Objective:Laparoscopic cholecystectomy is currently the gold standard for treating symptomatic gallstone disease.Despite its success,approximately 10%of patients may experience persistent biliary symptoms,leading to t...Objective:Laparoscopic cholecystectomy is currently the gold standard for treating symptomatic gallstone disease.Despite its success,approximately 10%of patients may experience persistent biliary symptoms,leading to the post-cholecystectomy syndrome.A remnant gallbladder with cystic duct or bile duct stones is one of the causes of this syndrome.The objective of this study was to shed light on the clinical manifestations,evaluation,therapeutic strategies,and outcomes associated with laparoscopic management of symptomatic remnant gallbladders.Methods:This was a retrospective study,conducted over a five-year period(January 2017 to December 2022)at Apollo Hospitals in South India.All patients who underwent laparoscopic completion cholecystectomy for a remnant gall bladder were included.The following data were collected:patient demographics,symptoms,preoperative investigations,intraoperative details and post operative outcomes.Results:In total,36 patients were included and analysed.The majority of patients were male(25,69.4%),with a mean age of 50.7±12.1 years.The most common presentation was pain in the upper abdomen or right upper quadrant region(24,66.7%).The laparoscopic approach was attempted in all patients,with a success rate of 94.4%.Two patients required conversion to open surgery.Cholecystoenteric fistula to the colon was observed in one patient.Choledocholithiasis was observed in 7 patients(19.4%),and stone clearance was successfully achieved using endoscopic retrograde cholangiopancreatography in all patients preoperatively.Conclusion:Incomplete gall bladder removal either intentionally or unintentionally leaves a remnant gall bladder that is at risk for stone formation and infection.Patients who have this clinical entity with symptoms require a redo or complete cholecystectomy,a complex procedure associated with certain risks.This study highlights the feasibility and safety of laparoscopic completion cholecystectomy for the management of remnant gallbladder with cystic duct or bile duct stones.展开更多
Gall bladder cancer(GBC)is becoming a very devastating form of hepatobiliary cancer in India.Every year new cases of GBC are quite high in India.Despite recent advanced multimodality treatment options,the survival of ...Gall bladder cancer(GBC)is becoming a very devastating form of hepatobiliary cancer in India.Every year new cases of GBC are quite high in India.Despite recent advanced multimodality treatment options,the survival of GBC patients is very low.If the disease is diagnosed at the advanced stage(with local nodal metastasis or distant metastasis)or surgical resection is inoperable,the prognosis of those patients is very poor.So,perspectives of targeted therapy are being taken.Targeted therapy includes hormone therapy,proteasome inhibitors,signal transduction and apoptosis inhibitors,angiogenesis inhibitors,and immunotherapeutic agents.One such signal transduction inhibitor is the specific short interfering RNA(siRNA)or short hairpin RNA(shRNA).For developing siRNAmediated therapy shRNA,although several preclinical studies to evaluate the efficacy of these key molecules have been performed using gall bladder cells,many more clinical trials are required.To date,many such genes have been identified.This review will discuss the recently identified genes associated with GBC and those that have implications in its treatment by siRNA or shRNA.展开更多
Introduction: Gallstone disease, also known as gallbladder stones or GBS, is almost always asymptomatic but can result in a number of problems, including ascending cholangitis and obstructive jaundice. The frequency o...Introduction: Gallstone disease, also known as gallbladder stones or GBS, is almost always asymptomatic but can result in a number of problems, including ascending cholangitis and obstructive jaundice. The frequency of gallbladder stones among patients who were sent for abdominal ultrasound at Mogadishu Somali Turkey Training and Research Hospital, Mogadishu, Somalia, during the period between January 2018 and June 2022 was assessed in this study. Methods: This is a record-based study that was carried out at the radiology department of Mogadishu Somali Turkey Training and Research Hospital on patients who were chosen for abdominal ultrasounds during the months of January 2018 and January 2022. The study focused on cases that occurred within those periods. Reports of abdominal ultrasounds served as the source of the collected data. Results: Records from 2352 patients are included in this study. They were divided into 451 (19.1%) males and 1901 (80.8%) females. Patients with GBS were present in 76.4 percent of cases. 73.2 percent of patients had big stones larger than 5 mm, while 53.4 percent of patients had several stones. GBS 1474 (77.5%) was substantially more common in females than in males (71.6%: 323/451) (P 0.008). The presence of small stones (less than 5 mm) was also shown to be significantly different between males and females (P = 0.015). Furthermore, compared with men, females had a considerably higher frequency of big GBS (5 mm) (P 0.015). Conclusion: In this study, it was discovered that females were significantly more likely than males to have GBS. Small stones were found much more frequently in the males. When compared to men, females had a considerably higher frequency of large GBS.展开更多
