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Desai G, Bhardwaj A, Lokhande K, Wagle PK. Synchronous Multifocal Gall Bladder Cancer and Extrahepatic Cholangiocarcinoma. J Gastrointest Cancer 2023; 54:989-991. [PMID: 36195740 DOI: 10.1007/s12029-022-00869-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 10/10/2022]
Affiliation(s)
- Gunjan Desai
- Department of Surgical Gastroenterology, Lilavati Hospital and Research Centre, Bandra Reclamation, A-791, Bandra (West), Mumbai- 400050, India.
- Navi Mumbai, Maharashtra, 410210, Mumbai, India.
| | - Amol Bhardwaj
- Department of Surgical Gastroenterology, Lilavati Hospital and Research Centre, Bandra Reclamation, A-791, Bandra (West), Mumbai- 400050, India
| | - Kaustubh Lokhande
- Department of Radiology, Lilavati Hospital and Research Centre, Bandra Reclamation, A-791, Bandra (West), Mumbai- 400050, India
| | - Prasad K Wagle
- Department of Surgical Gastroenterology, Lilavati Hospital and Research Centre, Bandra Reclamation, A-791, Bandra (West), Mumbai- 400050, India
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Hsiao TH, Wu CC, Tseng HH, Chen JH. Synchronous but separate neuroendocrine tumor and high-grade dysplasia/adenoma of the gall bladder: A case report. World J Clin Cases 2022; 10:2322-2329. [PMID: 35321155 PMCID: PMC8895191 DOI: 10.12998/wjcc.v10.i7.2322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/22/2021] [Accepted: 01/20/2022] [Indexed: 02/06/2023] Open
Abstract
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.
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Affiliation(s)
- Tsung-Hsien Hsiao
- Division of Gastroenterology and Hepatology, Taipei Tzu Chi Hospital, New Taipei City 231, Taiwan
| | - Chao-Chuan Wu
- Department of Surgery, Taipei Tzu Chi Hospital, New Taipei City 231, Taiwan
| | - Hui-Hwa Tseng
- Department of Pathology, Taipei Tzu Chi Hospital, New Taipei City 231, Taiwan
| | - Jiann-Hwa Chen
- Division of Gastroenterology and Hepatology; Department of Internal Medicine, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan
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Simpson FH, Auld M, Kandpal H, Tran K, Chandrasegaram MD. Double trouble: synchronous extrahepatic cholangiocarcinoma and gallbladder cancer in a Caucasian woman with no pancreaticobiliary maljunction. J Surg Case Rep 2022; 2022:rjab587. [PMID: 35079333 PMCID: PMC8784173 DOI: 10.1093/jscr/rjab587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/03/2021] [Indexed: 11/14/2022] Open
Abstract
Synchronous malignancies of the bile duct and the gallbladder are rare. These cases are often associated with pancreaticobiliary maljunction which is characterized by a long common shared pancreatobiliary channel leading to the Sphincter of Oddi. This predisposes the biliary epithelium to pancreatic enzyme reflux and makes the development of neoplasia more likely. We describe the case of a 64-year-old Caucasian female who presented with new jaundice and severe cholecystitis secondary to an impacted gallstone which was seen on ultrasound. Magnetic resonance cholangiopancreatography was organized with suspicion of a possible Mirizzi syndrome. This revealed a mid-distal bile duct cancer in addition to cholecystitis from an impacted gallstone. She was treated with intravenous antibiotics for her cholecystitis and underwent an urgent endoscopic retrograde cholangiopancreatography procedure for biliary decompression and stenting for her obstructive jaundice. The patient proceeded to pancreaticoduodenectomy with final histopathology revealing a synchronous primary gallbladder malignancy in addition to the known bile duct cancer.
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Affiliation(s)
- Fraser Hugh Simpson
- Correspondence address. Northside Clinical School, University of Queensland, The Prince Charles Hospital, Brisbane, Queensland, Australia. Tel: +61 439 637 851; Fax: +61 7 3139 4000; E-mail:
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Rajput D, Gupta A, Gupta S, Kumar S. A Series of Biliary Tract Cancer With Coexistent Non-biliary Second Malignancy From Sub-Himalayan Region of India. Cureus 2021; 13:e13415. [PMID: 33758710 PMCID: PMC7978136 DOI: 10.7759/cureus.13415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background When researching female patients with breast or ovarian neoplasms, our research will sensitize oncologists to the prevalence of biliary tract cancers such that early cancers are not overlooked. Depending on different inherited, environmental, and iatrogenic risk factors, patients diagnosed with cancer have a risk of harboring another de novo malignancy. The additional primary identification of late has increased mainly due to progress in both diagnosis and treatment modalities, improvement in life expectancy, and understanding. Methods This is a descriptive study of retrospectively collected data from health records over 15 months, of patients who had biliary tract cancer and incidentally detected coexisting second non-biliary malignancy, from July 2018 to September 2019 at a tertiary care hospital. Details such as age, sex, smoking history, family history, occupation, body mass index (BMI), the organ involved, levels of tumor markers, treatment, and outcome were recorded. Results Six consecutive patients with biliary tract cancer presented during this duration and incidentally detected the second primary was ovarian cancer in three (50%) patients, breast carcinoma in two (33%) patients, and urinary bladder carcinoma in the remaining one patient (17%). The median age at diagnosis was 52.5 years with a range of 40-65 years. All patients were females (100%), non-smokers, homemaker, and without any history of cancer in family members. Only two patients who had a resectable disease were alive at one year's follow-up. Conclusion The mechanisms of carcinogenesis in multiple primary malignancies are mainly genetic, epigenetics, and immunological. Prognosis, as well as the intent of treatment, depends on the respective stages of the two malignancies. In our study, most of the patients were in an advanced stage that demanded palliative care.
