ObjectiveTo introduce the current study of the metastatic mode and operation methods in advanced gallbladder carcinoma. MethodsThe literatures about metastatic mode and operation methods of advanced gallbladder carcinoma in recent 5 years were reviewed.ResultsLymph node and hepatic invasion were the main mode of advanced gallbladder carcinoma. The Japanese Society of Biliary Surgery （JSBS） classification to gallbladder carcinoma was more reasonable than the UICC classification. The survival rate after radical resection was higher than that after cholecytectomy in patients with T2n1-2M0. In the patients that tumor extended adjacent organs but the lymph node metastatic localized within n2, extended radical resection provided a survival advantage. If the patients’ tumor was not resectable or who had lymph node metastasis beyond n3, the benefit of extended radical resection seemed limited.ConclusionIn the carefully selected patients, extended radical resection will improve the prognosis of advanced gallbladder carcinoma.
Objective To study the relationship between the expression of apoptosisrelated gene bclx,bax and estrogen receptor (ER) in primary gallbladder carcinoma (PGC) and its clinical significance. MethodsImmunohistochemistry of labeled dextran polymer (LDP) with EnvisionTM system was used to detect ER and gene bclx and bax. ResultsThe positive rate of bclx,bax and ER were 72.3%,66.0% and 59.6% in 47 cases with primary gallbladder carcinoma and 40.0%,93.3% and 93.3% in 6 cases with gallbladder adenomahyperplastic. The expression of bax and ER in PGC was significantly lower than that in gallbladder adenomahyperplastic (P＜0.05),the expression of bclx was significantly higher in PGC than that in the latter (P＜0.05).The expression of bclx and ER in well differentiated PGC was significantly higher than that in moderately, poorly differentiated PGC (P＜0.05); bax expression in well differentiated PGC was lower. ER and bax expression in male PGC was significantly lower than that in female PGC （P＜0.01）, the expression of bclx in male PGC was higher (P＜0.05).ER was more highly expressed in smaller PGC than in larger one (P＜0.05). ER and bax, bclx were not different between various clinical stages and ages (P＞0.05,respectively). Conclusion The expression ER, apoptosisrelated gene bclx and bax have correlation with differentiation and sex in PGC, their levels shows significance in the prognosis of PGC.
ObjectiveTo discuss the relationship between angiogenesis and the clinical pathological characteristics, prognosis in primary gallbladder carcinoma (PGC ). MethodsThe specimens of 42 patients with PGC who underwent operation during 1993 and 1996 were collected. The immunohistochemical staining was performed in these specimens through SABC manner. Angiogenesis was represented by intratumor microvessel count (MVC ) and expression of vascular endothelial growth factor (VEGF ).ResultsIn all the patients, the average MVC was 70.4±20.7, and the VEGF positive expression rate was 69.0%. The mean MVC was 57.9±15.4 in the tumor of histograde Ⅰ and Ⅱ, and was 88.8±11.5 in another group of grade Ⅲ and Ⅳ respectively. The mean MVC was 45.0±17.0 in the cases of Nevin stage Ⅰ, Ⅱ and Ⅲ, and was 77.2±16.0 in the other cases of Nevin stage Ⅳ and Ⅴ. There were significant differences between two groups. VEGF expression positive rate was correlated with grade and stage, in the patients with poordifferentiated grade and late stage the MVC was significant higher. The expression of VEGF was markedly correlated with MVC. The 3year survival rate was significant lower in the group of high MVC or VEGF positive expression. Conclusion Manifold VEGF secretion in PGC may increase the MVC value, and accelerate the tumor advance and metastasis. Angiogenesis may be considered as an effective predictor to the prognosis of the primary gallbladder carcinoma.
To study the red cell′s deformation and the immune adhesion functions to tumor cell in patients with primary gallbladder carcinoma (PGC)， twenty-seven patients with PGC and twenty normal persons were investigated by means of BL88B type laser diffraction RBC deformation instrument and agglutinate method of tumor cell. The result showed that the RBC deformation index was lower in patients with PGC than that in the normal persons (Ｐ＜0.01). Also was the enhance factor of RBC immune adherent functions lower than that in the normal persons. While the inhibitory factor was higher than that in the normal persons. The result suggests that the decrease of RBC immune function be related with change of serum modulating factors in patient with PGC.
Expression of bcl-2 in 45 cases of primary gallbladder carcinomas and 39 cases of gallbladder adenomas were detected by streptavidin-biotin-peroxidase complex (SABC) methods. The results revealed that the positive rate of bcl-2 in primary gallbladder carcinomas was 71.1% and that in gallbladder adenomas was 87.2%, there was no obvious difference between them (Ｐ＞0.05). Expression of bcl-2 in well, moderately and poorly differentiated primary gallbladder carcinomas were 82.8%, 82.4% and 50.0% respectively with significant statistical difference (Ｐ＜0.01). The positive rate of bcl-2 in stages Ⅰ,Ⅱ and Ⅲ of primary gallbladder carcinomas were 81.3% and 55.2% respectively with no significant differnce. The result suggests that expression of bcl-2 in primary gallbladder carcinomas has no correlation with clinic stages.