BACKGROUND Gall bladder neuroendocrine tumors(GB-NETs)are rare,accounting for less than 0.5%of all NETs.They usually lack specific symptoms and are difficult to diagnose preoperatively.In most cases,GB-NETs are incide...BACKGROUND Gall bladder neuroendocrine tumors(GB-NETs)are rare,accounting for less than 0.5%of all NETs.They usually lack specific symptoms and are difficult to diagnose preoperatively.In most cases,GB-NETs are incidentally found after cholecystectomy for large polyps or cholelithiasis,causing acute or chronic cholecystitis.The coexistence of GB-NET and GB adenocarcinoma is very rare.CASE SUMMARY We report a case of synchronous but separate GB-NET and adenoma with high-grade dysplasia in a patient who had undergone surgery for a progressively growing GB polypoid lesion.To the best of our knowledge,simultaneous separation of NETs and cancer in the GB has not been reported.CONCLUSION Coexistent GB carcinoid tumor and adenocarcinoma is rare.A surveillance program is needed for these large GB polyps.展开更多
AIM: To determine the outcome of polypoidal lesions within the gall bladder (PLG) diagnosed by trans-abdominal scanning.METHODS: A nine-year (1993-2002) retrospective casenote review of all patients who underwent ultr...AIM: To determine the outcome of polypoidal lesions within the gall bladder (PLG) diagnosed by trans-abdominal scanning.METHODS: A nine-year (1993-2002) retrospective casenote review of all patients who underwent ultrasound scanning after referral to a single Upper GI Surgeon at a District General Hospital was conducted. Patients who were diagnosed with a PLG were included in our study. A database was constructed and patient details, investigations including ultrasound scan (USS) findings, treatment and histology and final diagnosis were recorded. RESULTS: Twenty-three (out of 651) patients were diagnosed pre-operatively by USS to have a polyp-likegall bladder lesion (PLG). Post cholecystectomy histological examination revealed 12 gallstones, 7 cholesterol polyps, 3 adenocarcinomas within polyps and 1 normal gall bladder. The specificity of USS in the diagnosis of PLG was 92.3%. All the true polyps were malignant. Overall USS had 66.66% sensitivity and 100% specificity in the pre-operative suspicion of malignancy. Using size greater than 10 mm as measured on USS as a cut-off, we find 100% sensitivity and 86.95% specificity with a positive predictive value of 50% in the diagnosis of malignancy in PLG.CONCLUSION: A large number of PLG are in fact calculi within diseased gall bladder. In cases of gall bladder polyps more then 10 mm in size on USS further imaging (crosssectional and/or EUS) is indicated prior to surgery. This will help in the optimal management of patients and avoid histological surprises.展开更多
Carcinosarcoma,which comprises less than one percent of all gall bladder neoplasms,is characterized by the presence of variable proportions of carcinomatous and sarcomatous elements.Recently,several reports have descr...Carcinosarcoma,which comprises less than one percent of all gall bladder neoplasms,is characterized by the presence of variable proportions of carcinomatous and sarcomatous elements.Recently,several reports have described patients suffering from carcinosarcoma of the gall bladder.However,there are no large studies regarding the clinicopathologic features,therapeutic management,and surgical outcome of this disease because the number of patients who undergo resection of gall bladder carcinosarcoma at a single institution is limited.A Medline search was performed using the keywords 'gall bladder' and 'carcinosarcoma'.Additional articles were obtained from references within the papers identified by the Medline search.Optimal adjuvant chemotherapy and/or radiotherapy protocols for carcinosarcoma of the gall bladder have not been established.Curative surgical resection offers the only chance for long-term survival from this disease.The outcome of 36 patients who underwent surgical resection for carcinosarcoma of the gall bladder was poor;the 3-year overall survival rate was only 31.0% and the median survival time was 7.0 mo.Since the postoperative prognosis of carcinosarcoma of the gall bladder is worse than that of adenocarcinoma,new adjuvant chemotherapies and/or radiation techniques are essential for improvement of surgical outcome.展开更多
