In primary sclerosing cholangitis, gallbladder polyps are frequently malignant
ABSTRACT The management of gallbladder polyps/masses in patients with primary sclerosing cholangitis (PSC) (i.e., cholecystectomy vs observation) remains problematic. Given the risk of biliary tract cancer in PSC in the face of the benign nature of most gallbladder polyps in the general population, our aim was to determine the prevalence of gallbladder cancer in PSC patients with a gallbladder mass who had undergone cholecystectomy.
The case records of all patients with PSC undergoing a cholecystectomy at the Mayo Clinic between 1977-1999 were reviewed.
Of the 102 patients with PSC who underwent a cholecystectomy, 14 of 102 (13.7%) had a gallbladder mass. In the subset of patients with gallbladder masses, eight of 14 (57%) had adenocarcinomas (seven primary adenocarcinomas and one metastatic cholangiocarcinoma); the other six had benign masses (five adenomas and one cholesterol polyp). In those patients with benign masses, 33% had associated epithelial cell dysplasia; in patients with primary gallbladder cancers, 57% had associated dysplasia. The patients with primary gallbladder adenocarcinoma had a favorable outcome after cholecystectomy, with a 36-month survival of 66%.
In conclusion, gallbladder neoplasms in PSC patients are malignant in approximately 40-60% of the cases. The presence of gallbladder epithelial cell dysplasia suggests a dysplasia-carcinoma sequence in PSC similar to that observed in ulcerative colitis. Consideration should be given to performing a cholecystectomy in PSC patients with gallbladder polyps. If a cholecystectomy is not performed, careful interval follow-up is warranted.
- SourceAvailable from: Jeffrey C Flynn
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- "It would be of value to remark on these markers of cellular dysplasia with regards to GBC, especially since the natural history of GBC is still under consideration, but there is limited preoperative value in these histological factors unless acquired under biopsy. Despite improvements in imaging, post-operative pathology remains the main diagnostic method for GBC . The results of this study are consistent with the literature . "
ABSTRACT: Background: Gallbladder cancer (GBC) is a rare disease of the hepatobiliary tract characterized by silent presentation, poor prognosis, and limited therapy. Current imaging modalities, clinical symptoms and laboratory values are of limited value in diagnosis and tumour markers are used as a clinical adjunct. Five year survival is 5% -12% and a majority of patients survive less than 1 year. Early identification, negative nodal status, and extended cholecystectomy improve survival; adjuvant therapy does not appear to play a role. Objective: To evaluate the effects of stage and nodal status of GBC on survival by analyzing clinical and radiological factors leading to preoperative diagnosis and appropriate sub-sequent management. Results: Forty-three patients (31 female, 12 male) had primary GBC. Average age was 69 years. The most common presenting symptom was pain (65%). Fifteen (35%) patients presented with acute cholecystitis; 9 were suspicious for a mass. Ultrasound and computed tomography were the imaging modalities most often used. Pre-operative diagnoses were made in only 7 (16%) patients, whereas 16 (37%) patients were diagnosed intra-operatively and 20 (47%) post-operatively. Adjuvant chemotherapy was offered in 16 (37%) patients. Average survival was 28 months (range 0.5 -238 months), with a 5-year survival of 13% across all stages. Early GBC (stages 1 -2) had a 5-year survival of 43%, and late GBC (stages 3 -4) had no survival at 5 years, with an average survival of 9 months. Positive nodes decreased survival. Conclusion: Our results mirror what has been reported in the literature. Most patients pre-sented with acute cholecystitis, with confounding clinical data, but few were preoperatively diagnosed with GBC. Im-aging was rarely diagnostic. Late stage GBC, as well as node-positive status, had dismal outcomes with low 1-year and 5-year survival rates. Improved preoperative suspicion of early GBC would allow for more intentional curative resec-tions, before nodes become positive.Journal of Cancer Therapy 01/2012; 03(02). DOI:10.4236/jct.2012.32019
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- "ime risk for the development of cholangiocarcinoma , and patients with ulcerative colitis and PSC are at a higher risk for colonic dysplasia and colon cancer ( 0 . 5 – 1% per year of disease , explaining the recommendation for regular colonoscopy in those with IBD and PSC , including post - transplant ) . Gallbladder malignancy is also a concern [ Buckles et al . 2002 ] . There are a few publications supporting the notion that UDCA use is associated with a lower prevalence of colonic neoplasia in patients with PSC and concomitant ulcerative colitis , and this parallels in vivo experimental data [ Rudolph et al . 2007 ; Pardi et al . 2003 ] ."
ABSTRACT: Therapeutic strategies for autoimmune liver diseases are increasingly established. Although proportionately uncommon, specialist centers have with time refined the best approaches for each disease, based on an improved understanding of the spectrum of presentation. The major treatment aims are to prevent end-stage liver disease and its associated complications. As a result of drugs such as ursodeoxycholic acid, predniso(lo)ne and azathioprine, both primary biliary cirrhosis and autoimmune hepatitis are now less commonly indications for liver transplantation. Unfortunately, the same inroads in treatment efficacy have as yet not been made for primary sclerosing cholangitis, although the recognition that a subset of patients may have a treatable secondary sclerosing cholangitis (IgG4 related) is helping a proportion. With better biological understanding, more specific interventions are expected that will benefit all those with autoimmune liver diseases.Therapeutic Advances in Gastroenterology 01/2009; 2(1):11-28. DOI:10.1177/1756283X08098966
- Digestive Diseases and Sciences 49(11-12):1922-9. · 2.55 Impact Factor