBCs with an ICPN component have more favorable prognoses than those without an ICPN component. Some BilINs show a relatively exophytic papillary pattern but do not meet the ICPN criteria; at our institution, we call these papillary neoplasias. To clarify the clinical significance of papillary neoplasia, we herein examined 80 invasive GBCs and classified them into three groups based on the type of preinvasive lesions: those with ICPN (ICPN group, n = 35), those with papillary neoplasia (pap-neoplasia group, n = 13), and those without ICPN/papillary neoplasia (group without ICPN/pap-neoplasia, n = 32). We then compared the prognostic differences and characterized the tumors of each group by determining the immunohistochemical expressions of various biomarkers. The overall survival periods of the ICPN and pap-neoplasia groups were significantly longer than that of the group without ICPN/pap-neoplasia (P < 0.0001, P = 0.0036, respectively). Multivariate analysis revealed that lacking ICPN/papillary neoplasia was independently associated with poor prognosis (P = 0.0007), as were poor differentiation (P = 0.0395), presence of preoperative symptoms (P = 0.0488), and advanced stage (P = 0.0234). Invasive components of the ICPN and pap-neoplasia groups were characterized by higher expressions of p16 and p53 compared with those of the group without ICPN/pap-neoplasia. The prognoses of the invasive GBCs with either papillary neoplasia or ICPN were thus more favorable than those of the invasive GBCs without ICPN/pap-neoplasia. Invasive GBCs with exophytic papillary preinvasive lesions (ICPN and papillary neoplasia) may be biologically different from those without such lesions.

PMID:33989638 | DOI:10.1016/j.humpath.2021.05.001
ASO Author Reflections: Gallbladder Cancer Research, "One for All and All for One" Strategy to Improve Research

Fetched: May 15th, 2021, 5:01am GMT by Eduardo A Vega

Ann Surg Oncol. 2021 May;28(5):2683-2684. doi: 10.1245/s10434-021-09628-1. Epub 2021 Mar 14.

NO ABSTRACT

PMID:33718976 | PMC:PMC7955947 | DOI:10.1245/s10434-021-09628-1
Rare Mixed Adenoneuroendocrine Carcinoma of the Gallbladder: Case Report and Review of Literature

Fetched: May 15th, 2021, 5:01am GMT by Adriano C Costa

Am J Case Rep. 2021 May 4;22:e929511. doi: 10.12659/AJCR.929511.

ABSTRACT

BACKGROUND Mixed adenoneuroendocrine carcinoma of the gallbladder (gMANEC) is an extremely rare cancer. Most of the cases are reported in Asia, North America, and Europe, with no cases reported in Latin America; this is the first report for this region, and the 24th case reported worldwide. CASE REPORT A 68-year-old woman was referred to our department due to asthenia and moderate abdominal pain in the right upper quadrant for 6 months, with imaging examinations showing a solid heterogeneous expansive lesion in gallbladder topography and segment IV of the liver. The MRI displayed an expansive and heterogeneous lesion with inaccurate limits in the gallbladder affecting segment IVb of the liver, in addition to lymphadenopathy in the hepatic hilum. A cholecystectomy with resection of segments IV-B and V of the liver (radical cholecystectomy) and hepatic hilar lymphadenectomy were performed. Anatomopathological examination and immunohistochemistry confirmed a primary mixed adenoneuroendocrine carcinoma of the gallbladder. The patient received adjuvant chemotherapy and radiotherapy; however, after the patient reported experiencing low back pain, a CT was performed, revealing retroperitoneal metastasis, and the radiotherapy was interrupted. Currently, the patient has a stable disease, following a protocol of 5-Fluorouracil and somatostatin, and she reports having low back pain of low intensity. CONCLUSIONS This is the 24th gMANEC case reported in the literature. The tumor was successfully resected; however, the patient presented retroperitoneal metastasis 6 months after surgery, despite combined adjuvant therapy.

PMID:33945521 | PMC:PMC8105744 | DOI:10.12659/AJCR.929511
Frequency of gall bladder carcinoma in cholecystectomies performed for symptomatic cholelithiasis

Fetched: May 15th, 2021, 5:01am GMT by Muhammad Amar Qudeer

J Pak Med Assoc. 2021 Feb;71(2(B)):779. doi: 10.47391/JPMA.660.

NO ABSTRACT

PMID:33941983 | DOI:10.47391/JPMA.660
Primary clear cell carcinoma of gallbladder arising in porcelain gallbladder

Fetched: May 15th, 2021, 5:01am GMT by Sujata Sarangi

BMJ Case Rep. 2021 Apr 1;14(4):e240319. doi: 10.1136/bcr-2020-240319.

ABSTRACT

Gallbladder carcinomas (GBCs) are the most common carcinomas of the biliary tract. The clear cell variant is encountered rarely, accounting for approximately 1% of all GBCs.Due to its rarity, the exact incidence and pathogenesis of this variant are unknown. Though hyalinising cholecystitis (porcelain gallbladder) is an established risk factor for development of conventional adenocarcinomas of the gallbladder, its role in the pathogenesis of the rare variants of GBC is not well-established. The current case raises the possibility that clear cell carcinoma of the gallbladder may arise through the same pathways as conventional adenocarcinomas of the gallbladder.

PMID:33795272 | PMC:PMC8021755 | DOI:10.1136/bcr-2020-240319
SERPINB5 Genetic Variants rs2289519 and rs2289521 are Significantly Associated with Gallbladder Cancer Risk

Fetched: May 13th, 2021, 5:01am GMT by Biswaheree Mahananda

DNA Cell Biol. 2021 May;40(5):706-712. doi: 10.1089/dna.2021.0056. Epub 2021 Mar 10.

ABSTRACT

Serine protease inhibitor b5 (SERPINB5) is a tumor suppressor gene that plays a critical role in various cellular processes. In gallbladder cancer (GBC), SERPINB5's aberrant expression is reported but its role in genetic predisposition is not known. We enrolled 270 cases and 296 controls and genotyped them for single nucleotide polymorphisms (SNPs) using direct DNA sequencing, followed by genotype-phenotype analysis in GBC and other cancer cell lines. Luciferase assay was done to determine the role of rs2289521 SNP on expression regulation. We found that two SERPINB5 variants rs2289519 and rs2289521 are significantly associated with GBC and contribute to genetic predisposition. The TT genotype of variant rs2289519 was found to be significantly associated (p = 0.008) with GBC in a recessive model. C allele of rs2289521 increased the risk for GBC significantly at genotypic (CT, p = 0.026) and allelic (p = 0.04) levels. In silico analysis and luciferase assay uncovered the probable regulatory role of the rs2289521 variant on expression. Genotype-phenotype correlation in GBC and breast cancer cell lines showed reduced expression of SERPINB5 in the presence of C allele that was consistent with the result of luciferase assay. Overall, our study reveals the genetic association of two SERPINB5 variants with GBC and rs2289521's possible role in the regulation of expression.

PMID:33691472 | DOI:10.1089/dna.2021.0056
Ivosidenib: an investigational drug for the treatment of biliary tract cancers

Fetched: May 13th, 2021, 5:01am GMT by Angelos Angelakas

Expert Opin Investig Drugs. 2021 Apr;30(4):301-307. doi: 10.1080/13543784.2021.1900115. Epub 2021 Apr 26.

ABSTRACT

Introduction: Biliary tract cancers (BTCs) [including cholangiocarcinoma and gallbladder cancer] are rare cancers associated with poor survival; most patients have advanced disease at diagnosis. Current chemotherapy reference regimens include cisplatin and gemcitabine as first-line; and oxaliplatin and 5-fluorouracil (FOLFOX) in second-line. Molecular profiling has identified several actionable therapeutic targets including isocitrate dehydrogenase (IDH)1 mutations. Ivosidenib is a reversible inhibitor of mutant IDH1; it is currently approved for the treatment of acute myeloid leukemia and has been studied in patients with advanced cholangiocarcinoma.Areas covered: This article introduces current treatments for BTC and sheds light on the mechanism of action, pharmacodynamics, pharmacokinetics, clinical efficacy, and safety of ivosidenib in advanced cholangiocarcinoma. The authors conclude with insights on the changing treatment paradigm created by emerging drugs and precision approaches.Expert opinion: Ivosidenib is well tolerated, with good oral exposure and long half-life as shown by phase I data. In a phase III study, ivosidenib has demonstrated improved progression-free survival compared to placebo (median 2.7 vs 1.4 months; hazard ratio 0.37; 95% confidence interval 0.25-0.54; one-sided p < 0.0001); it has also demonstrated a trend toward increased overall survival in patients with cholangiocarcinoma and disease progression on prior chemotherapy. Final survival data from this study are pending presentation. Increased use of molecular profiling will continue to identify potential therapeutic targets and improve the prognosis of patients with these cancers.

PMID:33683991 | DOI:10.1080/13543784.2021.1900115
Expression and functional characterization of INPP4B in gallbladder cancer patients and gallbladder cancer cells

Fetched: May 11th, 2021, 5:01am GMT by Youliang Wu

BMC Cancer. 2021 Apr 20;21(1):433. doi: 10.1186/s12885-021-08143-6.

ABSTRACT

BACKGROUND: Inositol polyphosphate 4-phosphatase type II (INPP4B) is a negative regulator of the PI3K-Akt signalling pathway and plays a contradictory role in different types of cancers. However, the its biological role played by INPP4B in human gallbladder cancer (GBC) has not been elucidated. In this study, we investigated the expression, clinical significance and biological function of INPP4B in GBC patients and cell lines.

METHODS: The INPP4B protein expression levels in gallbladder cancer tissues and normal gallbladder tissues were detected by immunohistochemistry, and the clinical significance of INPP4B was analysed. Knockdown and overexpression of INPP4B in GBC-SD and SGC-996 cells followed by cell proliferation, clonogenic, apoptosis detection, scratch wound-healing and transwell assays were used to identify INPP4B function in vitro.

RESULTS: INPP4B was up-regulated in human GBC tissues compared with normal gallbladder tissues and was related to histopathological differentiation (p = 0.026). Here, we observed that INPP4B was highly expressed in high-moderately differentiated tumours compared with low-undifferentiated tumours (p = 0.022). Additionally, we found that INPP4B expression was not associated with overall survival of GBC patients (p = 0.071) and was not an independent prognostic factor. Furthermore, when we stratified the relationship between INPP4B expression and the prognosis of GBC based on histopathological differentiation, we found that INPP4B played a contradictory role in GBC progression depending on the degree of differentiation. In addition, INPP4B knockdown inhibited the proliferation, colony formation, migration and invasion in GBC cells, while INPP4B overexpression had the opposite effects in vitro, which indicates its role as an oncoprotein.

CONCLUSIONS: These findings suggested that INPP4B may play a dual role in the prognosis of GBC depending on the degree of differentiation and that INPP4B might act as an oncogene in gallbladder cancer cells.

PMID:33879096 | PMC:PMC8056679 | DOI:10.1186/s12885-021-08143-6
Squamous cell carcinoma of the gallbladder complicating a cystic dilation of the cystic duct and common bile duct: a case report

Fetched: May 5th, 2021, 5:01am GMT by Mohamed Boudou

Pan Afr Med J. 2021 Feb 9;38:144. doi: 10.11604/pamj.2021.38.144.22684. eCollection 2021.

ABSTRACT

Congenital cystic disease of the biliary tree is a known risk factor for gallbladder cancer. We here report a case of squamous cell carcinoma of the bile duct (BD) complicating a cystic dilatation of the bile ducts in a 54-year-old woman hospitalized for biliary pancreatitis. Abdominal scanner showed nodular thickening of the fundus of the gallbladder and fusiform dilation of the cystic duct and the main bile duct (VBP) with lesion of the tail of the pancreas, initially suggesting mucinous cystadenoma. Extended cholecystectomy involving the gallbladder fossa with resection of the distal biliary tract, choledocoduodenal anastomosis with caudal splenopancreatectomy + drainage were performed. Histopathological examination of the gallbladder mass revealed moderately differentiated invasive squamous cell carcinoma without infiltration of the hepatic parenchyma. The patient underwent adjuvant chemotherapy. The patient did not have the common symptoms of gallbladder cancer. Then radiology was necessary to make a diagnosis. Surgery is the best therapeutic option for early-stage gallbladder cancer, but adjuvant chemo-radiation may also be useful in treating these patients. Cholecystectomy with resection of cystic dilatation of the bile duct in high-risk patients are the most effective means of prevention.

PMID:33912314 | PMC:PMC8052619 | DOI:10.11604/pamj.2021.38.144.22684
Chronic lymphoid leukemia metastasis to the gallbladder as a focal mass: A case report

Fetched: May 4th, 2021, 5:01am GMT by Abtin Jafroodifar

Radiol Case Rep. 2021 Apr 15;16(6):1477-1484. doi: 10.1016/j.radcr.2021.03.018. eCollection 2021 Jun.

ABSTRACT

Chronic lymphocytic leukemia (CLL) is the second most common hematologic malignancy, and it is characterized by lymphocytic leukocytosis and secondary hematologic deficiencies. While it most commonly presents as a systemic disease, extramedullary involvement may rarely occur. The literature surrounding CLL metastatic disease to the gallbladder is particularly sparse. Interestingly, we describe a case of a 67-year-old female who presented with painless jaundice and was found to have a rapidly growing gallbladder wall mass which was determined to be CLL metastatic disease after extensive surgical resection. It is important for radiologists to recognize the possibility of CLL metastatic disease to the gallbladder when evaluating potential cases of cholecystitis due to the overlapping spectrum of imaging findings. Cognizant radiologists can potentially save patients from surgical intervention as CLL is classically treated with chemotherapy.

PMID:33936353 | PMC:PMC8079244 | DOI:10.1016/j.radcr.2021.03.018
Endoscopic drainage for management of infected necrosis following EUS-TA in a patient with pancreatic cancer: A case report

Fetched: May 4th, 2021, 5:01am GMT by Young Jung Kim

Medicine (Baltimore). 2021 Apr 23;100(16):e25466. doi: 10.1097/MD.0000000000025466.

ABSTRACT

RATIONALE: Endoscopic ultrasonography-guided tissue acquisition (EUS-TA) has become the norm for the diagnosis of pancreatic solid lesions. EUS-TA is relatively safe, but various complications can occur. Infected pancreatic necrosis (IPN) is a rare but serious complication. The latest guidelines suggest that all invasive interventions in patients with IPN should be delayed until walled-off necrosis appears.

PATIENT CONCERNS: A 73-year-old man was referred to our hospital with double primary cancers including gallbladder and pancreas. We performed EUS-TA on metastatic pancreatic tail cancer to confirm histologic diagnosis. Six days after the procedure, he developed abdominal pain and fever.

DIAGNOSES: The patient's laboratory findings showed leukocytosis and C-reactive protein elevation. Fluid collection around pancreas tail and stomach was detected in computed tomography (CT) scan, and the patient was diagnosed with IPN.

INTERVENTIONS AND OUTCOMES: EUS-guided endoscopic transmural drainage (EUS-TD) was performed for the treatment of IPN. Two days after the procedure with antibiotics, his CRP level decreased abruptly, and he received chemotherapy for the treatment of pancreatic ductal adenocarcinoma (PDAC) 5 days after the procedure. He was discharged from our hospital without complications 15 days after chemotherapy.

LESSONS: In selected patients with PDAC, early endoscopic drainage may be recommended as treatment for IPN resulting from complications of EUS-TA.

PMID:33879679 | PMC:PMC8078367 | DOI:10.1097/MD.0000000000025466
A simple method for diagnosing gallbladder malignant tumors with subserosa invasion by endoscopic ultrasonography

Fetched: May 4th, 2021, 5:01am GMT by Mitsuru Sugimoto

BMC Cancer. 2021 Mar 17;21(1):288. doi: 10.1186/s12885-021-08017-x.