Candida endocarditis is extremely rare in term neonates,and gall bladder involvement due to candidemia has never been reported amongst neonates and infants.A term,appropriate for gestational age neonate developed Cand...Candida endocarditis is extremely rare in term neonates,and gall bladder involvement due to candidemia has never been reported amongst neonates and infants.A term,appropriate for gestational age neonate developed Candida tropicalis blood stream infection in second week of life.He was started on conventional amphotericin B.However,he failed to show any clinical improvement,and candidemia keep on persisting.Repeat sanctuary sites screening revealed multiple echogenic masses in heart(vegetations) and gall bladder.On changing the treatment to liposomal amphotericin B and fluconazole,he recovered clinically,echogenic masses in gall bladder disappeared,and intracardiac vegetations decreased in size.展开更多
Gall bladder torsion(GBT) is a relatively uncommon entity and rarely diagnosed preoperatively. A constant factor in all occurrences of GBT is a freely mobile gall bladder due to congenital or acquired anomalies. GBT i...Gall bladder torsion(GBT) is a relatively uncommon entity and rarely diagnosed preoperatively. A constant factor in all occurrences of GBT is a freely mobile gall bladder due to congenital or acquired anomalies. GBT is commonly observed in elderly white females. We report a 77-year-old, Caucasian lady who was originally diagnosed as gall bladder perforation but was eventually found with a two staged torsion of the gall bladder with twisting of the Riedel's lobe(part of tongue like projection of liver segment 4A). This together, has not been reported in literature, to the best of our knowledge. We performed laparoscopic cholecystectomy and she had an uneventful postoperative period. GBT may create a diagnostic dilemma in the context of acute cholecystitis. Timely diagnosis and intervention is necessary, with extra care while operating as the anatomy is generally distorted. The fundus first approach can be useful due to altered anatomy in the region of Calot's triangle. Laparoscopic cholecystectomy has the benefit of early recovery.展开更多
Gall bladder cancer(GBC) has one of the poorest outcomes of all cancers. Early GBC is difficult to diagnose on even computed tomography. GB has no submucosa and the cancer infiltrates directly into the muscularis prop...Gall bladder cancer(GBC) has one of the poorest outcomes of all cancers. Early GBC is difficult to diagnose on even computed tomography. GB has no submucosa and the cancer infiltrates directly into the muscularis propria. GB wall is thin and important adjacent organs viz. liver, duodenum and pancreas get easily infiltrated. Tumor in the GB neck often needs extended right hepatectomy. Infiltration of duodenum/pancreas may necessitate pancreato-duodenectomy or evenhepato-pancreato-duodenectomy. Mortality of surgical procedures, when performed for GBC, is higher than when performed for other cancers. Survival in GBC, even after R0 resection, is poor. There is no proven role of neo-adjuvant or adjuvant therapy for loco-regionally advanced GBC. There is no role of palliative surgery in metastatic GBC. Early GBC is diagnosed incidentally after cholecystectomy for stones and requires reoperation for completion extended cholecystectomy but unfortunately, most surgeons are not aware of this. GBC has a peculiar epidemiology and is uncommon in the West and has, therefore, not received much attention. Preventive cholecystectomy for asymptomatic stones is not recommended and there is no serum marker for screening. With all factors pitched against it, it does appear that GBC is a bad cancer per se!展开更多
Neuroendocrine tumors (NET) of the gallbladder are a rare entity with only 0.2% of all NET located in the gall bladder. Well-differentiated NETs occur at a relatively lower age group unlike other gallbladder tumors, w...Neuroendocrine tumors (NET) of the gallbladder are a rare entity with only 0.2% of all NET located in the gall bladder. Well-differentiated NETs occur at a relatively lower age group unlike other gallbladder tumors, whereas neuroendocrine carcinoma (NEC) occurs in an older category of patients. The aim of our study is to discuss the current level of evidence regarding this pathological entity by means of a rare case report on a neuroendocrine carcinoma of the gall bladder in a 63-year-old patient with a history of diabetes. Patient underwent cholecystectomy for acute cholecystitis. Pathology findings on surgical specimen came back for neuroendocrine tumour.展开更多
