Stromal Distribution of CA 19-9 as a Predictor of Lymph Node Metastases in Gallbladder Cancer without Serosal Invasion

Abstract Background Metachronous pancreatic and gallbladder cancer is a rare condition and has a dismal prognosis. Herein, we present a patient with triple metachronous primary pancreatic and gallbladder cancer associated with pancreaticobiliary maljunction who achieved long-term survival after undergoing repeat curative surgery. Case presentation A 65-year-old female patient with advanced gallbladder cancer associated with pancreaticobiliary maljunction underwent extended cholecystectomy with extrahepatic bile duct resection. The pathological diagnosis was T3N0M0 stage III A papillary adenocarcinoma with hepatic invasion. During a monthly follow-up, a diffuse hypovascular 2.0 × 1.5-cm mass was detected in the pancreatic head 6.2 years after the initial surgery. Hence, the patient underwent pancreaticoduodenectomy. Histological examination revealed T3N0M0 stage IIA well-differentiated adenocarcinoma without lymph node metastases. Marked inflammatory reaction was observed in the non-cancerous lesions of the proximal pancreatic head parenchyma containing bile pigment within ductular lumens. After 12.5 years from the initial surgery, total pancreatectomy for a 4.0 × 3.0-cm mass in the remnant pancreas was performed. Histological examination revealed T3N1M0 stage IIB moderately differentiated adenocarcinoma with lymph node metastases. Hence, surgical curative resection was achieved. Based on the pathological findings, a definitive diagnosis of triple metachronous pancreatic and gallbladder cancer was made. The pathology suggests no precursor lesions such as pancreatic intraepithelial neoplasia (PanIN) and atypical flat lesions, but marked inflammations in the non-cancerous lesions, strengthening our hypothesis that chronic inflammation induced by the pancreaticobiliary maljunction is related to carcinogenesis of the pancreas. Despite further adjuvant chemotherapy, the patient’s general condition worsened; however, she remained alive 15.2 years after the initial surgery while receiving the best supportive care. Conclusions Repeat curative surgery for triple metachronous cancer was associated with a favorable prognosis. Both the biliary tract and the pancreas should be closely monitored during follow-up among patients with pancreaticobiliary maljunction, which can be managed with curative surgery.

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Residual disease in lymph nodes has no influence on survival in patients with incidental gallbladder cancer – institution experience with literature review

Radiology and Oncology ◽

10.2478/raon-2021-0048 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Mihajlo Đokic ◽

Urban Stupan ◽

Sabina Licen ◽

Blaz Trotovsek

Keyword(s):

Lymph Node ◽

Survival Rate ◽

Lymph Nodes ◽

Gallbladder Cancer ◽

Lymph Node Metastases ◽

Residual Disease ◽

Treatment Strategies ◽

Node Metastases ◽

Incidental Gallbladder Cancer

Abstract Background A better appreciation of the course and factors that influence incidental gallbladder cancer (iGBC) is needed to develop treatment strategies aimed to improve outcomes. The purpose of the study was to determine the influence of residual disease in the liver and lymph nodes on overall survival in re-resected patients with iGBC. Patients and methods Patients undergoing radical re-resection for iGBC from January 2012 to December 2018 were retrospectively identified. Patients with a 5-year follow-up and submitted to complete resection with stage I, II and III disease were analysed. The influence of residual disease (RD) in liver and lymph nodes on survival was assessed using the Kaplan-Meier curves. In addition, the rest of the group was assessed based on type of primary/secondary procedure, number of harvested lymph nodes and RD in liver and/or lymph nodes. Results In this retrospective study 48 out of 58 (83%) patients underwent re-resection. Among the group with a 5-year follow-up (re-operation between 2012–2014), 22 patients out of 28 (79%) were re-resected. Survival analysis showed that patients with no RD in the liver and lymph nodes had statistically significant better 5-year survival than those with RD. Comparing 5-year survival rate in patients with RD in the liver or lymph nodes against no RD group, patients with RD in the liver had statistically significantly worse 5-year survival, while lymph node metastases did not show any statistically significant different in 5-year survival. Besides, a statistically significant better prognosis was found in stage II disease compared to stage III, as expected. Conclusions The most important predictors of a 5-year survival in our study were RD in liver and stage of the disease. Lymph node metastases did not have any impact on the overall 5-year survival rate.

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The diagnostic accuracy of CT and MRI for the detection of lymph node metastases in gallbladder cancer: A systematic review and meta-analysis

European Journal of Radiology ◽

10.1016/j.ejrad.2018.11.034 ◽

2019 ◽

Vol 110 ◽

pp. 156-162 ◽

Cited By ~ 10

Author(s):

E.A.J. de Savornin Lohman ◽

T.J.J. de Bitter ◽

C.J.H.M. van Laarhoven ◽

J.J. Hermans ◽

R.J. de Haas ◽

...