ABSTRACT

BACKGROUND: If the depth of gallbladder malignant tumor (GBMT) invasion is deeper than the subserosa (ss), cholecystectomy is insufficient. In past reports that used endoscopic ultrasonography (EUS) to diagnose the depth of tumor invasion, it was difficult to diagnose GMBT invasion in the ss without a narrow or disrupted lateral hyperechoic layer (LHEL). Therefore, we developed a simple preoperative method to diagnose GBMTs with ss invasion.

METHODS: Forty-nine GBMT patients who underwent both EUS and surgery were enrolled: 15 patients whose tumors invaded the mucosa (m) or muscularis propria (mp) were classified as the "shallow group", and 34 patients whose tumors invaded the ss were classified as the "deep group". The EUS findings were compared between the two groups.

RESULTS: An irregular (narrow or thickened) LHEL was significantly more frequently observed on EUS in the deep group than in the shallow group. The diagnosis of ss invasion based on an irregular LHEL had the highest sensitivity and accuracy among the EUS imaging parameters (sensitivity 97.1% (33/34), specificity 86.7% (13/15), accuracy 93.8% (46/49)). When the deep group was limited to patients with a tumor depth of ss, the results were similar. When an irregular LHEL was used, the diagnostic accuracy of GBMTs with ss invasion was not significantly different between EUS specialists and beginners.

CONCLUSIONS: The observation of an irregular (thickened or narrow) LHEL observed on EUS could be a reliable and simple method of diagnosing GBMTs with ss invasion and could contribute to choosing an appropriate surgical method.

PMID:33731052 | PMC:PMC7972348 | DOI:10.1186/s12885-021-08017-x
Programmed Death Ligand-1 (PD-L1) Is an Independent Negative Prognosticator in Western-World Gallbladder Cancer

Fetched: May 1st, 2021, 5:01am GMT by Thomas Albrecht

Cancers (Basel). 2021 Apr 2;13(7):1682. doi: 10.3390/cancers13071682.

ABSTRACT

Inhibition of the programmed cell death protein-1/ligand-1 (PD-1/PD-L1) axis has opened a new era in the treatment of solid cancers. However, there is no data on the expression and relevance of PD-L1 in Western gallbladder cancer (GBC). We assessed PD-L1 immunohistochemically in 131 GBC patients as Tumor Proportion Score (TPS), Immune Cell Score (IC) and Combined Positivity Score (CPS). Tumor cells expressed PD-L1 in a subset of 14.7% GBC patients at a TPS cut-off of 1%. Higher PD-L1 levels above 10% and 25% TPS were reached in 4.7% and 3.1% of GBC cases, respectively. At a 10% cut-off, TPS was associated with distinct histomorphological subtypes and correlated with poor tumor differentiation. Survival analysis revealed a TPS above 10% to be a highly significant and independent negative prognosticator in GBC. PD-L1 expression was associated with increased CD4⁺, CD8⁺ and PD-1⁺ immune cell densities. In 14.8% of the cases, scattered immune cells expressed T-cell immunoreceptor with Ig and ITIM domains (TIGIT), which was correlated to tumoral expression of its ligand CD155. We here show that a high PD-L1 expression confers a negative prognostic value in Western-world GBC and highlight the TIGIT/CD155 immune checkpoint as a potential new target for GBC immunotherapy.

PMID:33918309 | PMC:PMC8038183 | DOI:10.3390/cancers13071682
Clinical features and prognosis of patients with leptomeningeal metastases

Fetched: April 29th, 2021, 5:01am GMT by M L Zhang

Zhonghua Yi Xue Za Zhi. 2021 Apr 27;101(16):1154-1159. doi: 10.3760/cma.j.cn112137-20201020-02881.

ABSTRACT

Objective: To describe the clinical manifestations, neuroimaging, cerebrospinal fluid(CSF) cytology and prognosis of Leptomeningeal metastases(LM). Methods: The clinical manifestations, imaging features and CSF cytology of LM patients admitted to Henan Provincial People's Hospital from May 1, 2015 to May 31, 2020 were retrospectively analyzed. The overall survival (OS) was evaluated by the time from the diagnosis of LM to death. Results: A total of 88 patients with LM were enrolled in the study, and the median age was 59 years (range:28-78 years). There were 42 males (47.7%) and 46 females (52.3%). According to the pathological classification, it was lung cancer in 58 cases (65.9%), gastric cancer in 13 cases (14.8%), breast cancer in 7 cases (8.0%), melanoma in 1 case, esophageal cancer in 1 case, gallbladder cancer in 1 case, renal cell carcinoma in 1 case, double source cancer in 2 cases, and unknown source in 4 cases. The median Karnofsky Performance Scale (KPS) score was 50. LM was the initial manifestation of cancer in 34 patients. All patients had LM-related clinical symptoms, including headache in 73 cases (83.0%), nausea and vomiting in 63 cases (71.6%), abnormal physical and mental behaviors in 37 cases (42.0%), seizure in 41 cases (46.6%). Cranial nerve involvement was observed in 23 patients (39.0%) and spinal nerve involvement in 20(33.9%). There were 61 patients (83.6%) who showed neuroimaging features of LM. Tumor cells or atypical cells were found in 90.8% of patients for the first time, and activated monocytes in 47 cases (54.7%). The median OS was 13.0 weeks (95%CI:2.9-23.1) with the 1-year survival rate of 19.1%. Univariate analysis of survival indicated that lung cancer, lower KPS score, tyrosine kinase inhibitors (TKIs) and whole brain radiotherapy were favorable predictors of survival (P<0.05). Conclusions: The overall prognosis of LM is poor. Good physical condition, TKIs treatment and whole brain radiotherapy might improve clinical outcomes of LM patients.

PMID:33902246 | DOI:10.3760/cma.j.cn112137-20201020-02881
Nab-paclitaxel: An effective third-line chemotherapy in patients with advanced, unresectable gallbladder cancer

Fetched: April 28th, 2021, 5:01am GMT by Vineet Talwar

Indian J Med Res. 2020 Nov;152(5):475-481. doi: 10.4103/ijmr.IJMR_930_18.

ABSTRACT

BACKGROUND & OBJECTIVES: Gallbladder (GBC) is an aggressive form of cancer and most patients present with advanced unresectable disease due to lack of early signs and symptoms. This retrospective study was conducted to present the treatment outcomes with three lines of chemotherapies in a subset of patients with advanced, unresectable GBC with the primary objective to determine the response rates with nab-paclitaxel as the third-line chemotherapy after failure of the first-line gemcitabine and platinum and the second-line FOLFOX-4 (oxaliplatin, leucovorin and 5-FU) therapy. Another objective was to evaluate the toxicity, progression-free survival (PFS) and overall survival (OS).

METHODS: Treatment-naive patients with histologically proven inoperable GBC treated with gemcitabine/platinum, FOLFOX-4 and nab-paclitaxel as the first-, second- and third-line chemotherapy were included in this study. The dose of gemcitabine and cisplatin or carboplatin was 1 g/m^[2] on days 1 and 8 and 75 mg/m^[2] (or target AUC of 5) on day 1, in a 21-day cycle. FOLFOX-4 was administered every two weeks and nab-paclitaxel was administered as 125 mg/m^[2] on days 1, 8 and 15 in a 28-day cycle.

RESULTS: There were eight men and 13 women with a median age of 57 yr who received nab-paclitaxel therapy. The overall response rate of the first-, second- and third-line chemotherapy was 61.9, 57.1 and 52.4 per cent, respectively. The median PFS for the gemcitabine/platinum, FOLFOX-4 and nab-paclitaxel therapy was 5.5, 5.4 and 2.9 months, respectively. The median OS with three lines of therapies was 14.0 months. Common Terminology Criteria (CTC) grade 3 or 4 haematological toxicities were observed in 28.6, 38.1 and 23.8 per cent of patients on gemcitabine/platinum, FOLFOX-4 and nab-paclitaxel therapy, respectively.

INTERPRETATION & CONCLUSIONS: Our study suggests the clinical benefit of nab-paclitaxel chemotherapy in prolonging OS in a selected subgroup of advanced, unresectable GBC patients after failure of the first-line gemcitabine and platinum and the second-line FOLFOX-4 therapy.

PMID:33707389 | DOI:10.4103/ijmr.IJMR_930_18
Anatomical segment 4b/5 resection for gall bladder cancer using intraoperative ultrasound

Fetched: April 27th, 2021, 5:01am GMT by S Singh

J Visc Surg. 2021 Jun;158(3):253-257. doi: 10.1016/j.jviscsurg.2021.04.003. Epub 2021 Apr 23.

NO ABSTRACT

PMID:33896696 | DOI:10.1016/j.jviscsurg.2021.04.003
Association between non-alcoholic fatty liver disease and the risk of biliary tract cancers: A South Korean nationwide cohort study

Fetched: April 25th, 2021, 5:01am GMT by Joo-Hyun Park

Eur J Cancer. 2021 Jun;150:73-82. doi: 10.1016/j.ejca.2021.03.024. Epub 2021 Apr 20.

ABSTRACT

AIMS: The association between non-alcoholic fatty liver disease (NAFLD) and cholangiocarcinoma has been previously reported only in case-control studies. Therefore, we conducted this nationwide cohort study to evaluate the longitudinal association between NAFLD and the risk of biliary tract cancer (BTC), including cholangiocarcinoma and gallbladder cancer.

METHODS: We included 8,120,674 adults who underwent national health screening in 2009 based on the Korean National Health Insurance Service data. NAFLD was determined using the fatty liver index: ≥60, NAFLD; 30-59, intermediate score; <30, no NAFLD. The exclusion criteria were baseline clinical liver disease, heavy alcohol consumption and cancer. Participants were followed up until December 2017 for the development of BTC. Cox proportional hazards regression models were performed.

RESULTS: During the median follow-up period of 7.2 years, 13,043 patients were with newly diagnosed BTC. NAFLD was associated with an increased risk of BTC (adjusted hazard ratio [aHR], 1.28; 95% CI, 1.20-1.37) compared with no NAFLD. The aHRs for the association of cholangiocarcinoma and gallbladder cancer with NAFLD were 1.33 (95% CI, 1.23-1.43) and 1.14 (95% CI, 1.003-1.29), respectively. Overall, the aHR for BTC tended to increase with the increasing fatty liver index (P for trend < 0.001). Concomitant NAFLD and diabetes were associated with an increased risk of BTC by 47% (aHR, 1.47; 95% CI, 1.35-1.60).

CONCLUSION: In this nationwide cohort study, NAFLD was associated with an increased risk of cholangiocarcinoma and gallbladder cancer. This finding suggests that NAFLD is a potentially modifiable risk factor for BTC.

PMID:33892409 | DOI:10.1016/j.ejca.2021.03.024
Update in clinical management for gallbladder neuroendocrine carcinoma

Fetched: April 23rd, 2021, 5:01am GMT by Hongwu Chu

Medicine (Baltimore). 2021 Apr 9;100(14):e25449. doi: 10.1097/MD.0000000000025449.

ABSTRACT

BACKGROUND: Gallbladder neuroendocrine carcinoma (GB-NEC) is rare and there are few reports at present. We sought to review the current knowledge of GB-NEC and provide recommendations for clinical management.

METHODS: A systemic literature research was conducted in the websites of Pubmed, Medline, Web of Science, CNKI, Wanfang Data using the keywords including gallbladder combined with neuroendocrine carcinoma or neuroendocrine tumor or neuroendocrine neoplasm. Two reviewers independently screened the articles by reading the title, abstract and full-text.

RESULTS: In computed tomography (CT) and magnetic resonance imaging (MRI) examination, a well-defined margin, gallbladder replacing type with larger hepatic and lymphatic metastases could be helpful for differential diagnosis of GB-NEC and gallbladder adenocarcinoma (GB-ADC). Older age, unmarried status, large tumor size (>5 cm), positive margins, and distant Surveillance, Epidemiology and End result (SEER) stage are independently associated with poor survival. Surgical resection remains as the preferred and primary treatment. The potential survival benefit of lymphadenectomy for patients remains controversial. Platinum-based postoperative adjuvant chemotherapy may improve the survival. The efficacy of other treatments including immunotherapy, targeted therapy and somatostatin analogue needs further investigation.

CONCLUSION: Typical imaging features could be helpful for preoperative diagnosis. Age, margin status, tumor size, marital status, histopathologic subtype and SEER stage may be independent predictors for the survival. Remarkable advances regarding the treatment for GB-NEC have been achieved in recent years. Further studies are needed to investigate the survival benefit of lymphadenectomy for patients with GB-NEC.

PMID:33832150 | PMC:PMC8036038 | DOI:10.1097/MD.0000000000025449
Precision modeling of gall bladder cancer patients in mice based on orthotopic implantation of organoid-derived tumor buds

Fetched: April 19th, 2021, 5:02am GMT by Shingo Kato

Oncogenesis. 2021 Apr 17;10(4):33. doi: 10.1038/s41389-021-00322-1.

ABSTRACT

Genetically engineered mice (GEM) are the gold standard for cancer modeling. However, strict recapitulation of stepwise carcinogenesis from a single tumor-initiating epithelial cell among genetically intact cells in adults is not feasible with the currently available techniques using GEM. In previous studies, we partially overcame this challenge by physically isolating organs from adult animals, followed by genetic engineering in organoids and subcutaneous inoculation in nude mice. Despite the establishment of suitable ex vivo carcinogenesis models for diverse tissues, tumor development remained ectopic and occurred under immunodeficient conditions. Further refinement was, therefore, necessary to establish ideal models. Given the poor prognosis and few models owing to the lack of gall bladder (GB)-specific Cre strain, we assumed that the development of authentic models would considerably benefit GB cancer research. Here, we established a novel model using GB organoids with mutant Kras and Trp53 loss generated in vitro by lentiviral Cre transduction and CRISPR/Cas9 gene editing, respectively. Organoid-derived subcutaneous tumor fragments were sutured to the outer surface of the GB in syngeneic mice, which developed orthotopic tumors that resembled human GB cancer in histological and transcriptional features. This model revealed the infiltration of similar subsets of immune cells in both subcutaneous and orthotopic tumors, confirming the appropriate immune environment during carcinogenesis. In addition, we accurately validated the in vivo efficacy of gemcitabine, a common therapeutic agent for GB cancer, in large cohorts. Taken together, this model may serve as a promising avatar of patients with GB cancer in drug discovery and precision medicine.

PMID:33866327 | PMC:PMC8053198 | DOI:10.1038/s41389-021-00322-1
Gallbladder carcinoma - when to use laparoscopic approach?

Fetched: April 16th, 2021, 5:01am GMT by M Bakos

Bratisl Lek Listy. 2021;122(5):341-346. doi: 10.4149/BLL_2021_058.

ABSTRACT

AIM: To assess how laparoscopy has altered the presentation of patients with gallbladder cancer and determine whether radical resection in patients with gallbladder cancer is beneficial.

METHOD: 47 patients underwent surgery because of suspected gallbladder cancer. Cancer was found incidentally in 29 patients (61.7 %) during routine laparoscopic cholecystectomy using frozen biopsy. Gallbladder cancer had been diagnosed preoperatively in the other 18 patients (38.3 %).

RESULTS: Patients in whom carcinoma was found incidentally at laparoscopic cholecystectomy had a significant increase in survival when compared with those who were admitted electively with a known diagnosis. All patients who presented with a known diagnosis had stage II or higher, and 38.3 % of these were in stage IV. However, 58.6 % of those patients who were found incidentally were in stage I or II. The overall 2-year survival for all patients was 45 %; those discovered incidentally at laparoscopic cholecystectomy (Tis-T2) had a 2-year survival of 87 %.