In India, GI tract cancer is one of the ten leading cancers. Among Indian males it stands second to oral cancer and in females, it shares the third place. Most common malignant disorder of GIT is seen in our country t...In India, GI tract cancer is one of the ten leading cancers. Among Indian males it stands second to oral cancer and in females, it shares the third place. Most common malignant disorder of GIT is seen in our country that of liver, bile, gall bladder, pancreas, bileduct and colorectal. Aim: To see the significance of tumour markers in gall bladder cancer. Materials and Methods:This study comprise 225 cases of GI tract cancers was carried for more than two years. Of these, 22 subjects had gallbladder cancer. Tumour markers viz. CA19-9, CEA and AFP were assayed pre and post-operative cases and their role in gallbladder cancer was evaluated. Results: It was observed that serum concentration of CA 19-9 increased with advancing stage, but the same is not true for AFP and CEA. Sensitivity of these markers AFP, CA 19-9 and CEA in the detection of gall bladder cancer was determined. CA 19-9 is the most sensitive of all the three tumour markers in the detection of gall bladder cancer. Conclusion: The combination of CA19-9 and CT (or US) is a reasonable, cost-effective, noninvasive approach to establishing the diagnosis of pancreatic, cholangitic, or biliary cancer in nonicteric patients.展开更多
Duplication of gall bladder is a rare congenital anomaly of the hepatobiliary system. It is a very important entity in clinical practice as preoperative diagnosis plays a significant role in the management and to avoi...Duplication of gall bladder is a rare congenital anomaly of the hepatobiliary system. It is a very important entity in clinical practice as preoperative diagnosis plays a significant role in the management and to avoid unnecessary bile duct injury during surgery. We report a case of duplicated gall bladder presenting as acute cholecystitis.展开更多
BACKGROUND Isolated gallbladder injury(GI)(IGI)directly induced by abdominal trauma is rare.Symptoms,indications,and imaging examinations of IGI are frequently non-specific,posing tremendous diagnostic challenges,whic...BACKGROUND Isolated gallbladder injury(GI)(IGI)directly induced by abdominal trauma is rare.Symptoms,indications,and imaging examinations of IGI are frequently non-specific,posing tremendous diagnostic challenges,which are simple to overlook and may have severe implications.Improving doctors'understanding of gallbladder injury(GI)facilitates early detection and decreases the likelihood of severe consequences,including death.CASE SUMMARY We report a case of IGI caused by blunt violence(after falling from three meters with the umbilicus as the stress point)and performed laparoscopic repair of the gallbladder rupture,which helps clinicians understand IGI and reduce the severe consequences of delayed diagnosis.Through extensive medical history and dynamic abdominal ultrasound evaluation,doctors can identify GI early and begin surgery,thereby decreasing the devastating repercussions of delayed diagnosis.CONCLUSION This article aims to improve clinicians'understanding of IGI and propose a method for the diagnosis and treatment of GI.展开更多
Post-traumatic injuries of the gall bladder are rare. We report through a clinical description of its physio-pathological and evolutionary aspects. A 14-year-old boy was received 48 hours after a stabbing attack. Afte...Post-traumatic injuries of the gall bladder are rare. We report through a clinical description of its physio-pathological and evolutionary aspects. A 14-year-old boy was received 48 hours after a stabbing attack. After initial haemorrhage, the patient presented clinical improvement;then a sudden deterioration with vague symptoms and disturbance of the hepatic balance. The abdominal CT scan revealed a perivesicular hematoma with a focus on hepatic contusion. Laparoscopy showed a penetrating sore of the liver, but the exploration was limited by an important inflammation of the digestive tract. The diagnosis of gall bladder perforation was made during the operation. We performed a cholecystectomy by laparotomy. Postoperative evolution was simple, removal of the slides at D + 4 and discharged at D + 7 postoperative after improvement. At the 6th month, he presented an acute intestinal obstruction on bridles, managed at emergency by open surgery. After one year of follow up, the patient has no symptoms. We note that the vague clinical presentation and the limit of imaging examinations made the early diagnosis of a vesicular perforation a real challenge for the clinician. Cholecystectomy remains the optimal treatment.展开更多
