Kai Keita, Irie Hiroyuki, Ide Takao, Masuda Masanori, Kitahara Kenji, Miyoshi Atsushi, Miyazaki Kohji, Noshiro Hirokazu, Tokunaga Osamu
Department of Pathology and Microbiology, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga City, Saga, 849-8501, Japan,
Indian J Gastroenterol. 2013 Nov;32(6):386-91. doi: 10.1007/s12664-013-0355-9. Epub 2013 Sep 10.
The purpose of this study was to reveal differences in clinical diagnosis of gallbladder cancer among patients with or without adenomyomatosis (ADM) by analyzing demonstrated tumor patterns on imaging and diagnostic opportunities.
Ninety-seven patients with gallbladder cancer were enrolled. Demonstrated imaging patterns were classified into mass lesion (ML), wall thickening (WT), and papillary lesion (PL). Clinical status during periodic follow up and other diagnostic opportunities were determined from medical records.
All adenomyomatosis-associated cases were diagnosed at the T2 or higher stage. The distribution of demonstrated imaging patterns was significantly different between the adenomyomatosis-associated and non-adenomyomatosis-associated groups (p = 0.0002). No adenomyomatosis-associated gallbladder cancer had the PL pattern, which was readily identifiable and characteristic of early-stage cancer. The WT pattern presented difficulties for diagnosis, and the ML pattern was relatively specific, although most of these cases were at advanced stages. Approximately 40% of ADM patients were found to be in advanced stages of gallbladder cancer, in spite of undergoing periodic follow up.
This study revealed the difficulty of early diagnosis of primary gallbladder cancer in the setting of concurrent ADM. Current results suggest the possible utility of preventive cholecystectomy for management of asymptomatic ADM patients.
本研究旨在通过分析影像学上显示的肿瘤模式和诊断机会，揭示伴有或不伴有腺肌增生症（ADM）的胆囊癌患者在临床诊断上的差异。
纳入97例胆囊癌患者。将影像学上显示的模式分为肿块病变（ML）、壁增厚（WT）和乳头状病变（PL）。通过病历确定定期随访期间的临床状况和其他诊断机会。
所有与腺肌增生症相关的病例均在T2期或更高分期被诊断出来。与腺肌增生症相关组和非腺肌增生症相关组之间显示的影像学模式分布有显著差异（p = 0.0002）。没有与腺肌增生症相关的胆囊癌具有PL模式，PL模式易于识别且是早期癌症的特征。WT模式在诊断上存在困难，ML模式相对具有特异性，尽管这些病例大多处于晚期。尽管接受了定期随访，但约40%的ADM患者被发现处于胆囊癌晚期。
本研究揭示了在并发ADM的情况下原发性胆囊癌早期诊断的困难。目前的结果表明预防性胆囊切除术可能有助于管理无症状的ADM患者。