CONCLUSION: Laparoscopic cholecystectomy resulted in an earlier discovery of gallbladder cancer in some patients, resulting in increased probability of survival. Adjunctive radical surgical resection, either at the time of cholecystectomy or subsequently, increases survival significantly in early stage disease (Tab.2, Fig. 2, Ref. 24). Text in PDF www.elis.sk Keywords: gallbladder carcinoma, laparoscopic approach.

PMID:33848185 | DOI:10.4149/BLL_2021_058
Cancer in Chile and worldwide: an overview of the current and future epidemiological context

Fetched: April 15th, 2021, 5:02am GMT by Solange Parra-Soto

Rev Med Chil. 2020 Oct;148(10):1489-1495. doi: 10.4067/S0034-98872020001001489.

ABSTRACT

Cancer is a chronic non-communicable disease associated with a high mortality burden. The prevalence of cancer is increasing rapidly worldwide. However, this scenario will be worse in low and middle-income countries such as Chile, where 70% of cancer deaths occur. The aim of this review was to assess the epidemiological scenario of cancer and its projection for the Chilean population. In Chile, 53,365 new cases of cancer were diagnosed in 2018, led by prostate, colorectal, breast, stomach, lung and gallbladder cancer. From 1986 to 2016, cancer increased by 109%. When we reviewed mortality by sex, stomach and prostate cancer were responsible for more than 30% of cancer deaths among men. However, for women the first three places were occupied by breast, colorectal and lung cancer, as in the rest of the world. Considering that 40% of cancers are related to unhealthy lifestyles, working on the prevention of modifiable risk factors represents an opportunity for the creation of public health policies that allow changes at the environmental and individual level.

PMID:33844720 | DOI:10.4067/S0034-98872020001001489
Prevalence of cholelithiasis and gallbladder cancer among Aymara individuals

Fetched: April 15th, 2021, 5:02am GMT by Marcelo Fonseca C

Rev Med Chil. 2020 Oct;148(10):1398-1405. doi: 10.4067/S0034-98872020001001398.

ABSTRACT

BACKGROUND: The prevalence of cholelithiasis and gallbladder cancer may be different across ethnic groups.

AIM: To study the prevalence of cholelithiasis and gallbladder cancer among Aymara individuals.

MATERIAL AND METHODS: An abdominal ultrasound was carried out in a sample of 182 Aymara women aged 46 ± 16 years and 76 Aymara men aged 55 ± 16 years. In addition, the histopathological reports of both patients with a history of previous cholecystectomy and those operated after the study were reviewed.

RESULTS: Ultrasound was normal in 150 participants (58%), 76 had cholelithiasis (30%) and 32 (12%) had a history of cholecystectomy. Pathological reports of the excised gallbladder were available for 106 cases and showed a chronic cholecystitis in 98% of cases. Gallbladder cancer was not reported.

CONCLUSIONS: There is a 42% prevalence of cholelithiasis and no gallbladder cancer in this sample of Aymara population.

PMID:33844709 | DOI:10.4067/S0034-98872020001001398
A case of simultaneous multicentric cancer in the gallbladder duct and the common bile duct without pancreaticobiliary maljunction

Fetched: April 14th, 2021, 5:01am GMT by Yoko Yamaji

Nihon Shokakibyo Gakkai Zasshi. 2021;118(4):366-373. doi: 10.11405/nisshoshi.118.366.

ABSTRACT

A 68-year-old man who underwent cholecystectomy for acute cholecystitis and was diagnosed with gallbladder duct carcinoma was referred to our hospital. Postoperative computed tomography showed thickening of the middle to lower bile duct without any tumorous lesions. Endoscopic retrograde cholangiopancreatography and intraductal ultrasonography revealed irregular wall thickening of the lower bile duct and apparent infiltration of gallbladder duct tumor to the common bile duct without pancreaticobiliary maljunction. Subtotal stomach-preserving pancreaticoduodenectomy was performed. Pathological examination showed papillary adenocarcinoma and tubular adenocarcinoma in the gallbladder duct and BilIN-3 lesion in the distal bile duct. The final diagnosis was biliary simultaneous multicentric cancer without pancreaticobiliary maljunction.

PMID:33840718 | DOI:10.11405/nisshoshi.118.366
Cholecystectomy, porta hepatis stripping, and omental bursectomy

Fetched: April 13th, 2021, 5:01am GMT by Joo-Hyuk Son

Gland Surg. 2021 Mar;10(3):1230-1234. doi: 10.21037/gs-2019-ursoc-02.

ABSTRACT

As ovarian cancer commonly involves the visceral organs without boundary, more aggressive procedures are adopted during cytoreductive surgery. One of the most difficult aspect of the operation involves the procedure for the gall bladder, porta hepatis, and omental bursa. As the upper abdominal surgical field is not familiar to the gynecologic surgeon, and the vital organs or vessels are densely positioned, these procedures can be challenging for achieving the optimal cytoreductive surgery. The surgical approaches for advanced ovarian cancer that are required in the upper abdomen have evolved with the progress in surgical techniques. This article will discuss the surgical approach by focusing on cholecystectomy, porta hepatis debulking, and omental bursectomy, as well as the regional anatomy in patients with advanced ovarian cancer.

PMID:33842269 | PMC:PMC8033069 | DOI:10.21037/gs-2019-ursoc-02
Anatomic location of residual disease after initial cholecystectomy independently determines outcomes after re-resection for incidental gallbladder cancer

Fetched: April 13th, 2021, 5:01am GMT by Takuya Ando

Langenbecks Arch Surg. 2021 Apr 10. doi: 10.1007/s00423-021-02165-1. Online ahead of print.

ABSTRACT

PURPOSE: This study aimed to elucidate the impact of anatomic location of residual disease (RD) after initial cholecystectomy on survival following re-resection of incidental gallbladder cancer (IGBC).

METHODS: Patients with pT2 or pT3 gallbladder cancer (36 with IGBC and 171 with non-IGBC) who underwent resection were analyzed. Patients with IGBC were classified as follows according to the anatomic location of RD after initial cholecystectomy: no RD (group 1); RD in the gallbladder bed, stump of the cystic duct, and/or regional lymph nodes (group 2); and RD in the extrahepatic bile duct and/or distant sites (group 3).

RESULTS: Timing of resection (IGBC vs. non-IGBC) did not affect survival in either multivariate or propensity score matching analysis. RD was found in 16 (44.4%) of the 36 patients with IGBC; R0 resection following re-resection was achieved in 32 patients (88.9%). Overall survival (OS) following re-resection was worse in group 3 (n = 7; 5-year OS, 14.3%) than in group 2 (n = 9; 5-year OS, 55.6%) (p = 0.035) or in group 1 (n = 20; 5-year OS, 88.7%) (p < 0.001). There was no survival difference between groups 1 and 2 (p = 0.256). Anatomic location of RD was independently associated with OS (group 2, HR 2.425, p = 0.223; group 3, HR 9.627, p = 0.024).

CONCLUSION: The anatomic location of RD independently predicts survival following re-resection, which is effective for locoregional disease control in IGBC, similar to resection for non-IGBC. Not all patients with RD have poor survival following re-resection for IGBC.

PMID:33839959 | DOI:10.1007/s00423-021-02165-1
Comparison of Inflammation-based Prognostic Scores in Patients With Biliary Tract Cancer After Surgical Resection

Fetched: April 10th, 2021, 5:01am GMT by Masashi Utsumi

Anticancer Res. 2021 Apr;41(4):2147-2155. doi: 10.21873/anticanres.14987.

ABSTRACT

BACKGROUND/AIM: Inflammation-based prognostic scores are proven prognostic biomarkers in various cancers. This study aimed to identify a useful prognostic score for patients with biliary tract cancer (BTC) after surgical resection.

PATIENTS AND METHODS: This retrospective study recruited 115 patients with BTC during 2010-2020. The relationship between clinicopathological variables, including various prognostic scores and overall survival (OS), was investigated using univariate and multivariate analyses.

RESULTS: BTC included 58 cholangiocarcinoma, 29 gallbladder carcinoma, 16 ampullary carcinoma, and 12 perihilar cholangiocarcinoma cases. A significant difference was detected in OS of patients with a Japanese modified Glasgow prognostic score (JmGPS) 0 (n=62) and JmGPS 1 or 2 (high JmGPS) (n=53). In the multivariate analysis, tumour differentiation (p=0.014) and a high JmGPS (p=0.047) were independent prognostic factors.

CONCLUSION: The high JmGPS was an independent prognostic predictor after surgical resection and was superior to other prognostic scores.

PMID:33813426 | DOI:10.21873/anticanres.14987
TUBB3 Promotes Growth and Invasion of Gallbladder Cancer Cells by Akt/mTOR Signal Pathway

Fetched: April 9th, 2021, 5:01am GMT by Zijun Liu

J Environ Pathol Toxicol Oncol. 2021;40(2):23-33. doi: 10.1615/JEnvironPatholToxicolOncol.2021036821.

ABSTRACT

Aberrant expression of β-tubulin-III (TUBB3) is known that related to aggressive tumor features and poor clinical outcomes. However, there is limited research about TUBB3 expression and its role in the outcomes and the progression of gallbladder cancer. We have measured TUBB3 level in gallbladder cancer samples and cell lines from 2012 to 2016, and tested the effects of TUBB3 in cancer cell growth, apoptosis and cell cycle arrest by using appropriate methods. The results revealed that TUBB3 was significantly over-expressed in gallbladder cancer samples and cell lines, and high TUBB3 level contributed to shorter overall survival in patients. The knockdown of TUBB3 with sh-TUBB3 inhibited the proliferation, migration and invasion of cancer cells. Meanwhile, it promotes apoptosis and changes the cell cycle distribution. Suppression of TUBB3 expression could increase p21 and cyclin B1 expression, and decrease cyclin D1. Xenograft mouse model also showed that low expression of TUBB3 reduced the growth of established gallbladder cancer xenograft in vivo. Furthermore, TUBB3 knockdown significantly decreased phosphorylation of Akt and mTOR in vitro and in vivo. TUBB3 can induce the development of gallbladder cancer by Akt/mTOR signal pathway and we point out a potential therapeutic target for gallbladder cancer treatment.

PMID:33822514 | DOI:10.1615/JEnvironPatholToxicolOncol.2021036821
Bladder-to-bladder metastasis: gallbladder cancer metastasising to the urinary bladder

Fetched: April 8th, 2021, 5:01am GMT by S Mukherjee

Ann R Coll Surg Engl. 2021 Apr;103(4):e116-e119. doi: 10.1308/rcsann.2020.7048. Epub 2021 Mar 8.

ABSTRACT

We report a 48-year-old fit and healthy woman who was incidentally diagnosed to have adenocarcinoma of gallbladder after laparoscopic cholecystectomy. Subsequent imaging showed no evidence of regional or distant spread. She was scheduled for elective laparotomy and resection of gallbladder bed, but during laparotomy frozen section analysis of an incidentally discovered peritoneal deposit confirmed metastasis, so the procedure was abandoned. Thereafter, she received cisplatin and gemcitabine chemotherapy. However, surveillance computed tomography incidentally noted a urinary bladder mass which had not been present before. Transurethral resection of the bladder lesion revealed moderately differentiated adenocarcinoma of urinary bladder. The appearance and immunoprofile of the lesion confirmed metastasis from the primary gallbladder cancer, which has not been documented in the literature to the best of our knowledge. Her disease progressed and she is being challenged with gemcitabine and carboplatin as second-line palliative chemotherapy. She is still alive two years after the initial diagnosis.

PMID:33682446 | DOI:10.1308/rcsann.2020.7048
Metastatic Tumors to the Ovary-a Surgeon's Dilemma

Fetched: April 6th, 2021, 5:01am GMT by Ramesan C K

Indian J Surg Oncol. 2021 Mar;12(1):152-157. doi: 10.1007/s13193-020-01267-4. Epub 2021 Jan 7.

ABSTRACT

The ovary is a common site of metastasis. Differential diagnosis of ovarian carcinomas, including secondary tumors, remains a challenging task. Clinical decision-making depends on an accurate diagnosis of the type of ovarian cancer. This study was done to evaluate the pattern of metastatic tumors to the ovary and clinical details and to analyze the survival outcomes over a period of 5 years. Patients who had metastatic tumors to the ovary are identified from the electronic database from 1 January 2015 to 30 September 2019. Clinical details are collected from the electronic charts. Survival data is collected over the phone. The total number of ovarian cancers treated during the time period was 720, of which primary high-grade mucinous tumors contributed 9 (1.2%), and metastatic tumors to ovary 70 (10%). The highest levels of CEA were seen in carcinoma rectum, colon, and cholangiocarcinoma. CA 19-9 was very high in carcinoma gall bladder, pancreas, and cholangiocarcinoma. Common primaries were stomach (23%), gall bladder (13%), and colon (13%). Adenocarcinoma with signet ring cells was found in 29% of the patients. The median follow-up was 7 months (range 1 to 40 months). The median overall survival was 10 months after diagnosis (95% CI,7.9-12.0). There was no statistically significant difference in survival between patients who had peritoneal carcinomatosis with enlarged ovaries and those who had metastasis confined to ovaries (p value 0.360). A diagnosis of metastatic tumors to the ovary is associated with a very poor prognosis and the focus of treatment should be to improve the quality of life.

SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s13193-020-01267-4.

PMID:33814846 | PMC:PMC7960848 | DOI:10.1007/s13193-020-01267-4
S100P as a marker for poor survival and advanced stage in gallbladder carcinoma

Fetched: April 4th, 2021, 5:01am GMT by Alka Mary Mathai

Ann Diagn Pathol. 2021 Jun;52:151736. doi: 10.1016/j.anndiagpath.2021.151736. Epub 2021 Mar 22.

ABSTRACT

AIMS: Gallbladder carcinomas usually present in advanced stages and has a dismal prognosis despite modern imaging techniques and aggressive surgical intervention. Identification of biologic markers for early diagnosis and improved therapeutic strategies is thus of paramount importance. S100P has been identified in a variety of malignant neoplasms of the gastrointestinal and pancreaticobiliary systems, but it is not yet known if S100P expression is associated with clinically-relevant characteristics of gall bladder carcinoma. The aims of the present study were: 1) to investigate the relationship between S100P expression and histological type, grade, tumor-node-metastasis stage, presence of vascular invasion, perineural invasion and necrosis; and 2) to evaluate for any S100P-defined difference in the risk for tumor recurrence or death.

METHOD: Immunostains for S100P were performed on 4 tissue microarray blocks containing 91 cases of gall bladder carcinoma.

RESULT: The intensity of S100P staining was significantly associated with pathological T stage 4 (p = 0. 0238). Staining intensity ≥3 in ≥25% tumor cells was associated with pathological T stage 4 (p = 0.0005). A higher S100P immunoreactivity score (IRS) was significantly associated with higher TNM stage (p = 0.0341). Age (p = 0.0485), presence of vascular invasion (p = 0.0359), pathological T stage (p = 0.0291) and TNM stage (p = 0.0153) were significantly associated with tumor recurrence. Intense S100P reactivity was associated with decreased overall survival [hazard ratio = 9.614; 95% confidence interval (CI), 1.873-49.338; p = 0.0067].

CONCLUSION: Our findings indicate that S100P over-expression is a potential prognostic marker for gall bladder carcinoma and is significantly associated with advanced tumor stage and poorer survival.

PMID:33798925 | DOI:10.1016/j.anndiagpath.2021.151736
Pembrolizumab-induced large duct cholangiopathy: Diagnosis and follow.up imaging

Fetched: April 1st, 2021, 5:01am GMT by A Chatterjee

J Postgrad Med. 2021 Jan-Mar;67(1):43-45. doi: 10.4103/jpgm.JPGM_793_20.