BACKGROUND Bile duct cancer constitutes gallbladder cancer(GBC),intrahepatic cholangiocarcinoma(ICA),and extrahepatic cholangiocarcinoma(ECA).These three entities show morphological and immunohistochemical resemblance...BACKGROUND Bile duct cancer constitutes gallbladder cancer(GBC),intrahepatic cholangiocarcinoma(ICA),and extrahepatic cholangiocarcinoma(ECA).These three entities show morphological and immunohistochemical resemblance so that it is difficult to differentiate between primary ICA and liver metastasis of GBC,which sometimes becomes a point of discussion in clinical practice.Although these cancers demonstrate significant differences in their mutational landscape,several reports demonstrated shared genomic alteration in paired primary and metastatic site aids in distinguishing metastatic recurrence from second primary cancers.CASE SUMMARY We present a 73-year-old female patient who underwent curative resection for GBC harboring epidermal growth factor receptor 2(ERBB2)activating mutation on next-generation sequencing(NGS)-based genomic testing.One year later,a hepatic lesion was observed on follow-up imaging and she underwent surgical resection for a pathological diagnosis.The histological findings of the hepatic lesion were similar to those of the primary lesion.Additionally,using NGS panel testing,the hepatic lesion was found to have ERBB2 activating mutation,which is the identical mutation detected in the sequencing result of the primary site.ERBB2 activating mutation occurs more frequently in GBC than ICA and ECA.Therefore,in the present case,we think this molecular finding potentiated the diagnosis of the liver mass toward a metastatic recurrence.Additionally,this patient underwent HER2-targeted treatment with lapatinib in combination with capecitabin and obtained clinical benefit.CONCLUSION This case illustrated NGS panel usefulness in distinguishing GBC recurrence from second primary cancer and HER2-targeted agent efficacy on ERBB2 mutated GBC.展开更多
基金The study was approved by the institutional review board and the approval number is AMH-C-S-042/07-23.
文摘Objective:Laparoscopic cholecystectomy is currently the gold standard for treating symptomatic gallstone disease.Despite its success,approximately 10%of patients may experience persistent biliary symptoms,leading to the post-cholecystectomy syndrome.A remnant gallbladder with cystic duct or bile duct stones is one of the causes of this syndrome.The objective of this study was to shed light on the clinical manifestations,evaluation,therapeutic strategies,and outcomes associated with laparoscopic management of symptomatic remnant gallbladders.Methods:This was a retrospective study,conducted over a five-year period(January 2017 to December 2022)at Apollo Hospitals in South India.All patients who underwent laparoscopic completion cholecystectomy for a remnant gall bladder were included.The following data were collected:patient demographics,symptoms,preoperative investigations,intraoperative details and post operative outcomes.Results:In total,36 patients were included and analysed.The majority of patients were male(25,69.4%),with a mean age of 50.7±12.1 years.The most common presentation was pain in the upper abdomen or right upper quadrant region(24,66.7%).The laparoscopic approach was attempted in all patients,with a success rate of 94.4%.Two patients required conversion to open surgery.Cholecystoenteric fistula to the colon was observed in one patient.Choledocholithiasis was observed in 7 patients(19.4%),and stone clearance was successfully achieved using endoscopic retrograde cholangiopancreatography in all patients preoperatively.Conclusion:Incomplete gall bladder removal either intentionally or unintentionally leaves a remnant gall bladder that is at risk for stone formation and infection.Patients who have this clinical entity with symptoms require a redo or complete cholecystectomy,a complex procedure associated with certain risks.This study highlights the feasibility and safety of laparoscopic completion cholecystectomy for the management of remnant gallbladder with cystic duct or bile duct stones.
文摘Gall bladder cancer(GBC)is becoming a very devastating form of hepatobiliary cancer in India.Every year new cases of GBC are quite high in India.Despite recent advanced multimodality treatment options,the survival of GBC patients is very low.If the disease is diagnosed at the advanced stage(with local nodal metastasis or distant metastasis)or surgical resection is inoperable,the prognosis of those patients is very poor.So,perspectives of targeted therapy are being taken.Targeted therapy includes hormone therapy,proteasome inhibitors,signal transduction and apoptosis inhibitors,angiogenesis inhibitors,and immunotherapeutic agents.One such signal transduction inhibitor is the specific short interfering RNA(siRNA)or short hairpin RNA(shRNA).For developing siRNAmediated therapy shRNA,although several preclinical studies to evaluate the efficacy of these key molecules have been performed using gall bladder cells,many more clinical trials are required.To date,many such genes have been identified.This review will discuss the recently identified genes associated with GBC and those that have implications in its treatment by siRNA or shRNA.
