Juan C Araya O

Carcinoma incipiente de la vesícula biliar. Estudio clínico-patólogico y pronóstico de 196 casos

Background: There is little information about the behavior of early gallbladder carcinoma. Aim: To report the clinical and pathological features of 196 patients with early gallbladder carcinoma. Material and methods: All patients with gallbladder cancer diagnosed between 1988 and 1997 were reviewed. In 703 of 829 patients, there was information about clinical features and follow up, and were included in this study. All gallbladders were subjected to a complete mapping. When neoplastic cells involved only the mucosa or muscular layer, the tumors were considered as early. Results: One hundred ninety six patients had an early carcinoma (161 women, aged 57.5 years and 35 male, aged 63.4 years). One hundred twenty eight tumors were located in the mucosa and 68 in the muscular layer. Patients with tumors involving the mucosa were younger than those with tumors involving the muscular layer. All tumors were adenocarcinomas, 66% were well differentiated and 32% moderately differentiated. Tumors were not visible macroscopically in 132 cases. Five and 10 years survival was 92%. Subjects of less than 40 years old had a 100% survival at 5 years. A hepatic and lymph node resection was done in 12 patients with tumors infiltrating the muscular layer but in only one, the tumor infiltrated the liver. No difference in survival was observed when a simple cholecystectomy or radical surgery was done. Conclusions: Nearly 25% of gallbladder carcinomas can be classified as early and its diagnosis requires a directed study

Pólipos y adenomas de la vesícula biliar: consideraciones clínico-patológicas

: In a period of 10 years, 21.412 gall-bladders were processed. Among these, 884 carcinomas were diagnosed and in 219 cases (1%)a polyp was found. One hundred and eighty three patients were females (mean age 49.3 years)and 36 males (mean age 53.4 years). The preoperative diagnosis of gallbladder polyp was doneonly in 26 cases (12%). Eighty five percent of polyps were non-neoplastic (metaplastic in 32%,cholesterol in 29%, hyperplastic in 22% and inflammatory in 2%). The remaining 15% wereadenomas. Seventy five percent of non-neoplastic polyps were located in the proximal half of thegallbladder and 88% of adenomas in the distal half. Ninety five percent of non-neoplastic pol-yps measured less than 10 mm. Among adenomas, 47% measured less than 5 mm and 28%more than 10 mm. Smaller polyps were of cholesterol and larger polyps were adenomas. Eightadenomas were associated with an adenocarcinoma, two had less than 5 mm lenght. Mean ageof patients with adenomas associated to cancer was higher than patients with pure adenomas(64.6 and 44.3 years respectively, p >0.001).

Elementos morfológicos pronósticos en el cáncer de la vesícula biliar

Background: The exact survival rates and prognostic factors of gallbladder cancer are still incompletely known. Aim: To report the actuarial survival of patients with gallbladder cancer. Material and methods: Six hundred thirty seven women, aged 59 years old as a mean and 108 men, aged 64 years old as a mean, with gallbladder cancer are reported. Patients were followed for up to 150 months. Results: Two hundred twenty four patients had an early and 521 had an advanced carcinoma. Overall survival was 38% at ten years. Sex or ethnic origin did not influence survival. Early tumors had a 92% survival at 10 years whereas the survival of advanced tumors was 16% at 5 years. Subserous tumors had a 5 years survival of 32% whereas serous tumors had a 5 years survival of 11%. Well-differentiated advanced tumors had a significantly better survival than moderately or poorly differentiated tumors. Vascular or lymphatic infiltration was also associated to a lower survival. All patients with advanced tumors and vascular infiltration died before 5 years. Conclusions: Tumor infiltration and differentiation degree were the most important prognostic independent factors in gallbladder cancer (Rev Med Chile 2002; 130: 387-395)

Es el cáncer de la vesícula biliar una enfermedad de mal pronóstico en Chile

Gallbladder cancer is frequent in Chile, but it is not uniformly mortal. The diagnosis is usually made after a cholecystectomy. indicated for a symptomatic cholelithiasis. Global survival of gallbladder cancer can be as high as 40% at five years. In 69% of women of less than 30 years old, the tumor is detected in early stages. In these cases, cholecystectomy is the curative procedure, with a 90% survival at five years. According to our experience, cholecystectomies should be performed between 40 and 50 years of age in men and between 30 and 40 years in women. The prognostic factors that should be considered are symptoms associated to lithiasis, age, parity, obesity, size of stones and the size of the gallbladder. If the tumor is detected in early stages, the survival is good. The natural history of the disease would change significantly if all women with symptomatic stones were operated (Rev Med Chile 2002; 130: 1295-1302).