ABSTRACT

Immune-checkpoint inhibitor mediated hepatobiliary injury is an emerging concern in cancer treatment. Most of these adverse reactions are attributed to nivolumab and are characterized by panlobular hepatitis. Large duct cholangiopathy related to these drugs is extremely rare. We present a case of adenocarcinoma of lung treated with pembrolizumab who developed biochemical and imaging features consistent with cholangiopathy characterized by common bile duct dilatation, wall enhancement, and gallbladder wall edema. On follow-up in the fourth month, the imaging features persisted despite the normalization of liver enzymes. To the best of our knowledge, this is the first description of diagnosis and follow-up imaging of pembrolizumab-related cholangiopathy in imaging literature.

PMID:33533751 | DOI:10.4103/jpgm.JPGM_793_20
A case of idiopathic retroperitoneal fibrosis presenting as gallbladder carcinoma

Fetched: April 1st, 2021, 5:01am GMT by Rui Li

BMC Surg. 2021 Mar 25;21(1):162. doi: 10.1186/s12893-021-01162-x.

ABSTRACT

BACKGROUND: Retroperitoneal fibrosis (RPF) is a rare disease with a poor prognosis characterized by systemic inflammation and fibroinflammatory tissue. Idiopathic RPF (IRPF) accounts for approximately two-thirds of RPF cases.

CASE PRESENTATION: A 56-year-old female patient with abdominal distension was admitted to Changxing Hospital. Laboratory tests revealed mild anemia and elevated CA125, while IgG4 and autoantibodies were within the normal ranges. Computed tomography (CT) revealed a gallbladder-occupying lesion, pancreatic cyst and retroperitoneal mass, which may have contributed to bilateral ureteral compression and hydronephrosis. The initial diagnosis was gallbladder carcinoma with lymph node metastasis. Then, abdominal adhesiolysis, cholecystectomy and partial hepatectomy were performed. Histologically, there were fibrosis and inflammation in the retroperitoneal tissue without any malignant cells in the retroperitoneal or gallbladder tissue. Finally, we confirmed the diagnosis of idiopathic retroperitoneal fibrosis, chronic cholecystitis and pancreatic cyst. The patient recovered well following the CT scan, in which dilatation of the bile duct was reduced, and effusion of the bilateral upper ureter was no longer significant.

CONCLUSION: This atypical case illustrates that RPF can be combined with other biliary tract diseases. The coexistence of other diseases conceals the symptoms of RPF, which increases the difficulty of image identification. A high degree of suspicion is necessary for routine clinical work. As more cases are reported, further advances in the diagnosis and treatment of RPF can be expected.

PMID:33765983 | PMC:PMC7993538 | DOI:10.1186/s12893-021-01162-x
Gallbladder cancer radical surgery is a matter of specialized centers

Fetched: March 31st, 2021, 5:01am GMT by Chafik Bouzid

J Surg Oncol. 2021 Apr;123(5):1361-1362. doi: 10.1002/jso.26250. Epub 2021 Feb 16.

NO ABSTRACT

PMID:33590476 | DOI:10.1002/jso.26250
Recurrent Mixed Neuroendocrine-Non-Neuroendocrine Neoplasm in the Gallbladder: A Case Report

Fetched: March 30th, 2021, 5:01am GMT by Turki Al-Fayea

Case Rep Oncol. 2021 Mar 11;14(1):411-417. doi: 10.1159/000513031. eCollection 2021 Jan-Apr.

ABSTRACT

Mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN) of the gallbladder are rare with no established therapeutic strategies. We report a case of recurrent gallbladder MiNEN from a population with a low incidence of gallbladder carcinomas, a review of the current therapeutic options, and recent updates on the nomenclature proposed by the World Health Organization in 2017.

PMID:33776736 | PMC:PMC7983664 | DOI:10.1159/000513031
Strategies for the Delay of Surgery in the Management of Resectable Hepatobiliary Malignancies during the COVID-19 Pandemic

Fetched: March 30th, 2021, 5:01am GMT by S Bennett

Curr Oncol. 2020 Oct 1;27(5):501-511. doi: 10.3747/co.27.6785.

ABSTRACT

Objective: We aimed to review data about delaying strategies for the management of hepatobiliary cancers requiring surgery during the covid-19 pandemic. Background: Given the covid-19 pandemic, many jurisdictions, to spare resources, have limited access to operating rooms for elective surgical activity, including cancer, thus forcing deferral or cancellation of cancer surgeries. Surgery for hepatobiliary cancer is high-risk and particularly resource-intensive. Surgeons must critically appraise which patients will benefit most from surgery and which ones have other therapeutic options to delay surgery. Little guidance is currently available about potential delaying strategies for hepatobiliary cancers when surgery is not possible. Methods: An international multidisciplinary panel reviewed the available literature to summarize data relating to standard-of-care surgical management and possible mitigating strategies to be used as a bridge to surgery for colorectal liver metastases, hepatocellular carcinoma, gallbladder cancer, intrahepatic cholangiocarcinoma, and hilar cholangiocarcinoma. Results: Outcomes of surgery during the covid-19 pandemic are reviewed. Resource requirements are summarized, including logistics and adverse effects profiles for hepatectomy and delaying strategies using systemic, percutaneous and radiation ablative, and liver embolic therapies. For each cancer type, the long-term oncologic outcomes of hepatectomy and the clinical tools that can be used to prognosticate for individual patients are detailed. Conclusions: There are a variety of delaying strategies to consider if availability of operating rooms decreases. This review summarizes available data to provide guidance about possible delaying strategies depending on patient, resource, institution, and systems factors. Multidisciplinary team discussions should be leveraged to consider patient- and tumour-specific information for each individual case.

PMID:33704138 | DOI:10.3747/co.27.6785
Study On The Prevalence Of Gallstones In Patients Undergoing Cholecystectomy In Benazir Bhutto Shaheed Hospital (DHQ) Abbottabad

Fetched: March 29th, 2021, 5:01am GMT by Sara Jadoon

J Ayub Med Coll Abbottabad. 2021 Jan-Mar;33(1):102-104.

ABSTRACT

BACKGROUND: The incidence of gall bladder diseases is increasing day by day in developing as well as developed countries. Most common gall bladder diseases include gallstones (cholelithiasis) and cancer of gall bladder.

OBJECTIVE: To determine and compare the surgical incidence of gallstones on the basis of gender and age in patients undergoing elective cholecystectomy in Benazir Bhutto Shaheed Hospital (DHQ) Abbottabad.

METHODS: This was a descriptive study which was carried out for a period of one year from January 2017 to December 2017 in surgical unit of Benazir Bhutto Shaheed Hospital Abbottabad on patients who had cholecystectomy secondary to symptomatic gall stone disease diagnosed on the basis of history and ultrasonography. Gallstones were then analysed for bilirubin, cholesterol, calcium and phosphate. The data was analysed by using SPSS Version 16.00.

RESULTS: In our research study 88% of patients were females while 11.8% were males, the mean age being 35.81±8.12 year. The frequencies of different types of gall stones were: mixed type of stones 80.0% and cholesterol stones 20.0.

CONCLUSIONS: Cholecystectomy secondary to gallstones is more common in women of forty to sixty age groups as compared to men of same age. Majority of gall stones are of mixed type.

PMID:33774963
Selective or Routine Histology of Cholecystectomy Specimens for Diagnosing Incidental Carcinoma of Gallbladder and Correlation with Careful Intraoperative Macroscopic Examination? A Systematic Review

Fetched: March 29th, 2021, 5:01am GMT by Shujaat Khan

Asian Pac J Cancer Prev. 2021 Mar 1;22(3):651-659. doi: 10.31557/APJCP.2021.22.3.651.

ABSTRACT

BACKGROUND: Selective or Routine histology of cholecystectomy specimens for benign gallbladder disease has always been a matter of debate because of the low prevalence and bad prognosis associated with gall bladder carcinoma. The objective of this study is to ascertain whether selective histology can be preferred over Routine histology without any harm.

METHODS: This systematic review is conducted according to PRISMA's checklist; relevant articles were searched in the database until September 1 2020 in PubMed, Scopus, Science Direct, and Web of Science databases, manually, with search queries and without date restrictions. Studies included in this systematic review involved patients who underwent cholecystectomy for benign gallbladder disease and were diagnosed with gallbladder carcinoma incidentally either after selective or routine histology of the gallbladder.

RESULTS: A total of 24 routine or selective histology recommending studies were selected for the systematic review after following the inclusion and exclusion criteria. These studies comprised 77,213 numbers of patients and 486 numbers of Malignancies. These studies correlate the number of IGBC diagnosed histologically with the number of IGBC's that were suspected by the surgeons intraoperative by macroscopy. Routine recommending studies show a significant number of IGBC diagnosed histologically as missed by surgeons whereas the selective recommending studies show most of the histologically diagnosed IGBC already suspected by the surgeons intraoperative. When comparing the macroscopic details of the IGBC's between routine and selective studies, we found that there was significant overlap. Most of the findings missed by the surgeons as suspicious in routine studies were suspected by the surgeons involved in selective histology recommending studies. Thereby, favouring selective histology and emphasizing the need for careful intraoperative macroscopy for suspecting IGBC.

CONCLUSION: Selective Histological examination of cholecystectomy specimens can be preferred if a careful intraoperative macroscopic examination is done and patient risk factors are taken into consideration.

PMID:33773526 | DOI:10.31557/APJCP.2021.22.3.651
Surgery of the primary tumour in 201 patients with high-grade gastroenteropancreatic neuroendocrine and mixed neuroendocrine-non-neuroendocrine neoplasms

Fetched: March 27th, 2021, 5:01am GMT by Hans-Christian Pommergaard

J Neuroendocrinol. 2021 May;33(5):e12967. doi: 10.1111/jne.12967. Epub 2021 Mar 26.

ABSTRACT

The benefit of surgery in high-grade gastroenteropancreatic neuroendocrine neoplasms (GEP NEN) and mixed neuroendocrine-non-neuroendocrine neoplasms (MiNEN) is uncertain. The present study aimed to investigate outcomes after tumour surgery in patients with high-grade (Ki-67 > 20%) GEP NEN or MiNEN stage I-III or stage IV. We analysed data from patients treated in the period 2007-2015 at eight Nordic university hospitals. Overall survival (OS) and progression-free survival (PFS)/disease-free survival (DFS) were analysed by Kaplan-Meier estimates. Prognostic factors were evaluated using Cox regression. We included 201 surgically resected patients, 143 stage I-III and 58 stage IV, with 68% having neuroendocrine carcinoma, 23% MiNEN, 5% neuroendocrine tumour G3 and 4% uncertain NEN G3. Primary tumours were located in colon/rectum (52%), oesophagus/cardia (19%), pancreas (10%), stomach (7%), jejunum/ileum (5%), duodenum (4%), gallbladder (2%) and anal canal (1%). For patients with stage I-III, median DFS was 12 months (95% confidence interval [CI] = 5.5-18.5) and median OS was 32 months (95% CI = 24.0-40.0). For patients with stage I-III and an R0 resection, median DFS was 21 months (95% CI = 4.9-37.1) and median OS was 39 months (95% CI = 25.0-53.0). For patients with stage IV, median PFS/DFS was 4 months (95% CI = 1.9-6.1) and median OS was 11 months (95% CI = 4.8-17.2). For patients with stage IV and an R0 resection, median DFS was 6 months (95% CI = 0-16.4) and median OS was 32 months (95% CI = 25.5-38.5). Performance status > 1 and colorectal primary were associated with poor prognosis. There was no difference in survival between patients with high-grade GEP NEN and MiNEN. Surgery of the primary tumour in patients with loco-regional high-grade GEP NEN or MiNEN led to good long-term results and should be considered if an R0 resection is considered achievable. Highly selected patients with stage IV disease may also benefit from surgery.

PMID:33769624 | DOI:10.1111/jne.12967
Nab-paclitaxel - Third-line chemotherapy in advanced gallbladder cancer

Fetched: March 25th, 2021, 5:01am GMT by Amol Patel

Indian J Med Res. 2020 Nov;152(5):442-443. doi: 10.4103/ijmr.IJMR_2709_19.

NO ABSTRACT

PMID:33707384 | DOI:10.4103/ijmr.IJMR_2709_19
Predictors of toxicity after neoadjuvant chemoradiotherapy for locally advanced gall bladder cancer

Fetched: March 24th, 2021, 5:01am GMT by Anushree Loyal

Indian J Cancer. 2021 Jan 27. doi: 10.4103/ijc.IJC_822_19. Online ahead of print.

ABSTRACT

BACKGROUND: The present study evaluated the correlation of hepatobiliary toxicity and radiation dose received in patients undergoing neoadjuvant chemoradiotherapy (NACRT) for locally advanced unresectable gall bladder cancers (LAGBC).

METHODS: Twenty-six patients with LAGBC, treated with NACRT (55-57 Gy/25 fractions/5 weeks and weekly gemcitabine 300 mg/m²) within a phase II study, were included. Whenever feasible, surgery was performed after NACRT. Acute and late hepatobiliary toxicity was recorded. Treatment scans were retrieved to delineate central porto-hepatobiliary system (CPHBS), resected liver surface, segment IV B and V, and duodenum. The doses received by these structures were recorded and correlated with toxicity.

RESULTS: Of 26 patients, 20 (77%) had partial or complete response and 12 (46%) had R0 resection. At the median follow-up of 38 months, overall survival was 38%. Eight (30%) patients had post-treatment toxicity, of which most common was biliary toxicity (30%). A correlation was observed between the biliary leak and V45Gy CPHBS >50 cm³ (P = 0.070). Higher toxicity was observed in those with metallic stents (P = 0.072).

CONCLUSION: The incidence of the biliary leak was 46%. CPHBS dose was found to correlate with biliary leaks. Restricting V45Gy CPHBS <50 cm³ and using plastic stent may facilitate a reduction in hepatobiliary toxicity in patients undergoing NACRT and surgery.

PMID:33753615 | DOI:10.4103/ijc.IJC_822_19
Development of a system combining comprehensive genotyping and organoid cultures for identifying and testing genotype-oriented personalised medicine for pancreatobiliary cancers

Fetched: March 23rd, 2021, 5:01am GMT by Masahiro Shiihara

Eur J Cancer. 2021 May;148:239-250. doi: 10.1016/j.ejca.2021.01.047. Epub 2021 Mar 19.

ABSTRACT

BACKGROUND: Pancreatobiliary cancer is a highly aggressive tumour with a dismal prognosis. Personalised medicine represents a promising and effective therapeutic approach for this intractable disease. In this study, we aimed to establish a system for identifying and testing genotype-oriented targeted drugs for pancreatobiliary cancers by combining exome sequencing and organoid culture of primary tumours.

METHODS: Tumour cells isolated from resected tumours were subjected to organoid cultures based on published protocols with modifications. Exome sequencing was performed on the primary tumours. Histopathological and molecular features of the primary tumours were validated in the corresponding organoids. Genotype-oriented candidate targeted drugs were identified from exome sequencing, and their efficacies were tested in the organoids.

RESULTS: Organoid cultures succeeded in 30 of 54 (55.6%) cases. Six primary cancers of the biliary tract and gall bladder were subjected to exome sequencing, which revealed a variety of somatic mutations of genes involved in signalling pathways, epigenetic modifiers, genome maintenance and metabolic enzymes. Most of the organoids of these 6 cases showed identical histopathological features and genomic aberrations as those of the primary tumours. Some of the aberrations were candidates for targeted therapies. Integrin-linked kinase (ILK) was one such candidate target, and an ILK inhibitor was confirmed to suppress proliferation of patient-derived organoids.

CONCLUSIONS: By combining exome sequencing and organoid culture, our model enabled to identify genotype-oriented targets for personalised medicine and to test efficacies of candidate targeted drugs in the organoids. The current proof-of-concept approach could increase therapeutic opportunities for patients with pancreatobiliary cancers.