文摘Introduction: Gallstone disease, also known as gallbladder stones or GBS, is almost always asymptomatic but can result in a number of problems, including ascending cholangitis and obstructive jaundice. The frequency of gallbladder stones among patients who were sent for abdominal ultrasound at Mogadishu Somali Turkey Training and Research Hospital, Mogadishu, Somalia, during the period between January 2018 and June 2022 was assessed in this study. Methods: This is a record-based study that was carried out at the radiology department of Mogadishu Somali Turkey Training and Research Hospital on patients who were chosen for abdominal ultrasounds during the months of January 2018 and January 2022. The study focused on cases that occurred within those periods. Reports of abdominal ultrasounds served as the source of the collected data. Results: Records from 2352 patients are included in this study. They were divided into 451 (19.1%) males and 1901 (80.8%) females. Patients with GBS were present in 76.4 percent of cases. 73.2 percent of patients had big stones larger than 5 mm, while 53.4 percent of patients had several stones. GBS 1474 (77.5%) was substantially more common in females than in males (71.6%: 323/451) (P 0.008). The presence of small stones (less than 5 mm) was also shown to be significantly different between males and females (P = 0.015). Furthermore, compared with men, females had a considerably higher frequency of big GBS (5 mm) (P 0.015). Conclusion: In this study, it was discovered that females were significantly more likely than males to have GBS. Small stones were found much more frequently in the males. When compared to men, females had a considerably higher frequency of large GBS.
文摘BACKGROUND Gall bladder neuroendocrine tumors(GB-NETs)are rare,accounting for less than 0.5%of all NETs.They usually lack specific symptoms and are difficult to diagnose preoperatively.In most cases,GB-NETs are incidentally found after cholecystectomy for large polyps or cholelithiasis,causing acute or chronic cholecystitis.The coexistence of GB-NET and GB adenocarcinoma is very rare.CASE SUMMARY We report a case of synchronous but separate GB-NET and adenoma with high-grade dysplasia in a patient who had undergone surgery for a progressively growing GB polypoid lesion.To the best of our knowledge,simultaneous separation of NETs and cancer in the GB has not been reported.CONCLUSION Coexistent GB carcinoid tumor and adenocarcinoma is rare.A surveillance program is needed for these large GB polyps.
文摘AIM: To determine the outcome of polypoidal lesions within the gall bladder (PLG) diagnosed by trans-abdominal scanning.METHODS: A nine-year (1993-2002) retrospective casenote review of all patients who underwent ultrasound scanning after referral to a single Upper GI Surgeon at a District General Hospital was conducted. Patients who were diagnosed with a PLG were included in our study. A database was constructed and patient details, investigations including ultrasound scan (USS) findings, treatment and histology and final diagnosis were recorded. RESULTS: Twenty-three (out of 651) patients were diagnosed pre-operatively by USS to have a polyp-likegall bladder lesion (PLG). Post cholecystectomy histological examination revealed 12 gallstones, 7 cholesterol polyps, 3 adenocarcinomas within polyps and 1 normal gall bladder. The specificity of USS in the diagnosis of PLG was 92.3%. All the true polyps were malignant. Overall USS had 66.66% sensitivity and 100% specificity in the pre-operative suspicion of malignancy. Using size greater than 10 mm as measured on USS as a cut-off, we find 100% sensitivity and 86.95% specificity with a positive predictive value of 50% in the diagnosis of malignancy in PLG.CONCLUSION: A large number of PLG are in fact calculi within diseased gall bladder. In cases of gall bladder polyps more then 10 mm in size on USS further imaging (crosssectional and/or EUS) is indicated prior to surgery. This will help in the optimal management of patients and avoid histological surprises.
文摘Carcinosarcoma,which comprises less than one percent of all gall bladder neoplasms,is characterized by the presence of variable proportions of carcinomatous and sarcomatous elements.Recently,several reports have described patients suffering from carcinosarcoma of the gall bladder.However,there are no large studies regarding the clinicopathologic features,therapeutic management,and surgical outcome of this disease because the number of patients who undergo resection of gall bladder carcinosarcoma at a single institution is limited.A Medline search was performed using the keywords 'gall bladder' and 'carcinosarcoma'.Additional articles were obtained from references within the papers identified by the Medline search.Optimal adjuvant chemotherapy and/or radiotherapy protocols for carcinosarcoma of the gall bladder have not been established.Curative surgical resection offers the only chance for long-term survival from this disease.The outcome of 36 patients who underwent surgical resection for carcinosarcoma of the gall bladder was poor;the 3-year overall survival rate was only 31.0% and the median survival time was 7.0 mo.Since the postoperative prognosis of carcinosarcoma of the gall bladder is worse than that of adenocarcinoma,new adjuvant chemotherapies and/or radiation techniques are essential for improvement of surgical outcome.
