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. Ann Surg 2022 Jul 01;276(1):e32-e39
Date
11/18/2020Pubmed ID
33201123Pubmed Central ID
PMC9305302DOI
10.1097/SLA.0000000000004482Scopus ID
2-s2.0-85105149329 (requires institutional sign-in at Scopus site) 26 CitationsAbstract
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.
Author List
Muraki T, Pehlivanoglu B, Memis B, Reid MD, Uehara T, Basturk O, Pernicka JG, Klimstra DS, Jarnagin WR, Ito T, Hasebe O, Okaniwa S, Horigome N, Hisa T, Mittal P, Sarmiento JM, Maithel SK, Koshiol J, Tsai S, Evans D, Erkan M, Adsay VAuthor
Douglas B. Evans MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
Bile DuctsCarcinogenesis
Common Bile Duct
Female
Gallbladder Neoplasms
Gastrointestinal Neoplasms
Humans
Middle Aged
Pancreatic Ducts