PMID:33752134 | DOI:10.1016/j.ejca.2021.01.047
Structural based screening of potential inhibitors of SMAD4: a step towards personalized medicine for gall bladder and other associated cancers

Fetched: March 23rd, 2021, 5:01am GMT by Rakesh Kumar

Mol Divers. 2021 Mar 22. doi: 10.1007/s11030-021-10210-w. Online ahead of print.

ABSTRACT

Gall bladder cancer (GBC) is an aggressive and most common malignancy of biliary tract lacking effective treatment due to unavailability of suitable biomarkers and therapeutics. SMAD4 is an essential mediator of transforming growth factor-β pathway involved in various cellular processes like growth, differentiation and apoptosis and also recognized as therapeutic target for GBC and other gastrointestinal tract cancers. In the present study, 3D structure of SMAD4 mutants was optimized through molecular dynamics simulation (MDS) along with wildtype. Furthermore, binding site of protein was predicted through hybrid approach and structural based virtual screening against two drug libraries was performed followed by docking. MDS of top docking score protein-ligand complexes were carried, and binding free energy was rescored. Two potential inhibitors, namely ZINC2098840 and ZINC8789167, were screened that displayed higher binding affinity towards mutant proteins compared with wildtype and both hydrophilic as well as hydrophobic interactions play a crucial role during protein-ligand binding. Current study identified novel and potent inhibitors of SMAD4 mutant that could be used as a drug candidate for the development of personalized medicine for gall bladder and other associated cancers.

PMID:33751339 | DOI:10.1007/s11030-021-10210-w
Interaction between non-coding RNAs and JNK in human disorders

Fetched: March 19th, 2021, 5:01am GMT by Soudeh Ghafouri-Fard

Biomed Pharmacother. 2021 Jun;138:111497. doi: 10.1016/j.biopha.2021.111497. Epub 2021 Mar 15.

ABSTRACT

Jun N-terminal Kinase (JNK) signaling pathway is a conserved cascade among species with particular roles in diverse processes during embryogenesis and normal life. These kinases regulate functions of neurons and the immune system by affecting the expression of genes, modulating the arrangement of cytoskeletal proteins, and regulating apoptosis/survival pathways. They are also involved in carcinogenesis. Several miRNAs and lncRNAs have a functional relationship with JNKs. This interaction contributes to the pathogenesis of traumatic brain injury, ulcerative colitis, hepatic ischemia/ reperfusion injury, acute myocardial infarction, and a number of other disorders. Lung cancer, hepatocellular carcinoma, gall bladder cancer, melanoma, and colon cancer are among malignant conditions in which JNK-related miRNAs/ lncRNAs contribute. The current review aims at depicting the functional interaction between JNKs and lncRNAs/ miRNAs and describing the role of these regulatory transcripts in the pathobiology of human disorders.

PMID:33735819 | DOI:10.1016/j.biopha.2021.111497
Mixed neuroendocrine-non-neuroendocrine neoplasms of the gallbladder: a case report

Fetched: March 18th, 2021, 5:02am GMT by Tatsuki Ishikawa

Surg Case Rep. 2021 Mar 17;7(1):70. doi: 10.1186/s40792-021-01152-4.

ABSTRACT

BACKGROUND: Primary neuroendocrine tumors of the gallbladder (GB-NETs) are rare, accounting for 0.5% of all NETs and 2.1% of all gallbladder cancers. Among GB-NETs, mixed neuroendocrine-non-neuroendocrine neoplasms of the gallbladder (GB-MiNENs) are extremely rare.

CASE PRESENTATION: We present the case of a 66-year-old woman who was referred to us for the management of a gallbladder tumor (incidentally found during abdominal ultrasonography indicated for gallbladder stones). The patient had no history of abdominal pain or fever, and the findings on a physical examination were unremarkable. Blood tests showed normal levels of tumor markers. Imaging studies revealed a mass of approximately 10 mm in diameter (with no invasion of the gallbladder bed) located at the fundus of the gallbladder. A gallbladder cancer was suspected. Therefore, an open whole-layer cholecystectomy with regional lymph nodes dissection was performed. The postoperative course was uneventful, and she was discharged on postoperative day 6. Pathological findings showed GB-MiNENs with invasion of the subserosal layer and no lymph node invasion (classified T2aN0M0 pStage IIA according to the Union for International Cancer Control, 8th edition staging system). Analysis of the neuroendocrine markers revealed positive chromogranin A and synaptophysin, and a Ki-67 index above 95%. Fourteen months after the operation, a local recurrence was detected, and she was referred to another hospital for chemotherapy.

CONCLUSIONS: GB-MiNENs are extremely aggressive tumors despite their tumor size. Optimal therapy should be chosen for each patient.

PMID:33730263 | PMC:PMC7969674 | DOI:10.1186/s40792-021-01152-4
The State of Perplexity During Management of Gall Bladder Malignancy in an Expectant Young Mother

Fetched: March 18th, 2021, 5:02am GMT by Deepak Rajput

Cureus. 2021 Feb 3;13(2):e13099. doi: 10.7759/cureus.13099.

ABSTRACT

During pregnancy, diagnosed cancer causes a major disturbance in the life of a pregnant woman and her family. The advanced stage of illness requiring systemic treatment inevitably leads the treating practitioner, with two lives at risk, into an ethical dilemma. The unborn child can be affected by the application of cancer medication to the mother as it is exposed to fetotoxic drugs. On the other hand, withholding therapy to allow fetal maturity may make the disease of the mother metastatic. Gall bladder carcinoma is often diagnosed as an unresectable disease (metastatic or locally advanced) due to its nonspecific symptomatology and carries the worst prognosis of any gastrointestinal or hepatobiliary neoplasm. We report a case of locally advanced gall bladder cancer (GBC) diagnosed during late pregnancy wherein the mother opted to continue the pregnancy without any intervention. A review of literature has been done to investigate the role of female hormones in a pregnancy complicating GBC with emphasis on management dilemma and the associated pitfalls.

PMID:33728121 | PMC:PMC7934605 | DOI:10.7759/cureus.13099
The giant resectable carcinoma of gall bladder-a case report

Fetched: March 18th, 2021, 5:02am GMT by Lovenish Bains

BMC Surg. 2021 Mar 16;21(1):133. doi: 10.1186/s12893-021-01117-2.

ABSTRACT

BACKGROUND: Gall bladder cancer (GBC) is the fifth most common malignancy in the gastrointestinal system and the most common malignancy of the biliary system. GBC is a very aggressive malignancy having a 5 year survival rate of 19%. Giant Gall Bladder (GGB) is an uncommon condition that can result from cholelithiasis or chronic cholecystitis and rarely with malignancy.

CASE REPORT: A 65 year old lady presented with vague abdominal pain for 12 years and right abdominal lump of size 20 × 8 cms was found on examination. CT scan showed a circumferentially irregularly thickened wall (2.5 cm) of gall bladder indicative of malignancy. Per-operatively a GB of size 24 × 9 cm was noted and patient underwent radical cholecystectomy. It was surprise to find such a giant malignant GB with preserved planes. Histopathology, it was well differentiated adenocarcinoma of gall bladder of Stage II (T2a N0 M0).

DISCUSSION: It is known that mucocoele of GB can attain large size, however chronic cholecystitis will lead to a shrunken gall bladder rather than an enlarged one. A malignant GB of such size and resectable is rare without any lymph node involvement or liver infiltration. Few cases of giant benign gall bladder have been reported in literature, however this appears to be the largest resectable gall bladder carcinoma reported till date as per indexed literature.

CONCLUSION: Giant GB is an uncommon finding. They are mostly benign, however malignant cases can occur. Radiological findings may suggest features of malignancy and define extent of disease. Prognosis depends on stage of disease and resectability, irrespective of size.

PMID:33726732 | PMC:PMC7962363 | DOI:10.1186/s12893-021-01117-2
Gallbladder polyps: modern approaches to diagnostics and treatment

Fetched: March 18th, 2021, 5:02am GMT by E V Onuchina

Ter Arkh. 2021 Jan 10;93(1):100-107. doi: 10.26442/00403660.2021.01.200544.

ABSTRACT

Gallbladder polyps are an elevation of the mucous membrane that protrudes into the lumen of the gallbladder cavity. Their prevalence in the general population varies from 0.3 to 13.8%. According to the modern classification, polyps of the gallbladder are divided into benign non-tumor, benign tumor and malignant tumor polyps. A review of modern literature presents cohort and randomized controlled trials, including those summarized in meta-analyzes and systematic reviews, suggesting that the dominant form of polypoid formations of the gallbladder are cholesterol pseudo-polyps with no malignant potential associated with impaired cholesterol metabolism, often combined with gallbladder cholesterosis, metabolic syndrome and cardiovascular morbidity. Evidence is building up on the effectiveness of ursodeoxycholic acid for controlling components of the metabolic syndrome and cardiovascular risks. Ursodeoxycholic acid preparations may become promising for the management of cholesterol polyps.

PMID:33720634 | DOI:10.26442/00403660.2021.01.200544
Pathological characterization of intracholecystic papillary neoplasm: A recently proposed preinvasive neoplasm of gallbladder

Fetched: March 17th, 2021, 5:02am GMT by Yasuni Nakanuma

Ann Diagn Pathol. 2021 Jun;52:151723. doi: 10.1016/j.anndiagpath.2021.151723. Epub 2021 Mar 3.

ABSTRACT

Intracholecystic papillary neoplasm (ICPN) is a recently proposed gallbladder neoplasm. Its prevalence and pathologies remain to be clarified. A total of 38 ICPN cases (28 ICPNs identified among 1904 cholecystectomies (1.5%) and in 100 surgically resected primary gallbladder neoplasms (28%) in Fukui Prefecture Saiseikai Hospital, Japan, and other 10 ICPNs) were examined pathologically and immunohistochemically. They were composed of 21 males and 17 females with a mean age of 75 years old, and presented intraluminal growth of papillary lesions with fine fibrovascular stalks. ICPNs were relatively frequent in the fundus (n = 11) and body (n = 9). Grossly, the conglomerated sessile type (n = 30) was more frequent than the isolated polypoid type (n = 8). All cases were classified as high-grade dysplasia, and they were further divided into 22 cases presenting irregular structures and 16 cases presenting regular structures. The former showed frequent complicated lesions and stromal invasion (54.5%) compared to the latter (12.5%). Twenty-four cases showed predominantly either of four subtypes (11 gastric, 7 intestinal, 4 biliary and 2 oncocytic subtype), while the remaining14 cases showed mixture of more than two subtypes. In conclusion, ICPN presented unique preinvasive neoplasm with characteristic histopathologies. Irregular histologies and complicated lesions of ICPN were related to stromal invasion.

PMID:33725666 | DOI:10.1016/j.anndiagpath.2021.151723
Fork head box M1 regulates vascular endothelial growth factor-A expression to promote the angiogenesis and tumor cell growth of gallbladder cancer

Fetched: March 16th, 2021, 5:01am GMT by Rui-Tao Wang

World J Gastroenterol. 2021 Feb 28;27(8):692-707. doi: 10.3748/wjg.v27.i8.692.

ABSTRACT

BACKGROUND: Gallbladder cancer (GBC) is an aggressive type of biliary tract cancer that lacks effective therapeutic targets. Fork head box M1 (FoxM1) is an emerging molecular target associated with tumor progression in GBC, and accumulating evidence suggests that vascular endothelial growth factor (VEGF) promotes various tumors by inducing neoangiogenesis.

AIM: To investigate the role of FoxM1 and the angiogenesis effects of VEGF-A in primary GBC.

METHODS: Using immunohistochemistry, we investigated FoxM1 and VEGF-A expression in GBC tissues, paracarcinoma tissues and cholecystitis tissues. Soft agar, cell invasion, migration and apoptosis assays were used to analyze the malignant phenotype influenced by FoxM1 in GBC. Kaplan-Meier survival analysis was performed to evaluate the impact of FoxM1 and VEGF-A expression in GBC patients. We investigated the relationship between FoxM1 and VEGF-A by regulating the level of FoxM1. Next, we performed MTT assays and Transwell invasion assays by knocking out or overexpressing VEGF-A to evaluate its function in GBC cells. The luciferase assay was used to reveal the relationship between FoxM1 and VEGF-A. BALB/c nude mice were used to establish the xenograft tumor model.

RESULTS: FoxM1 expression was higher in GBC tissues than in paracarcinoma tissues. Furthermore, the high expression of Foxm1 in GBC was significantly correlated with a malignant phenotype and worse overall survival. Meanwhile, high expression of FoxM1 influenced angiogenesis; high expression of FoxM1 combined with high expression of VEGF-A was related to poor prognosis. Attenuated FoxM1 significantly suppressed cell proliferation, transfer and invasion in vitro. Knockdown of FoxM1 in GBC cells reduced the expression of VEGF-A. Luciferase assay showed that FoxM1 was the transcription factor of VEGF-A, and knockdown VEGF-A in FoxM1 overexpressed cells could partly reverse the malignancy phenotype of GBC cells. In this study, we found that FoxM1 was involved in regulation of VEGF-A expression.

CONCLUSION: FoxM1 and VEGF-A overexpression were associated with the prognosis of GBC patients. FoxM1 regulated VEGF-A expression, which played an important role in the progression of GBC.

PMID:33716448 | PMC:PMC7934001 | DOI:10.3748/wjg.v27.i8.692
Yale Cancer Center Precision Medicine Tumor Board: molecular findings alter a diagnosis and treatment plan

Fetched: March 16th, 2021, 5:01am GMT by Joanna A Gibson

Lancet Oncol. 2021 Mar;22(3):306-307. doi: 10.1016/S1470-2045(20)30683-5.

NO ABSTRACT

PMID:33662283 | DOI:10.1016/S1470-2045(20)30683-5
Palliative gastrojejunostomy in unresectable cancer and gastric outlet obstruction: a retrospective cohort study

Fetched: March 16th, 2021, 5:01am GMT by J I Rodríguez

Ann R Coll Surg Engl. 2021 Mar;103(3):197-202. doi: 10.1308/rcsann.2020.7016.

ABSTRACT

INTRODUCTION: Palliative gastrojejunostomy is a surgical technique that allows restoration of oral intake among patients with gastric outlet obstruction (GOO) caused by unresectable neoplasms. Research suggests standard treatment for malignant GOO should be laparoscopic gastrojejunostomy (LGJ). This study presents the clinical outcomes of palliative gastrojejunostomy and compares results from LGJ and open gastrojejunostomy (OGJ) at our centre.

METHODS: We performed a retrospective analysis on patients who underwent palliative gastrojejunostomy for GOO caused by unresectable neoplasms between 2008 and 2018. We included demographic variables, time to recover intestinal transit, time to recover oral intake, hospital stay, complications and global survival.

RESULTS: A total of 39 patients underwent palliative gastrojejunostomy (20 OGJ, 19 LGJ). Patients in the LGJ group recovered oral intake and intestinal transit faster than those in the OGJ group (3 vs 5 days, p<0.05). There were no statistically significant differences in median operating time, hospital stay or postoperative complications between the two groups. No intraoperative complications occurred. The estimated global survival was 178 days, with no significant difference between the groups.

CONCLUSIONS: Palliative LGJ allows earlier restoration of oral intake and does not increase morbidity or mortality. Palliative LGJ should be considered the standard treatment for these patients.

PMID:33645283 | DOI:10.1308/rcsann.2020.7016
Gene and protein expression of mTOR and LC3 in hepatocellular carcinoma, colorectal liver metastasis and "normal" liver tissues

Fetched: March 16th, 2021, 5:01am GMT by Marina Bortolami

PLoS One. 2020 Dec 23;15(12):e0244356. doi: 10.1371/journal.pone.0244356. eCollection 2020.