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Affiliation(s)
- Deepak Rajput
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Amit Gupta
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Sweety Gupta
- Department of Radiation Oncology, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
| | - Shashank Kumar
- Department of Surgery, All India Institute of Medical Sciences, Rishikesh, Rishikesh, IND
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Dutta S, Jain A, Reddy A, Nelamangala Ramakrishnaiah VP. Anomalous Pancreaticobiliary Duct Junction in an Unusual Case of Synchronous Gallbladder and Bile Duct Malignancy. Cureus 2021; 13:e13331. [PMID: 33738174 PMCID: PMC7959653 DOI: 10.7759/cureus.13331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Synchronous malignancies involving the gallbladder and the bile duct are exceedingly rare. Moreover, their association with anomalous pancreaticobiliary duct junction (APBDJ) has been reported mostly from the Far Eastern countries. Over time, many studies have suggested the definite risk of malignancy attributable to the ‘carcinogenic anatomical configuration’ of the long common biliopancreatic channel, allowing reflux of pancreatic juices in the biliary tract. In this report, we present a case of an elderly man from South India who was initially diagnosed with synchronous gall bladder with bile duct malignancy; the patient turned out to have an APBDJ on further evaluation.
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Affiliation(s)
- Souradeep Dutta
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Ankit Jain
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, IND
| | - Abhinaya Reddy
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
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Tachibana S, Mizukami Y, Ono Y, Sugiyama Y, Okada T, Kitazaki A, Sasajima J, Tominaga M, Sakamoto J, Kimura K, Omori Y, Furukawa T, Kimura T, Tanaka S, Nagashima K, Karasaki H, Ohta T, Okumura T. Genetic Tracing of Clonal Expansion and Progression of Pancreatic Ductal Adenocarcinoma: A Case Report and Multi-Region Sequencing Analysis. Front Oncol 2020; 10:728. [PMID: 32582528 PMCID: PMC7280449 DOI: 10.3389/fonc.2020.00728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/16/2020] [Indexed: 11/13/2022] Open
Abstract
Pancreatobiliary tumors frequently contain multiple malignant and precancerous lesions; however, the origin of the driver mutations and the mechanisms that underlie the generation of distinct clones within an organ field remain unclear. Herein, we describe a 76-year-old male suffering from moderately differentiated adenocarcinomas of the pancreas that primarily involved the distal bile duct and multiple “dispersing” invasive lesions in the pancreatic head. The patient underwent pylorus-preserving pancreaticoduodenectomy with superior mesenteric vein resection, and targeted sequencing of 18 genes associated with pancreatic tumorigenesis and immunohistochemical analysis of RNF43 and ARID1A were performed on each tumor compartment, including the invasive and non-invasive areas. Multi-region sequencing revealed shared KRAS and TGFBR1 mutations in all invasive foci, including those involving the distal bile duct. Distinct KRAS variants were found to be present in other non-continuous and non-invasive lesions in the pancreas. Intraductal lesions with KRAS G12D and RNF43 V50R mutations were evident in the main pancreatic duct. This appeared to be a founder clone, given that the mutation profile was common to the invasive foci as well as the additional high-grade dysplasia harboring ARID1A mutations, thereby suggesting a clonal branch-off during tumor evolution. In addition, we also observed independent intraductal papillary mucinous neoplasms with KRAS G12V and GNAS R201H mutations. Our theory, learned from this patient, was that lesions skipped dissemination and wide-spread movement potentially through the pancreatic ductal system as a process of pancreatic cancer development.
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Affiliation(s)
- Shion Tachibana
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.,Center for Gastroenterology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.,Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Yusuke Mizukami
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.,Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Yusuke Ono
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.,Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Yuya Sugiyama
- Center for Gastroenterology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.,Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Tetsuhiro Okada
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.,Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Arisa Kitazaki
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Junpei Sasajima
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.,Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Motoya Tominaga
- Center for Gastroenterology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Jun Sakamoto
- Center for Gastroenterology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Keisuke Kimura
- Center for Gastroenterology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Yuko Omori
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Furukawa
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Taichi Kimura
- Department of Pathology, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Shinya Tanaka
- Department of Cancer Pathology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kazuo Nagashima
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Hidenori Karasaki
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Tomoyuki Ohta
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Toshikatsu Okumura
- Center for Gastroenterology, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
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