Keyword(s):

Systematic Review ◽

Lymph Node ◽

Diagnostic Accuracy ◽

Gallbladder Cancer ◽

Lymph Node Metastases ◽

Meta Analysis ◽

Node Metastases ◽

Ct And Mri

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The Multidisciplinary Treatment of Advanced Gallbladder Cancer to Disease-Free Survival: A Case Report

10.21203/rs.3.rs-488890/v1 ◽

2021 ◽

Author(s):

Biao Zhang ◽

Shuang Li ◽

Zhaoyi Liu ◽

Karieshinie Ghandalie Kalandika Peiris ◽

Lifu Song ◽

...

Keyword(s):

Lymph Node ◽

Gallbladder Cancer ◽

Lymph Node Metastases ◽

Radical Surgery ◽

Multidisciplinary Treatment ◽

Disease Free Survival ◽

Free Survival ◽

Node Metastases ◽

Advanced Gallbladder Cancer ◽

Disease Free

Abstract Background: Gallbladder cancer is the most common malignant tumor in the biliary system and is characterized by strong aggressiveness and an extremely poor prognosis. Current treatment for advanced gallbladder cancer remains unsatisfactory. Here we reported a patient with stage IV gallbladder cancer who achieved disease-free survival by multidisciplinary treatment.Case presentation: A 73-year-old man presented to our hospital with right abdominal pain for 3 days and was diagnosed with advanced gallbladder cancer with multiple intrahepatic metastases and distant lymph node metastases. The patient initially received chemotherapy, targeted therapy, radioactive seed implantation, and immunotherapy as there was no specific indications for radical surgery. With the progression of these adjuvant therapies, the patient’s tumor makers gradually decreased but remained higher than normal, lymph node metastases gradually disappeared, and intrahepatic metastases were gradually limited to the left liver. Finally, the patient received a radical surgery of left hepatectomy with partial diaphragmatic resection and radical lymphadenectomy. To date, the patient has survived for more than six years post-treatment, and the level of tumor markers is normal and the imaging examination shows no signs of disease recurrence.Conclusion: The treatment of advanced gallbladder cancer remains pessimistic in the current medical arena. This successful case is an inspiration and we believe that multidisciplinary treatment can benefit patients with advanced gallbladder cancer and help them achieve long-term survival or even disease-free survival.

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O-glicosylation alterations of proteins in gastric carcinoma.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.62 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 62-62

Author(s):

H. Santos Sousa ◽

T. Bouca-Machado ◽

E. Lima-da-Costa ◽

J. Pinto-de-Sousa ◽

C. Gomes ◽

...

Keyword(s):

Lymph Node ◽

Gastric Carcinoma ◽

Expression Pattern ◽

Lymph Node Metastases ◽

Biological Behavior ◽

Serosal Invasion ◽

Carbohydrate Antigens ◽

Gastric Carcinomas ◽

Starting Point ◽

Node Metastases

62 Background: The expression of immature forms of carbohydrates could help to better understand the biological behavior of gastric cancer. Methods: From a universe of 50 patients with gastric or gastroesophageal junction carcinoma submitted to surgical treatment between January and October 2009, in our department, 36 out of 38 carcinomas ressected during this period, were selected for a tumor tissue immunohistochemical study of the simple mucin-type carbohydrate antigens (Tn, STn, T and ST) and the Lewis carbohydrate antigens (SLea and SLex). Several clinico-pathological parameters were evaluated according to the expression pattern of the antigens studied. Results: The ressected gastric carcinomas presented a high incidence of tissue expression of the simple mucin-type and the Lewis carbohydrate antigens, with all cases presenting expression of at least 2 of the antigens and two thirds the expression of 4 or 5. The correlation between the simple mucin-type carbohydrate antigens was high, just as the same as with the Lewis carbohydrate antigens. The analysis of the clinico-pathological profile of gastric carcinomas according to the expression of these antigens revealed the following associations: Tn with venous invasion and perineural invasion; STn with tumor location and macroscopic form; T with age, gender, tumor dimensions and location; ST with macroscopic form and WHO classification; SLea and SLex with the tumor dimensions. Staging of the tumors also revealed associations with the expressions of these antigens: Tn with serosal invasion, lymph node metastases and stage; STn with lymph node ratio; SLea with serosal invasion and lymph node metastases; SLex with depth wall invasion, lymph node metastases and stage. The antigens T e ST did not reveal differences in the expression pattern according to staging. Conclusions: O-glicosylation alterations of proteins are related with gastric carcinoma, not only their incidence is high but they can also be linked with various clinico-pathological characteristics. The knowledge obtained from this study might serve as a starting point for future investigations taking into account the identification of new biomarkers based on glicosylation alterations of proteins. No significant financial relationships to disclose.

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