文摘Candida endocarditis is extremely rare in term neonates,and gall bladder involvement due to candidemia has never been reported amongst neonates and infants.A term,appropriate for gestational age neonate developed Candida tropicalis blood stream infection in second week of life.He was started on conventional amphotericin B.However,he failed to show any clinical improvement,and candidemia keep on persisting.Repeat sanctuary sites screening revealed multiple echogenic masses in heart(vegetations) and gall bladder.On changing the treatment to liposomal amphotericin B and fluconazole,he recovered clinically,echogenic masses in gall bladder disappeared,and intracardiac vegetations decreased in size.
基金Supported by Lilavati Hospital and Research Centre
文摘Gall bladder torsion(GBT) is a relatively uncommon entity and rarely diagnosed preoperatively. A constant factor in all occurrences of GBT is a freely mobile gall bladder due to congenital or acquired anomalies. GBT is commonly observed in elderly white females. We report a 77-year-old, Caucasian lady who was originally diagnosed as gall bladder perforation but was eventually found with a two staged torsion of the gall bladder with twisting of the Riedel's lobe(part of tongue like projection of liver segment 4A). This together, has not been reported in literature, to the best of our knowledge. We performed laparoscopic cholecystectomy and she had an uneventful postoperative period. GBT may create a diagnostic dilemma in the context of acute cholecystitis. Timely diagnosis and intervention is necessary, with extra care while operating as the anatomy is generally distorted. The fundus first approach can be useful due to altered anatomy in the region of Calot's triangle. Laparoscopic cholecystectomy has the benefit of early recovery.
文摘Gall bladder cancer(GBC) has one of the poorest outcomes of all cancers. Early GBC is difficult to diagnose on even computed tomography. GB has no submucosa and the cancer infiltrates directly into the muscularis propria. GB wall is thin and important adjacent organs viz. liver, duodenum and pancreas get easily infiltrated. Tumor in the GB neck often needs extended right hepatectomy. Infiltration of duodenum/pancreas may necessitate pancreato-duodenectomy or evenhepato-pancreato-duodenectomy. Mortality of surgical procedures, when performed for GBC, is higher than when performed for other cancers. Survival in GBC, even after R0 resection, is poor. There is no proven role of neo-adjuvant or adjuvant therapy for loco-regionally advanced GBC. There is no role of palliative surgery in metastatic GBC. Early GBC is diagnosed incidentally after cholecystectomy for stones and requires reoperation for completion extended cholecystectomy but unfortunately, most surgeons are not aware of this. GBC has a peculiar epidemiology and is uncommon in the West and has, therefore, not received much attention. Preventive cholecystectomy for asymptomatic stones is not recommended and there is no serum marker for screening. With all factors pitched against it, it does appear that GBC is a bad cancer per se!
文摘Neuroendocrine tumors (NET) of the gallbladder are a rare entity with only 0.2% of all NET located in the gall bladder. Well-differentiated NETs occur at a relatively lower age group unlike other gallbladder tumors, whereas neuroendocrine carcinoma (NEC) occurs in an older category of patients. The aim of our study is to discuss the current level of evidence regarding this pathological entity by means of a rare case report on a neuroendocrine carcinoma of the gall bladder in a 63-year-old patient with a history of diabetes. Patient underwent cholecystectomy for acute cholecystitis. Pathology findings on surgical specimen came back for neuroendocrine tumour.
文摘In India, GI tract cancer is one of the ten leading cancers. Among Indian males it stands second to oral cancer and in females, it shares the third place. Most common malignant disorder of GIT is seen in our country that of liver, bile, gall bladder, pancreas, bileduct and colorectal. Aim: To see the significance of tumour markers in gall bladder cancer. Materials and Methods:This study comprise 225 cases of GI tract cancers was carried for more than two years. Of these, 22 subjects had gallbladder cancer. Tumour markers viz. CA19-9, CEA and AFP were assayed pre and post-operative cases and their role in gallbladder cancer was evaluated. Results: It was observed that serum concentration of CA 19-9 increased with advancing stage, but the same is not true for AFP and CEA. Sensitivity of these markers AFP, CA 19-9 and CEA in the detection of gall bladder cancer was determined. CA 19-9 is the most sensitive of all the three tumour markers in the detection of gall bladder cancer. Conclusion: The combination of CA19-9 and CT (or US) is a reasonable, cost-effective, noninvasive approach to establishing the diagnosis of pancreatic, cholangitic, or biliary cancer in nonicteric patients.