Objective To study the association and the effect of the expression of p16 and p53 protein on the occurence and development of gallbladder carcinoma. Methods The expression of p16 and p53 protein were detected in 40 cases of gallbladder carcinoma with immunohistochemical method. Results The expressions of p16 and p53 protein were closely correlated to the tumor pathological grade, lymph mode metastasis and prognosis. p16 protein was correlated to the Nevin classifications. Conclusion The results indicate that the low expression rate of p16 protein occurred in the advanced stage of gallbladder carcinoma. The expression of p16 and p53 protein are helpful in judging the malignant degree and prognosis of primary gallbladder cancer.
Objective To study the effects of estrogen and progesterone and their receptors on the development of gallstone (GS) and primary gallbladder carcinoma (PGC), and probe to the relationship between the biological characteristic of PGC and female hormone and their receptors. Methods The study of PGC related to female hormone was reviewed by history document and experimental study in resently. Results The female hormone influenced human body extensively: they acted on not only the target organs, but also the nontarget organs with their receptors. The action was brought about by their receptors expression. The action intensity was dependent on not only the serum level of female hormone but also their corresponding receptors distributing in organs. The carcinogenic mechanism of estrogen was more clear with the discovery of estrogen-regulating-proteins. Conclusion The estrogen play an important role in the onset and development of GS and PGC. Estrogen and progestrone can inhance the patients′ susceptibility to the cholesterol gallstone and become a high risk factor in causing PGC through inducing their corresponding receptors expression in the gallbladder. Evaluating the effects of estrogen-estrogen receptor-estrogen-regulating-protein on biological characteristic of PGC is significant in guiding clinical endocrine treatment.
ObjectiveTo analyze the MR findings of primary gallbladder carcinoma so as to improve the diagnostic accuracy. MethodsA retrospective study was developed involving 15 primary gallbladder carcinoma patients identified by postoperative pathology between January 2010 and March 2013. Imaging findings were analyzed including lesions location, enhancement characteristics, the dilatation of bile ducts and gallstones. ResultsAmong the 15 gallbladder carcinoma patients, 5 were misdiagnosed as neoplasms in the porta hepatis combined with dilation of intrahepatic bile ducts. Intra- and extrahepatic bile ducts dilated in 7 patients, which were misdiagnosed as tumors or inflammation. Two cases of gallbladder carcinoma with right lobe mass were misdiagnosed as gallbladder polyps. One patient was misdiagnosed as cholecystitis. The retrospective analysis revealed that the gallbladder wall thickened in 12 cases, with focal thickening in 9 and diffuse thickening in 3 cases. Enhanced scanning demonstrated that gallbladder wall enhanced in varying degrees, and 11 cases had delayed enhancement features. There were 8 patients with gallstones and 2 with gallbladder wall nodules. ConclusionPrimary gallbladder carcinoma can easily cause bile duct dilatation, and manifests as focal or diffuse mural thickening, often accompanied by gallstones.
ObjectiveTo investigate the prognostic impact of tumor location in gallbladder carcinoma in different sites and evaluate the effect of surgical operation on the median survival time of patients.MethodsFrom 2012 to 2016, 382 patients with gallbladder cancer in the Eastern Hepatobiliary Surgery Hospital were divided into 163 cases of gallbladder duct cancer and 219 cases of gallbladder bottom and body cancer. They were received radical resection, extended radical resection and palliative resection.ResultsThe mean survival time was (19.57+15.63) months in the bottom and body cancer group, (14.62+11.12) months in the cystic duct carcinoma group, and the survival time was significantly different between the two groups (P<0.05). After radical surgery, the mean survival time in the cystic duct carcinoma group and the bottom and body cancer group were (23.82±12.47) months and (30.63±17.81) months, respectively, there was no significant difference between the two groups (P>0.05). The multivariate analysis indicated that tumor location, surgical radical therapy, clinical stage, pathological grade, and pathological classification were all independent risk factors influencing the prognosis of patients (P<0.05). There was no significant difference in median survival time between the two groups (P>0.05).ConclusionsThe prognosis of patients with cystic duct gallbladder carcinoma is worse than that of patients with the bottom and body cancer of the gallbladder, but the prognosis of the two groups after radical resection is similar. The prognosis of patients with extended radical operation according to the condition is similar to that of routine radical operation. There are some differences in clinical stage, pathological grade and pathological classification between the two groups of gallbladder cancer patients. In addition, the great differences exist in the surgical methods, especially in extended radical operation. Therefore, the treatment of gallbladder cancer in these two locations should be treated differently.