Pancreatobiliary maljunction-associated gallbladder cancer is as common in the west, shows distinct clinicopathologic characteristics and offers an invaluable model for anatomy-induced reflux-associated physio-chemical carcinogenesis Journal Article
| Authors: | Muraki, T.; Pehlivanoglu, B.; Memis, B.; Reid, M. D.; Uehara, T.; Basturk, O.; Pernicka, J. G.; Klimstra, D. S.; Jarnagin, W. R.; Ito, T.; Hasebe, O.; Okaniwa, S.; Horigome, N.; Hisa, T.; Mittal, P.; Sarmiento, J. M.; Maithel, S. K.; Koshiol, J.; Tsai, S.; Evans, D.; Erkan, M.; Adsay, V. |
| Article Title: | Pancreatobiliary maljunction-associated gallbladder cancer is as common in the west, shows distinct clinicopathologic characteristics and offers an invaluable model for anatomy-induced reflux-associated physio-chemical carcinogenesis |
| Abstract: | Objective: To determine the associations of pancreatobiliary maljunction (PBM) in the West. Background: PBM (anomalous union of common bile duct and pancreatic duct) is mostly regarded as an Asian-only disorder, with 200X risk of gallbladder cancer (GBc), attributed to reflux of pancreatic enzymes. Methods: Radiologic images of 840 patients in the US who underwent pancreatobiliary resections were reviewed for PBM and contrasted with 171 GBC cases from Japan. Results: Eight % of the US GBCs (24/300) had PBM (similar to Japan; 15/171, 8.8%), in addition to 1/42 bile duct carcinomas and 5/33 choledochal cysts. None of the 30 PBM cases from the US had been diagnosed as PBM in the original work-up. PBM was not found in other pancreatobiliary disorders. Clinicopathologic features of the 39 PBM-associated GBCs (US:24, Japan:15) were similar; however, comparison with non-PBM GBCs revealed that they occurred predominantly in females (F/M = 3); at younger (<50-year-old) age (21% vs 6.5% in non-PBM GBCs; P = 0.01); were uncommonly associated with gallstones (14% vs 58%; P < 0.001); had higher rate of tumor-infiltrating lymphocytes (69% vs 44%; P = 0.04); arose more often through adenoma-carcinoma sequence (31% vs 12%; P = 0.02); and had a higher proportion of nonconventional carcinomas (21% vs 7%; P = 0.03). Conclusions: PBM accounts for 8% of GBCs also in the West but is typically undiagnosed. PBM-GBCs tend to manifest in younger age and often through adenoma-carcinoma sequence, leading to unusual carcinoma types. If PBM is encountered, cholecystectomy and surveillance of bile ducts is warranted. PBM-associated GBCs offer an invaluable model for variant anatomy-induced chemical (reflux-related) carcinogenesis. |
| Keywords: | carcinogenesis; hyperplasia; carcinoma; dilatation; bile duct; squamous-cell; multicenter; gallbladder; bile-duct; junction; reflux; biliary; diagnostic-criteria; anomalous; mr cholangiopancreatography; union; choledochal cysts; anomaly; maljunction |
| Journal Title: | Annals of Surgery |
| Volume: | 276 |
| Issue: | 1 |
| ISSN: | 0003-4932 |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2022-07-01 |
| Start Page: | e32 |
| End Page: | e39 |
| Language: | English |
| ACCESSION: | WOS:000813847300013 |
| DOI: | 10.1097/sla.0000000000004482 |
| PROVIDER: | wos |
| PMCID: | PMC9305302 |
| PUBMED: | 33201123 |
| Notes: | Article -- Source: Wos |
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