Gen supresor de tumores p53 en neoplasias digestivas

Malignant diseases of the digestive tract cause more than 50% of deaths due to cancer in Chile. There is a high incidence of gastric and gallbladder cancer and an increasing frequency of colorectal cancer. P53 tumor suppressor gene has a great importance in carcinogenesis and its alterations are specially important in digestive tract tumors such as colorectal cancer. There is contradictory evidence about the frequency of p53 gene or protein alterations or their biological significance. There is little information about p53 in Chile and it is mostly limited to immunohistochemical studies. This revision analyzes the frequency of p53 alterations in digestive tract tumors in Chile, using immunohistochemical and molecular biology methods. A special emphasis is given to the prognostic importance of this gene (Rev Med Chile 2000; 128: 1269-78)

Detección de micrometástasis en médula ósea de pacientes con cáncer de vesícula biliar

: All frozen tumors were positive for CEA, CK19, and MUC1 mRNA and 70% werepositive for CK20. Seventeen of 20 donor samples were positive for MUC1 and only one samplefrom donors was positive for both CK20 and CK19 mRNA. Among the 38 blood and bone mar-row samples of gallbladder cancer patients, the expression of MUC1, CK19, CK20, and CEA,mRNA was 60.5% (23/38), 31.6% (12/38), 7.9% (3/38), and 7.9% (3/38), respectively. Disre-garding the MUC1 results. 37% (14/38), 13% (5/38) and 5% (2/38) were positive for one, twoand three markers respectively. Not significant differences were found in survival with a followup to 12 months.

Hallazgos en reintervenciones quirúrgicas por cáncer de la vesícula biliar en pacientes con y sin quimio-radiación preoperatoria

Background: The usefulness of surgery in the treatment of gallbladder cancer has not been clearly established. The benefits of chemo and radiotherapy are similarly dubious. Aim: To report the pathological findings in patients subjected to surgical reinterventions for gallbladder cancer. Patients and methods: We report 54 patients with gallbladder cancer that were subjected to a second surgical intervention for resection of liver segments IVb and V and lymph nodes corresponding to the liver hilar, portal, peripancreatic, celiac artery and periaortic territories. Thirteen of these patients were subjected to preoperative chemo-radiotherapy (4500 Gy and 5-fluouracil 500 mg/m2). Results: Lymph node metastases were found in 25 and 38%, and liver metastases in 25 and 28% of patients with or without chemo-radiotherapy respectively. The most frequent pathological findings attributed to radiation in the liver were fatty infiltration in 75% of cases, vascular transformation in 83% of cases and minimal periportal lymphocyte infiltration in 40% of cases. Lymph nodes were atrophic in 67% of cases and had foci of cortical necrosis in 46% of cases. Three cases had regional lymph node and liver metastases. Most tumor cells were viable. Conclusions: No differences in the number of lymph node or liver metastases were observed between patients with and without chemo-radiotherapy. No effect of the treatment on residual tumor was observed either (Rev Med Chile 2001; 129: 1013-20

Contenido de ADN y sobrevida en el carcinoma subseroso de la vesícula biliar

: All tumors were adenocarcinoma, andonly 16% were well differentiated. Aneuploidy was observed in 29 cases (26%) with DNA indexfluctuating between 1.1 and 1.8. Lymphatic vessel tumor involvement was present in 16 of 22cases with aneuploidy and in 22 of 46 diploid tumors (p= 0.05). Eighty nine percent of aneup-loid tumors were detected macroscopically and 11% were unapparent. Five years survival wasnon significantly better among patients with diploid tumors than in patients with aneuploid tu-mors (45 and 28%, respectively, p= 0.2). The histological differentiation was the only variablesignificantly associated with survival.