ABSTRACT

The physiological role of autophagy in the progression of liver diseases is still debated. To understand the clinical relevance of autophagy in primary e secondary hepatic tumors, we analyzed the expression of mTOR (mammalian target of rapamycin), a key regulator of autophagy; Raptor (regulatory-associated protein of mTOR); ULK1 (Unc-51 like kinase 1) determinant in the autophagy initiation; LC3 (microtubule-associated protein 1A/1B-light chain 3), a specific marker of autophagosomes; and p62, a selective autophagy receptor. Samples from subjects with chronic hepatitis (n.58), cirrhosis (n.12), hepatocellular carcinoma (HCC, n.56), metastases (n.48) from colorectal cancer and hyperplasia or gallbladder stones (n.7), the latter considered as controls, were examined. Gene expression analysis was carried out in n.213 tissues by absolute q-PCR, while protein expression by Western Blot in n.191 lysates, including tumoral, surrounding tumoral and normal tissues. Nonparametric statistical tests were used for comparing expression levels in the above-mentioned groups. Subgroup analysis was performed considering viral infection and chemotherapy treatment. The mTOR transcriptional level was significantly lower in metastases compared to HCC (P = 0.0001). p-mTOR(Ser2448) and LC3II/LC3I protein levels were significantly higher in metastases compared to HCC (P = 0.008 and P<0.0001, respectively). ULK(Ser757) levels were significantly higher in HCC compared to metastases (P = 0.0002) while the HCV- and HBV- related HCC showed the highest p62 levels. Chemotherapy induced a down-regulation of the p-mTOR(Ser2448) in metastases and in non-tumor surrounding tissues in treated patients compared to untreated (P = 0.001 and P = 0.005, respectively). Conclusions: the different expression of proteins considered, owning their interaction and diverse tissue microenvironment, indicate an impairment of the autophagy flux in primary liver tumors that is critical for the promotion of tumorigenesis process and a coexistence of autophagy inhibition and activation mechanisms in secondary liver tumors. Differences in mTOR and LC3 transcripts emerged in tumor-free tissues, therefore particular attention should be considered in selecting the control group.

PMID:33362215 | PMC:PMC7757890 | DOI:10.1371/journal.pone.0244356
Current and Future Systemic Therapies in Biliary Tract Cancer

Fetched: March 13th, 2021, 5:01am GMT by Arndt Vogel

Visc Med. 2021 Feb;37(1):32-38. doi: 10.1159/000513969. Epub 2021 Jan 6.

ABSTRACT

BACKGROUND: Despite an increasing incidence, biliary tumors are still considered a rare tumor entity. Due to an often long clinically inapparent course and a lack of early detection strategies, surgical resection is often not possible at the time of diagnosis. Since 2010, chemotherapy with gemcitabine and cisplatin is considered the standard of care in the palliative situation. Only recently, first studies have been published or initiated that expand the treatment options in the first line and, for the first time, also suggest valid systemic approaches in the second line.

SUMMARY: Molecularly targeted therapies in selected patient subgroups are rapidly changing the field. In addition to IDH1 mutations and FGFR2 fusions in patients with intrahepatic tumors, the therapeutic relevance of rare but targetable alterations such as HER2/neu amplification, NTRK fusions, or BRAF mutations should be considered in patients with biliary tract cancers.

KEY MESSAGE: The current study landscape clearly shows that precision medicine will play an important role in the therapy of biliary malignancies and underlines the importance of early tumor genetic diagnostics. In this article we provide an overview of systemic therapy concepts in the adjuvant and palliative setting.

PMID:33708816 | PMC:PMC7923904 | DOI:10.1159/000513969
The significance of anatomic tumor location in gallbladder cancer

Fetched: March 11th, 2021, 5:01am GMT by Natasha Leigh

J Surg Oncol. 2021 Mar;123(4):932-938. doi: 10.1002/jso.26345. Epub 2020 Dec 23.

ABSTRACT

BACKGROUND AND OBJECTIVES: Current management guidelines recognize the impact of hepatic versus peritoneal sided gallbladder cancers (GBC) on survival. However, no data exist regarding the significance of anatomic tumor location within the gallbladder.

METHODS: We retrospectively analyzed all GBC that underwent surgical resection with curative intent in our health system from 2007 to 2017. We evaluated the effect of anatomic pathologic tumor location (fundus/body, neck, and multifocal) on clinicopathologic, perioperative, and oncologic outcomes.

RESULTS: About 97 patients met criteria; 63% fundus/body, 22% multifocal, and 15% neck. Compared with fundus/body, neck tumors more frequently presented with preoperative jaundice (53% vs. 13%, p < .001), were smaller (20 mm vs. 30 mm, p = .068) and had significantly more biliary tree invasion (33% vs. 13%, p = .030) on histopathology. Although tumor characteristics (pTNM stage, liver invasion, lymphovascular invasion, prognostic nutritional index, and grade) were similar, neck tumors had significantly higher rates of R0 resection (53% vs. 11%, p < .001). Rates of adjuvant therapy were similar. Median PFS was similar between cohorts (p = .356). However, median overall survival (OS) was significantly shorter in neck (21 months) than fundus/body tumors (NR > 109 months), p = .015.

CONCLUSIONS: Neck tumors were rare, small and more likely to result in jaundice secondary to biliary tree invasion. Despite higher R0 resection rates, these tumors had significantly worse OS.

PMID:33368336 | DOI:10.1002/jso.26345
Abdominal investigations in the year preceding a diagnosis of abdominal cancer: A register-based cohort study in Denmark

Fetched: March 11th, 2021, 5:01am GMT by Nanna Holt Jessen

Cancer Epidemiol. 2021 Jun;72:101926. doi: 10.1016/j.canep.2021.101926. Epub 2021 Mar 6.

ABSTRACT

BACKGROUND: More than 11,500 abdominal cancers are yearly diagnosed in Denmark. Nevertheless, little is known about which investigations the patients undergo before a diagnosis of abdominal cancer. We aimed to investigate the frequency and timing of selected diagnostic investigations during the year preceding an abdominal cancer diagnosis.

METHODS: We conducted a nationwide registry-based cohort study of patients aged ≥ 18 years who were diagnosed with a first-time abdominal cancer in 2014-2018. We included the following cancer types: oesophageal, gastric, colon, rectal, liver, gall bladder/biliary tract, pancreatic, endometrial, ovarian, kidney, and bladder cancer. Investigations of interest were transvaginal ultrasound, abdominal ultrasound, colonoscopy, gastroscopy, endoscopic retrograde cholangiopancreatography, cystoscopy, hysteroscopy, abdominal computed tomography and abdominal magnetic resonance imaging. Generalised linear models were used to calculate incidence rate ratios to enable comparison of monthly rates of investigations.

RESULTS: All types of investigations were performed, with varying frequency, across the 11 abdominal cancer types in the year preceding the diagnosis. Increased use of investigations revealed that the timing of the onset differed for the different abdominal cancers, with increases seen 2-6 months before the diagnosis. Abdominal ultrasound, colonoscopy and computed tomography were the investigations with the earliest increase.

CONCLUSION: In the year before a diagnosis of an abdominal cancer, some patients appear to undergo investigations typically used to detect another cancer type. This indicates that a window of opportunity exists to diagnose some abdominal cancers at an earlier time point. Future studies should explore an alternative clinical pathway to promote earlier diagnosis of abdominal cancers.

PMID:33689927 | DOI:10.1016/j.canep.2021.101926
Identification of patients who may benefit the most from adjuvant chemotherapy following resection of incidental gallbladder carcinoma

Fetched: March 11th, 2021, 5:01am GMT by Jun-Xi Xiang

J Surg Oncol. 2021 Mar;123(4):978-985. doi: 10.1002/jso.26389. Epub 2021 Jan 26.

ABSTRACT

BACKGROUND: To develop a scoring system to identify the subset of patients who may benefit the most from adjuvant chemotherapy following curative-intent resection for incidental gallbladder cancer (IGBC).

METHODS: A novel scoring system was utilized to stratify patients relative to overall survival (OS), as well as potential benefit from adjuvant chemotherapy following curative resection for IGBC.

RESULTS: Among 266 patients with IGBC, a total of 99 (37.2%) patients received adjuvant chemotherapy. Five risk factors were used to develop an integer-based score to predict OS. Risk of death at 5-years incrementally increased among patients in the low (n = 42, 69.0%), medium (n = 64, 56.3%) and high-risk groups (n = 40, 30.0%) (median OS, 99.4 vs. 33.5 vs. 15.6 months, all p < .001). Use of adjuvant chemotherapy did not provide a survival benefit among patients in the low-risk group (median survival, 99.4 vs. 60.7 months, p = .56). In contrast, utilization of adjuvant chemotherapy was associated with an improvement in survival among medium- (median survival, 21.7 vs. 59.5 months, p = .04) and high-risk patients (median survival, 11.6 vs. 20.1 months, p = .01).

CONCLUSIONS: While low-risk patients did not benefit from adjuvant chemotherapy, individuals with medium or high-risk scores had an improved survival with the utilization of adjuvant chemotherapy.

PMID:33497466 | DOI:10.1002/jso.26389
Neuroendocrine neoplasms of the biliary tree, liver and pancreas: a pathological approach

Fetched: March 10th, 2021, 5:01am GMT by Claudio Luchini

Pathologica. 2021 Feb;113(1):28-38. doi: 10.32074/1591-951X-231.

ABSTRACT

Neuroendocrine neoplasms of the pancreatobiliary tract and liver are a heterogeneous group that encompass a spectrum of entities with distinct morphological, biological and clinical features. Although in the various anatomical sub-sites of this region they show specific characteristics, these tumors, as a whole, share several etiological and clinical aspects. This review systematically addresses NENs arising in the extrahepatic bile ducts, gallbladder, liver and pancreas, with the principal aim of pinpointing essential diagnostic and classification issues. In addition, the section on hepatic NENs has been expanded to include metastatic disease of unknown primary site.

PMID:33686308 | DOI:10.32074/1591-951X-231
Diagnostic performance of preoperative CT in differentiating between benign and malignant origin of suspicious gallbladder lesions

Fetched: March 8th, 2021, 5:01am GMT by Hendrien Kuipers

Eur J Radiol. 2021 May;138:109619. doi: 10.1016/j.ejrad.2021.109619. Epub 2021 Feb 26.

ABSTRACT

PURPOSE: To determine diagnostic performance of preoperative CT in differentiating between benign and malignant suspicious gallbladder lesions and to develop a preoperative risk score.

METHOD: All patients referred between January 2007 and September 2018 for suspicion of gallbladder cancer (GBC) or incidentally found GBC were retrospectively analyzed. Patients were excluded when preoperative CT or histopathologic examination was lacking. Two radiologists, blinded to histopathology results, independently reviewed CT images to differentiate benign disease from GBC. Multivariable analysis and internal validation were used to develop a risk score for GBC. Model discrimination, calibration, and diagnostic performance were assessed.

RESULTS: In total, 118 patients with 39 malignant (33 %) and 79 benign (67 %) lesions were included. Sensitivity of CT for diagnosing GBC was 90 % (95 % confidence interval [CI]: 76-97). Specificity rates were 61 % (95 % CI: 49-72) and 59 % (95 % CI: 48-70). Three predictors of GBC (irregular lesion aspect, absence of fat stranding, and locoregional lymphadenopathy) were included in the risk score ranging from -1 to 4. Adequate performance was found (AUC: 0.79, calibration slope: 0.89). In patients allocated >0 points, the model showed higher performance in excluding GBC than the radiologists (sensitivity 92 % [95 % CI: 79-98]). Moreover, when allocated >3 points, the risk score was superior in diagnosing GBC (specificity 99 % [95 % CI: 93-100]).

CONCLUSIONS: Sensitivity rates of CT for differentiation between benign and malignant gallbladder lesions are high, however specificity rates are relatively low. The proposed risk score may facilitate differentiation between benign and malignant suspicious gallbladder lesions.

PMID:33676357 | DOI:10.1016/j.ejrad.2021.109619
Relationship between Urban Green Spaces and Cancer: A Scoping Review

Fetched: March 7th, 2021, 5:01am GMT by Marion Porcherie

Int J Environ Res Public Health. 2021 Feb 11;18(4):1751. doi: 10.3390/ijerph18041751.

ABSTRACT

This scoping study aims to explore the relationships between urban green spaces (UGSs) and the onset, remission and recovery of cancer. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews (protocol published in 2018). Eligibility criteria for papers were: (1) to be concerned with UGSs, (2) reporting effects of UGSs on cancer-related outcomes including direct or indirect measures, (3) reporting randomized controlled trials, prospective cohort studies, case studies, observational studies, non-comparative studies, (4) in English or French. The search covered primary studies in the published and unpublished (grey) literatures searching by hand and electronic databases (MEDLINE, Green File, Cumulative Index to Nursing and Allied Health Literature and ScienceDirect). Among 1703 records screened by two reviewers independently, 29 were included for qualitative synthesis. We classify the cancers concerned and the effects reported i.e., protective effect, risk or without association. The most investigated cancers are bladder, breast and lung cancer. Our study also identified contributing factors and their mediating effects between UGSs and cancer. Even though the strength of the evidence of the associations between UGSs and cancer is still weak due to the low number of studies and their design, results highlight the wide variety of possible mediating factors between the use of green spaces and cancer occurrence, remission and/or prevention. Knowledge gaps and future research perspectives should be oriented to qualitative research on protective factors with an attention to equity in UGS access and use.

PMID:33670207 | PMC:PMC7916941 | DOI:10.3390/ijerph18041751
Additional Value of Integrated (18)F-FDG PET/MRI for Evaluating Biliary Tract Cancer: Comparison with Contrast-Enhanced CT

Fetched: March 5th, 2021, 5:01am GMT by Jeongin Yoo

Korean J Radiol. 2021 May;22(5):714-724. doi: 10.3348/kjr.2020.0689. Epub 2021 Feb 9.

ABSTRACT

OBJECTIVE: To evaluate the value of ¹⁸F-fluorodeoxyglucose PET/MRI added to contrast-enhanced CT (CECT) in initial staging, assessment of resectability, and postoperative follow-up of biliary tract cancer.

MATERIALS AND METHODS: This retrospective study included 100 patients (initial workup [n = 65] and postoperative follow-up [n = 35]) who had undergone PET/MRI and CECT for bile duct or gallbladder lesions between January 2013 and March 2020. Two radiologists independently reviewed the CECT imaging set and CECT plus PET/MRI set to determine the likelihood of malignancy, local and overall resectability, and distant metastasis in the initial workup group, and local recurrence and distant metastasis in the follow-up group. Diagnostic performances of the two imaging sets were compared using clinical-surgical-pathologic findings as standards of reference.

RESULTS: The diagnostic performance of CECT significantly improved after the addition of PET/MRI for liver metastasis (area under the receiver operating characteristic curve [Az]: 0.77 vs. 0.91 [p = 0.027] for reviewer 1; 0.76 vs. 0.92 [p = 0.021] for reviewer 2), lymph node metastasis (0.73 vs. 0.92 [p = 0.004]; 0.81 vs. 0.92 [p = 0.023]), and overall resectability (0.79 vs. 0.92 [p = 0.007]; 0.82 vs. 0.94 [p = 0.021]) in the initial workup group. In the follow-up group, the diagnostic performance of CECT plus PET/MRI was significantly higher than that of CECT imaging for local recurrence (0.81 vs. 1.00 [p = 0.029]; 0.82 vs. 0.94 [p = 0.045]).

CONCLUSION: PET/MRI may add value to CECT in patients with biliary tract cancer both in the initial workup for staging and determination of overall resectability and in follow-up for local recurrence.