文摘Duplication of gall bladder is a rare congenital anomaly of the hepatobiliary system. It is a very important entity in clinical practice as preoperative diagnosis plays a significant role in the management and to avoid unnecessary bile duct injury during surgery. We report a case of duplicated gall bladder presenting as acute cholecystitis.
文摘BACKGROUND Isolated gallbladder injury(GI)(IGI)directly induced by abdominal trauma is rare.Symptoms,indications,and imaging examinations of IGI are frequently non-specific,posing tremendous diagnostic challenges,which are simple to overlook and may have severe implications.Improving doctors'understanding of gallbladder injury(GI)facilitates early detection and decreases the likelihood of severe consequences,including death.CASE SUMMARY We report a case of IGI caused by blunt violence(after falling from three meters with the umbilicus as the stress point)and performed laparoscopic repair of the gallbladder rupture,which helps clinicians understand IGI and reduce the severe consequences of delayed diagnosis.Through extensive medical history and dynamic abdominal ultrasound evaluation,doctors can identify GI early and begin surgery,thereby decreasing the devastating repercussions of delayed diagnosis.CONCLUSION This article aims to improve clinicians'understanding of IGI and propose a method for the diagnosis and treatment of GI.
文摘Post-traumatic injuries of the gall bladder are rare. We report through a clinical description of its physio-pathological and evolutionary aspects. A 14-year-old boy was received 48 hours after a stabbing attack. After initial haemorrhage, the patient presented clinical improvement;then a sudden deterioration with vague symptoms and disturbance of the hepatic balance. The abdominal CT scan revealed a perivesicular hematoma with a focus on hepatic contusion. Laparoscopy showed a penetrating sore of the liver, but the exploration was limited by an important inflammation of the digestive tract. The diagnosis of gall bladder perforation was made during the operation. We performed a cholecystectomy by laparotomy. Postoperative evolution was simple, removal of the slides at D + 4 and discharged at D + 7 postoperative after improvement. At the 6th month, he presented an acute intestinal obstruction on bridles, managed at emergency by open surgery. After one year of follow up, the patient has no symptoms. We note that the vague clinical presentation and the limit of imaging examinations made the early diagnosis of a vesicular perforation a real challenge for the clinician. Cholecystectomy remains the optimal treatment.
文摘BACKGROUND Bile duct cancer constitutes gallbladder cancer(GBC),intrahepatic cholangiocarcinoma(ICA),and extrahepatic cholangiocarcinoma(ECA).These three entities show morphological and immunohistochemical resemblance so that it is difficult to differentiate between primary ICA and liver metastasis of GBC,which sometimes becomes a point of discussion in clinical practice.Although these cancers demonstrate significant differences in their mutational landscape,several reports demonstrated shared genomic alteration in paired primary and metastatic site aids in distinguishing metastatic recurrence from second primary cancers.CASE SUMMARY We present a 73-year-old female patient who underwent curative resection for GBC harboring epidermal growth factor receptor 2(ERBB2)activating mutation on next-generation sequencing(NGS)-based genomic testing.One year later,a hepatic lesion was observed on follow-up imaging and she underwent surgical resection for a pathological diagnosis.The histological findings of the hepatic lesion were similar to those of the primary lesion.Additionally,using NGS panel testing,the hepatic lesion was found to have ERBB2 activating mutation,which is the identical mutation detected in the sequencing result of the primary site.ERBB2 activating mutation occurs more frequently in GBC than ICA and ECA.Therefore,in the present case,we think this molecular finding potentiated the diagnosis of the liver mass toward a metastatic recurrence.Additionally,this patient underwent HER2-targeted treatment with lapatinib in combination with capecitabin and obtained clinical benefit.CONCLUSION This case illustrated NGS panel usefulness in distinguishing GBC recurrence from second primary cancer and HER2-targeted agent efficacy on ERBB2 mutated GBC.