PMID:33660461 | PMC:PMC8076821 | DOI:10.3348/kjr.2020.0689
An epidemiological study of neuroendocrine tumours at tertiary hospitals in Bosnia and Herzegovina

Fetched: March 4th, 2021, 5:01am GMT by Maja Konrad Čustović

Med Glas (Zenica). 2021 Feb 1;18(1):77-83. doi: 10.17392/1219-21.

ABSTRACT

Aim Neuroendocrine neoplasms (NENs) are a heterogeneous group of tumours with varying clinical expression and behaviour. Because of indolent behaviour of NENs, reviewing and evaluation of epidemiological characteristics is a challenge. The aim of this study was to assess prevalence of NENs at tertiary hospitals considering age, gender, location, and grade. Methods Electronic files were used for a retrospective assessment of the patients with NENs of the gastroenteropancreatic tract and bronchopulmonary system in tertiary hospitals in Bosnia and Herzegovina over the past 15 years (2005-2020). Results Among 438 patients, 291(66.4%) were males and 147 (33.6%) females; the median age was 62 years. The lungs were the most frequent site, 304 (69.4%), followed by the pancreas, 22 (5.0%), colon, 14 (3.2%), stomach, 13 (2.9%), appendix, 13 (2.9%), rectum,11 (2.5%), small intestine, eight (1.8%) and gallbladder, one (0.2%). Metastases were most frequently found in the liver, 35 (8%) and lymph nodes, 15 (3.42%). Conclusion The results were largely consistent with those in literature, including age, gender, location, and the degree of differentiation. Most metastases originated from high-grade tumours and greater impairment of the liver.

PMID:33655741 | DOI:10.17392/1219-21
Low-Grade Dysplastic Intracholecystic Papillary Neoplasia: A Case Report

Fetched: March 4th, 2021, 5:01am GMT by Ana Logrado

Am J Case Rep. 2021 Mar 3;22:e929788. doi: 10.12659/AJCR.929788.

ABSTRACT

BACKGROUND The World Health Organization classification of premalignant gallbladder lesions includes adenomas, intraductal papillary neoplasms, biliary intraepithelial neoplasia, and intracystic papillary neoplasms. Noninvasive neoplastic lesions >1 cm that originate from the pancreatobiliary system are defined as intraductal papillary neoplasia when they occur in the biliary ducts. The clinical and pathological features of preinvasive lesions arising in the gallbladder are not yet well defined. However, the most widely accepted classification is that of intracholecystic papillary neoplasm (ICPN). CASE REPORT We present the case of a 71-year-old woman referred to a General Surgery outpatient clinic for suspicious findings on imaging of the gallbladder, namely irregular infundibular parietal thickening. The patient underwent a laparoscopic cholecystectomy and histological examination revealed a thickened gallbladder with mucosa partially surrounded by ICPN with an intestinal pattern and some foci of low-grade dysplasia but no foci of high-grade dysplasia or invasive neoplasia. At follow-up at 30 months, the patient remains clinically well, with no changes visible on computed tomography scan. CONCLUSIONS ICPN of the gallbladder appears to be part of a spectrum of alterations encompassing bile duct or pancreatic lesions. Although it is uncommon, more than half of the lesions are known to have foci of invasive neoplasia at the time of diagnosis. Despite that, the prognosis for these neoplasms is more favorable than for gallbladder neoplasia that originates from another type of lesion. Pathological study of ICPN is essential to define the main characteristics that impact prognosis and survival in these patients.

PMID:33654049 | PMC:PMC7937593 | DOI:10.12659/AJCR.929788
Risk of cancer incidence and mortality associated with diabetes: A systematic review with trend analysis of 203 cohorts

Fetched: March 3rd, 2021, 5:02am GMT by Suping Ling

Nutr Metab Cardiovasc Dis. 2021 Jan 4;31(1):14-22. doi: 10.1016/j.numecd.2020.09.023. Epub 2020 Sep 25.

ABSTRACT

AIM: Whether the relative risk of cancer incidence and mortality associated with diabetes has changed over time is unknown.

DATA SYNTHESIS: On August 12th, 2020, we electronically searched for observational studies reporting on the association between diabetes and cancer. We estimated temporal trends in the relative risk of cancer incidence or mortality associated with diabetes and calculated the ratio of relative risk (RRR) comparing different periods. As many as 193 eligible articles, reporting data on 203 cohorts (56,852,381 participants; 3,735,564 incident cancer cases; 185,404 cancer deaths) and covering the period 1951-2013, were included. The relative risk of all-site cancer incidence increased between 1980 and 2000 [RRR 1990 vs.1980: (1.24; 95% CI: 1.16, 1.34); 2000 vs.1990: (1.23; 1.15, 1.31)] and stabilised thereafter at a relative risk of 1.2; the relative risk of all-site cancer mortality was constant at about 1.2 from 1980 to 2010. Both magnitudes and trends in relative risk varied across cancer sites: the relative risk of colorectal, female breast, and endometrial cancer incidence and pancreatic cancer mortality was constant during the observed years; it increased for bladder, stomach, kidney, and pancreatic cancer incidence until 2000; and decreased for liver while increased for prostate, colon and gallbladder cancer incidence after 2000.

CONCLUSIONS: Alongside the increasing prevalence of diabetes, the temporal patterns of the relative risk of cancer associated with diabetes may have contributed to the current burden of cancer in people with diabetes.

PMID:33223399 | DOI:10.1016/j.numecd.2020.09.023
Next generation sequencing for biliary tract cancers

Fetched: March 2nd, 2021, 5:03am GMT by Timothy P DiPeri

Expert Rev Gastroenterol Hepatol. 2021 Mar 1. doi: 10.1080/17474124.2021.1896967. Online ahead of print.

NO ABSTRACT

PMID:33641586 | DOI:10.1080/17474124.2021.1896967
Roles of Salmonella typhi and Salmonella paratyphi in Gallbladder Cancer Development

Fetched: March 1st, 2021, 5:02am GMT by Ratnakar Shukla

Asian Pac J Cancer Prev. 2021 Feb 1;22(2):509-516. doi: 10.31557/APJCP.2021.22.2.509.

ABSTRACT

BACKGROUND: Typhoid (Salmonella typhi and paratyphi) carriers and gall bladder cancer (GBC) are endemic in northern India. Results of previous studies about association of typhoid carriers with GBC are inconsistent. We studied antibodies against Salmonella typhi and paratyphi in serum samples of patients with GBC.

METHODS: We performed modified Widal test for antibodies against Salmonella typhi (Vi and O) and Salmonella paratyphi (AO and BO) antigens in patients with GBC (n=100), xanthogranulomatous cholecystitis (XGC, n=24), chronic cholecystitis (CC, n=200) and healthy controls (HC, n=200).

RESULTS: Serum antibodies against Salmonella were more frequently positive in GBC (22%) and XGC (29%), particularly in males in age ≥50 years (GBC: 47% and XGC: 50%) vs. HC (0) (p <0.01). Vi antibody was more common in GBC (13%, OR:9.8) and XGC (8%, OR:5.9) than HC (2%). O antibody was more common in GBC (8%, OR: 8.6) and XGC (8%, OR: 9.0) than HC (1%). O antibody was also more common in males with GBC (12%) than CC (1%) and HC (1%) (P=0.02 and p <0.001, respectively). AO (6%) and BO (4%) antibodies were detected in GBC, particularly in males, than HC (0), (p <0.01). Salmonella antibodies were more frequent in GBC with GS than those without GS (50% vs. 20%, OR=3.94, P=0.01).

CONCLUSIONS: Salmonella carrier state was more common in GBC and XGC, particularly in elderly males than HC. The Vi antibody was more common in GBC and XGC than HC. Salmonella infection was more common in GBC with GS than those without GS.

PMID:33639667 | DOI:10.31557/APJCP.2021.22.2.509
Brain metastasis from gallbladder neuroendocrine carcinoma

Fetched: February 27th, 2021, 5:02am GMT by Hanako Sasaki

BMJ Case Rep. 2020 Nov 30;13(11):e238114. doi: 10.1136/bcr-2020-238114.

ABSTRACT

A 52-year-old woman was diagnosed with unresectable gallbladder neuroendocrine carcinoma (GB-NEC) exhibiting lymph node and peritoneal metastases, and received eight courses of chemotherapy with irinotecan plus cisplatin. Radiological examinations revealed significant regression of the GB tumour and disappearance of metastatic lesions, so the patient underwent laparoscopic cholecystectomy. However, the patient presented with multiple haemorrhagic brain metastases (BMs) and died 13 months after the initial diagnosis despite neurosurgical interventions. Pathological examination of the resected gallbladder demonstrated an extensive fibrous scar along with tubular adenocarcinoma components, which may indicate that the chemotherapy eliminated a pre-existing neuroendocrine carcinoma (NEC) component. Furthermore, pathological analysis confirmed that the BMs comprised NEC. In patients with advanced GB-NEC, conversion surgery may be a reasonable option if a first-line chemotherapy leads to downstaging of the tumour. Second-line drug therapy and systemic screening might also be considered in cases with BMs.

PMID:33257386 | PMC:PMC7705493 | DOI:10.1136/bcr-2020-238114
Gallbladder Uptake Mimicking Liver Metastasis on 177Lu-DOTATATE Posttherapy Scan Gallbladder Uptake on 177Lu-DOTATATE Scan

Fetched: February 25th, 2021, 5:02am GMT by Mine Araz

Clin Nucl Med. 2021 Mar 1;46(3):e154-e155. doi: 10.1097/RLU.0000000000003475.

ABSTRACT

We represent the case of a 61-year-old man with atypical carcinoid tumor of the lung. On posttherapy 177Lu-DOTATATE whole-body scan, focal intense uptake in the inferomedial side of the liver was detected. Pretherapy 68Ga-DOTATATE PET/CT showed no sign of liver metastasis, and posttherapy diagnostic dynamic liver MRI is used to exclude metastatic liver disease. Focal intense uptake was attributed to physiological gallbladder uptake.

PMID:33512839 | DOI:10.1097/RLU.0000000000003475
The Chile Biliary Longitudinal Study: A Gallstone Cohort

Fetched: February 25th, 2021, 5:02am GMT by Jill Koshiol

Am J Epidemiol. 2021 Feb 1;190(2):196-206. doi: 10.1093/aje/kwaa199.

ABSTRACT

Gallbladder cancer (GBC) is a highly fatal cancer that can be cured through cholecystectomy if identified early. The presence of gallstones is the primary risk factor for GBC, but few people with gallstones develop GBC. A key question is what drives the development of GBC among persons with gallstones. We initiated the Chile Biliary Longitudinal Study (Chile BiLS) to address this question. From 2016 to 2019, Chile BiLS enrolled 4,726 women aged 50-74 years with ultrasound-detected gallstones from southern-central Chile, accounting for an estimated 36% of eligible women with gallstones in the study area. The median age was 59 years; 25% of the women were Amerindian (Mapuche), 60% were obese, 25% had diabetes, and 6% had cardiovascular disease. Participants will be followed for gallbladder dysplasia or cancer for 6 years. As of April 30, 2020, over 91% of those eligible completed the year 2 follow-up visit. Data being collected include epidemiologic and sociodemographic information, anthropometric measurements, blood pressure, and tooth counts. Biosamples being taken include baseline plasma, buffy coat, red blood cells, serum, blood clot from serum, and PAXgene whole blood (PreAnalytiX GmbH, Hombrechtikon, Switzerland). Complete gallbladder sampling is conducted for most participants undergoing cholecystectomy. The Chile BiLS cohort study will increase our understanding of GBC etiology and could identify potential risk stratification and early detection strategies in high-risk areas.

PMID:33524121 | PMC:PMC7850058 | DOI:10.1093/aje/kwaa199
Novel biomarkers for the diagnosis and prognosis of gallbladder cancer

Fetched: February 24th, 2021, 5:01am GMT by Hong Ze Lin

J Dig Dis. 2021 Feb;22(2):62-71. doi: 10.1111/1751-2980.12966.

ABSTRACT

Gallbladder cancer (GBC) is the most common form of biliary tract malignancy with a dismal prognosis. A poor outcome in patients with GBC is related to the aggressive nature of the tumor, delayed diagnosis, and a lack of reliable biomarkers and effective treatment. Therefore, early diagnosis and accurate disease assessment are crucial to prolonging the patient survival. Identification of novel prognostic and diagnostic biomarkers may help improve the early diagnostic rate and develop specific targeted treatments for patients with GBC. We herein review the novel biomarkers that may be associated with the diagnosis and prognosis in GBC and their potential clinical significance in the management of GBC.

PMID:33369216 | DOI:10.1111/1751-2980.12966
The clinical profiles, management, and prognostic factors of biliary mixed neuroendocrine nonneuroendocrine neoplasms: A systematic review of the literature

Fetched: February 24th, 2021, 5:01am GMT by Li-Jia Wen

Medicine (Baltimore). 2020 Dec 11;99(50):e23271. doi: 10.1097/MD.0000000000023271.

ABSTRACT

BACKGROUND: Mixed neuroendocrine nonneuroendocrine neoplasms (MiNENs) originating from the biliary system (gallbladder, biliary tract, or ampulla of Vater) are extremely rare and have not been discussed in detail or systematically. We aimed to present the demographics, clinicopathological characteristics, management, and prognostic factors of biliary MiNENs.

METHODS: A systematic search of electronic biomedical databases (Web of Science, PUBMED, and Embase) was performed to identify eligible studies. Survival was analyzed with the Kaplan-Meier method. Log-rank tests were used to evaluate the differences between groups, and the effects of various clinical and histopathological features on prognosis were analyzed by univariate and multivariate Cox regression.

RESULTS: Fifty-three publications (patients, n = 67) were included. The median overall survival time was 21.0 months. Fifty-one patients (76.1%) underwent radical surgery and median survival for 41 months (P < .001). Twenty-two patients who received adjuvant radiochemotherapy treatment after radical surgery had a median survival for 43 months (P = .076). Radical resection (P < .001), Ki-67 index (P = .011), tumor stage (P < .001), neuroendocrine (NEC) grade (P = .011), and non-NEC grade (P = .017) were independent statistically significant prognostic factors according to univariate analysis; radical resection (P = .010) and small morphological subtype (P = .036) were independent statistically significant prognostic factors associated with higher overall survival according to multivariate analysis, and radical resection (P = .005) and age < 65 years (P = .026) were associated with higher recurrence free survival time.

CONCLUSION: Radical resection is essential for long-term survival. Aggressive multimodality therapy with adjuvant radiochemotherapy and biotherapy may improve survival of biliary MiNENs. Further randomized controlled trials are needed to determine the standard treatment.

PMID:33327249 | PMC:PMC7738038 | DOI:10.1097/MD.0000000000023271
Associations between serum uric acid and hepatobiliary-pancreatic cancer: A cohort study

Fetched: February 24th, 2021, 5:01am GMT by Chong-Fei Huang

World J Gastroenterol. 2020 Nov 28;26(44):7061-7075. doi: 10.3748/wjg.v26.i44.7061.

ABSTRACT

BACKGROUND: Uric acid is the end product of purine metabolism. Previous studies have found that serum uric acid (SUA) levels are associated with the total cancer risk. However, due to the dual effect of uric acid on cancer, the relationship between the SUA levels and most specific-site cancer remains unclear.

AIM: To investigate the associations between the SUA levels and incidence of hepatobiliary-pancreatic cancer.

METHODS: In this prospective cohort study, 444462 participants free of cancer from the UK Biobank were included. The SUA levels were measured at baseline, and the incidence of hepatobiliary-pancreatic cancer was determined by contacting the cancer registry. The hazard ratios (HRs) and 95% confidence intervals (CIs) between the SUA levels and hepatobiliary-pancreatic cancer were investigated using multiple adjusted Cox regression models adjusted for potential confounders.

RESULTS: In total, 920 participants developed liver, gallbladder, biliary tract or pancreatic cancer during a median of 6.6 yrs of follow-up. We found that the HR of pancreatic cancer in the highest SUA group was 1.77 (95%CI: 1.29-2.42) compared with that in the lowest group. After stratifying by gender, we further found that SUA was associated with an increased risk of pancreatic cancer only among the females (highest quartile vs lowest quartile HR 2.04, 95%CI: 1.35-3.08). Among the males, the SUA levels were positively associated with the gallbladder cancer risk (highest quartile vs lowest quartile HR 3.09, 95%CI: 1.28-7.46), but a U-shaped association with the liver cancer risk was observed (P-nonlinear = 0.03).

CONCLUSION: SUA is likely to have gender-specific effects on hepatobiliary-pancreatic cancer. High SUA levels are a risk factor for pancreatic cancer in females and gallbladder cancer in males. A U-shaped association with the liver cancer risk was identified.

PMID:33311950 | PMC:PMC7701939 | DOI:10.3748/wjg.v26.i44.7061
PET/MRI of the hepatobiliary system: Review of techniques and applications

Fetched: February 24th, 2021, 5:01am GMT by Preethi Guniganti

Clin Imaging. 2021 Mar;71:160-169. doi: 10.1016/j.clinimag.2020.10.056. Epub 2020 Nov 5.

ABSTRACT

Simultaneous positron emission tomography and MRI (PET/MRI) is an emerging technology that offers the benefits of MRI, including excellent soft tissue contrast, lack of ionizing radiation, and functional MRI techniques, with the physiologic information provided by PET. Although most PET/MRI systems are currently installed in tertiary care centers, PET/MRI technology is becoming increasingly widespread. The usefulness of PET/MRI varies by tumor type and organ system and has been shown to have utility in evaluation of primary and secondary hepatic neoplasms. Understanding the appropriate applications, techniques and relevant imaging findings is important for practicing radiologists considering or currently utilizing PET/MR for the evaluation of primary liver neoplasms, including hepatocellular carcinoma (HCC), as well as staging of biliary neoplasms including cholangiocarcinoma and gallbladder cancer, identification of liver metastases, and staging of neuroendocrine tumor.

PMID:33285404 | DOI:10.1016/j.clinimag.2020.10.056
Metastasis to Breast From Carcinoma Gallbladder: A Case Report and Review of Literature

Fetched: February 24th, 2021, 5:01am GMT by Bijayalaxmi Sahoo

Cureus. 2020 Nov 3;12(11):e11307. doi: 10.7759/cureus.11307.

ABSTRACT

Gallbladder cancer (GBC) is the commonest malignancy among biliary tract cancers. Locoregional spread in GBC is more common than distant metastasis. The liver and abdominal lymph nodes is the most common site of distant metastasis. Breast metastasis is a rare site of dissemination. GBC is an aggressive tumor and carries a poor prognosis, with a five-year survival rate of less than 10%. Metastasis to the breast from a gallbladder is significantly less and accounts for very few cases. Here, we are reporting a rare case of carcinoma gallbladder metastasis to the breast who survived for 38 months from the diagnosis of GBC and around 25 months after breast metastasis.

PMID:33282584 | PMC:PMC7714739 | DOI:10.7759/cureus.11307
Gallbladder Metastasis from Renal Cell Carcinoma Four Years after Nephrectomy-A Case Report

Fetched: February 24th, 2021, 5:01am GMT by Takahiro Ozaki

Gan To Kagaku Ryoho. 2020 Nov;47(11):1609-1613.

ABSTRACT

An 80-year-old man who had undergone nephrectomy for renal cell carcinoma(RCC)4 years before presentation was admitted to our department for further investigation of the gallbladder tumor. The patient was diagnosed with early gallbladder carcinoma based on CT and MRI findings and treated with laparoscopic cholecystectomy. The intraoperative frozen section revealed that the identified tumor was clear cell carcinoma. Finally, morphological similarity with a previous specimen of RCC and immunostaining resulted in the diagnosis of gallbladder metastasis from RCC. Therefore, it is important to consider metastatic carcinoma of the gallbladder in the differential diagnosis of gallbladder tumors for patients with a history of renal cell carcinoma.

PMID:33268738
Clinical, histopathologic, and immunohistochemical features of 13 cases of canine gallbladder neuroendocrine carcinoma

Fetched: February 24th, 2021, 5:01am GMT by Kevin M O'Brien

J Vet Diagn Invest. 2021 Mar;33(2):294-299. doi: 10.1177/1040638720978172. Epub 2020 Dec 2.

ABSTRACT

In this retrospective descriptive study, we characterized the clinical, histologic, and immunohistochemical features of 13 cases of canine gallbladder neuroendocrine carcinoma (GB-NEC). Immunohistochemical stains for neuroendocrine (neuron-specific enolase [NSE], chromogranin A, synaptophysin) and gastrin markers were evaluated, and clinicopathologic and follow-up data were obtained for all cases. The average age at diagnosis was 8.9 y, and breeds included 6 Boston Terriers, 2 Bichon Frise, 1 Poodle, 1 English Bulldog, 1 French Bulldog, and 2 mixed-breed dogs. Boston Terriers were overrepresented in this cohort, and therefore a breed predilection is possible. Most dogs were presented with emesis and elevated liver enzyme activities: 13 of 13 had elevated alanine aminotransferase and alkaline phosphatase activities; 8 of 13 had elevated aspartate aminotransferase activity; 7 of 13 had elevated gamma-glutamyl transferase activity. Abdominal ultrasound and/or exploratory surgery revealed a gallbladder mass. All neoplasms had similar histologic features and positive immunoreactivity for NSE, chromogranin A, synaptophysin, and gastrin. Vascular invasion was noted in 8 of 13 neoplasms, and metastasis was present in 6 of 13 cases (4 hepatic and 2 pulmonary metastases). The median survival time was 3.7 y in patients who died; 5 of 8 deaths were directly attributed to the GB-NEC, 3 of which had metastatic spread. GB-NECs have the potential to metastasize; however, surgical excision may be curative in a subset of dogs.

PMID:33267749 | DOI:10.1177/1040638720978172
Progression to invasive cancer after snare polypectomy of intracholecystic papillary neoplasms during gallbladder stone removal by percutaneous transhepatic choledochoscopy: a case report

Fetched: February 24th, 2021, 5:01am GMT by Chi Hyuk Oh

BMC Gastroenterol. 2020 Nov 30;20(1):404. doi: 10.1186/s12876-020-01547-x.

ABSTRACT

BACKGROUND: Intracholecystic papillary neoplasms (ICPNs) of the gallbladder are rare, preinvasive lesions characterized by an intracholecystic papillary growth that may be associated with invasive adenocarcinoma. The natural history of ICPN is unknown. Here, we report a case of ICPN, highlighting its natural course.

CASE PRESENTATION: A 79-year-old woman presented to the emergency department with perforated cholecystitis. After percutaneous transhepatic gallbladder drainage, due to the presence of surgical risk factors, we opted to perform gallstone removal through percutaneous transhepatic cholangioscopy instead of cholecystectomy. ICPN, which was accidentally detected after the removal of the gallbladder stones, was also endoscopically removed. After 4 years, the patient came back to the hospital with a large gallbladder mass. After cholecystectomy, pathological examination revealed ICPN with invasive adenocarcinoma.

CONCLUSION: The current case showed endoscopic findings of ICPN and its natural progression, particularly its clinicopathological features and outcomes.

PMID:33256632 | PMC:PMC7708256 | DOI:10.1186/s12876-020-01547-x
Intracystic Papillary Neoplasm of Gallbladder Mimicking Metastatic Malignancy on PET/CT

Fetched: February 24th, 2021, 5:01am GMT by Rasha Ismail

Clin Nucl Med. 2020 Nov 23. doi: 10.1097/RLU.0000000000003442. Online ahead of print.

ABSTRACT

Intracystic papillary neoplasm of the gallbladder is a rare preinvasive neoplastic lesion with similar characteristics as intraductal papillary mucinous neoplasm and other papillary neoplasms of pancreaticobiliary system. We report a case of 48-year-old woman with a history of recurrent right flank chondrosarcoma and gallbladder lesion on MRI and PET/CT interpreted as indeterminate for metastatic disease. Subsequent cholecystectomy showed intracystic papillary neoplasm. With gallbladder lesions being rare on PET/CT, this case illustrates the importance of considering both primary and secondary tumors in the differential diagnosis.

PMID:33234941 | DOI:10.1097/RLU.0000000000003442
Diagnostic value of quantification of circulating free DNA for gall bladder cancer using a chemiluminescence DNA biosensor system based on DNA G-quadruplex/ hemin enzyme

Fetched: February 24th, 2021, 5:01am GMT by Hua Ying

Transl Oncol. 2021 Jan;14(1):100928. doi: 10.1016/j.tranon.2020.100928. Epub 2020 Nov 16.

ABSTRACT

Gall bladder cancer (GBC) is an insidious but rapidly progressed disease with a poor prognosis and high mortality rate. To explore a novel method for GBC diagnosis, we quantified circulating free DNA (cfDNA) in serum samples from 228 participants, including 83 patients with GBC, 75 patients with cholecystitis, and 70 healthy donors, using a chemiluminescence DNA biosensor system based on DNA G-quadruplex/hemin enzyme. We measured β-actin gene expression to evaluate serum cfDNA levels representing as chemiluminescence intensity with the addition of sufficient probes. We analyzed associations of cfDNA quantities in serum samples and corresponding pathological stages and found that the concentration of cfDNA was significantly higher in GBC group than in the healthy control and cholecystitis groups. The levels of cfDNA were significantly associated with TNM stage, lymph node involvement, metastasis, and jaundice. The ROC curves showed that the diagnostic value of chemiluminescence DNA biosensor system was nearly equivalent to that of qPCR. Our method can distinguish patients with GBC from healthy donors and patients with cholecystitis clearly; however, this method was not available to distinguish patients with cholecystitis from the healthy controls. In summary, cfDNA maybe serve as a new diagnostic and noninvasive marker for the diagnosis of GBC using chemiluminescence DNA biosensor system based on DNA G-quadruplex/hemin enzyme.

PMID:33212417 | PMC:PMC7679247 | DOI:10.1016/j.tranon.2020.100928
Incidence of Incidental Gall Bladder Cancer and Role of Routine Histopathological Examination in Cholecystectomies Specimens for Benign Disease

Fetched: February 24th, 2021, 5:01am GMT by Rajesh Poudel

J Nepal Health Res Counc. 2020 Nov 14;18(3):547-550. doi: 10.33314/jnhrc.v18i3.1974.

ABSTRACT

BACKGROUND: Gallbladder cancer is the most common biliary tract cancer. Incidence rate of gall bladder cancer varies worldwide. Most of the patient with gall bladder cancer remained asymptomatic until late. Preoperative early diagnosis of carcinoma of gallbladder is rare, occurring in fewer than 20% of patients. Role of routine histopathology for cholecystectomy specimen is debatable. Aim of this study is to find the incidence of incidental gall bladder cancer and determine whether routine histopathology of cholecystectomy specimen is required or not.

METHODS: This is a retrospective descriptive study carried out in Universal College of Medical Sciences, Bhairahawha, Nepal. Histopathology reports of all patients who had undergone cholecystectomies from June 2014 to September 2018 were reviewed. Patients' information regarding inpatient number, age, sex, year of diagnosis, preoperative diagnosis, intraoperative findings, histopathology report and pathological staging were recorded. Data were entered and analyzed using Microsoft Excel version 14.

RESULTS: Total of 418 routine cholecystectomies were performed during this period. Seven cases of incidental gall bladder cancer were diagnosed. None of the patients had preoperative suspicion for malignancy. One patient had intraoperative suspicion of lesion.

CONCLUSIONS: Incidence of incidental gallbladder cancer is 1.67%. It is recommended that routine histopathology of cholecystectomy specimen should be sent for early diagnosis and improve survival of patient with gall bladder cancer.

PMID:33210657 | DOI:10.33314/jnhrc.v18i3.1974
Safety of laparoscopic cholecystectomy for gallbladder cancer: a meta-analysis

Fetched: February 24th, 2021, 5:01am GMT by L X Zhang

Zhonghua Yi Xue Za Zhi. 2020 Nov 17;100(42):3342-3349. doi: 10.3760/cma.j.cn112137-20200418-01229.

ABSTRACT

Objective: To evaluate the effect and safety of laparoscopic cholecystectomy (LC) on the treatment of patients with gallbladder cancer (GBC), compared with patients undergoing open cholecystectomy (OC). Methods: PubMed, EMBASE, Web of Science, CNKI, CQVIP and WANFANG DATA and the Cochrane Library were searched for all Chinese and English literatures of randomized or non-randomized concurrent controlled trials of OC and LC treatment of GBC from the database establishment to March 2020. Two reviewers selected the studies according to inclusion and exclusion criteria, extracted the data, and then a meta-analysis was subsequently performed by the RevMan 5.3 software provided by the Cochrane Library. Results: A total of 15 studies (1 074 patients) including 14 retrospective studies and 1 prospective study met the inclusion criteria. The meta-analysis showed that compared with OC, LC has significant short-term efficacy in the treatment of patients with gallbladder cancer, including shorter operation time (mean difference (MD) =-18.78, 95% confidence interval (CI) : -36.68-0.88; P=0.04), less intraoperative blood loss (MD=-166.57, 95%CI: -248.51--84.63; P<0.000 1), shorter post-operative hospital stays (MD=-5.00, 95%CI: -6.43--3.57; P<0.000 1), less complication rate (OR=0.47, 95%CI: 0.28-0.79; P=0.004), but there was no significant difference on the aspects of recurrence rate (OR=0.48, 95%CI: 0.21-1.11; P=0.09), 5-year overall survival (HR=0.93, 95%CI: 0.54-1.61, I²=33.5%, P=0.198) and long-term survival. Conclusion: Whether it is radical cholecystectomy (RC) or simple cholecystectomy (SC), the short-term efficacy of LC is more significant than that of OC, and the long-term survival rate has no significant statistical difference. Limited by the quality of literature and experiments, the above conclusions still need to be supported by higher quality research.

PMID:33202499 | DOI:10.3760/cma.j.cn112137-20200418-01229
Imaging-based algorithmic approach to gallbladder wall thickening

Fetched: February 24th, 2021, 5:01am GMT by Pankaj Gupta

World J Gastroenterol. 2020 Oct 28;26(40):6163-6181. doi: 10.3748/wjg.v26.i40.6163.

ABSTRACT

Gallbladder (GB) wall thickening is a frequent finding caused by a spectrum of conditions. It is observed in many extracholecystic as well as intrinsic GB conditions. GB wall thickening can either be diffuse or focal. Diffuse wall thickening is a secondary occurrence in both extrinsic and intrinsic pathologies of GB, whereas, focal wall thickening is mostly associated with intrinsic GB pathologies. In the absence of specific clinical features, accurate etiological diagnosis can be challenging. The survival rate in GB carcinoma (GBC) can be improved if it is diagnosed at an early stage, especially when the tumor is confined to the wall. The pattern of wall thickening in GBC is often confused with benign diseases, especially chronic cholecystitis, xanthogranulomatous cholecystitis, and adenomyomatosis. Early recognition and differentiation of these conditions can improve the prognosis. In this minireview, the authors describe the patterns of abnormalities on various imaging modalities (conventional as well as advanced) for the diagnosis of GB wall thickening. This paper also illustrates an algorithmic approach for the etiological diagnosis of GB wall thickening and suggests a formatted reporting for GB wall abnormalities.

PMID:33177791 | PMC:PMC7596646 | DOI:10.3748/wjg.v26.i40.6163

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