Horiike Masaki, Morotomi Yoshiki, Takemura Shigekazu, Tanaka Shogo, Shinkawa Hiroji, Hashimoto Shigeo, Wakasa Kenichi, Kubo Shoji
Department of Pediatric Surgery, Japanese Red Cross Society Wakayama Medical Center, 4-20, Komatsubara-dori, Wakayama City, Japan.
Department of Pediatric Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
Ann Med Surg (Lond). 2021 Feb 23;63:102180. doi: 10.1016/j.amsu.2021.102180. eCollection 2021 Mar.
Pancreaticobiliary maljunction (PBM) is a congenital anomaly wherein the persistent reflux of the pancreatic juice into the biliary tract induces biliary tract cancer. The prediction criteria for gallbladder carcinogenesis have been reported previously through results obtained from examining carcinogenic and non-carcinogenic cases with the parameters that classified each confluent form in PBM. This study aimed to validate these previous study results and provide new recommendations for gallbladder carcinogenesis prevention.
Twenty-four patients with PBM underwent hepaticojejunostomy. The prediction criteria for gallbladder carcinogenesis consist of three elements. The confluent forms that satisfied none or one of the three criteria were defined as a low score group, and those that satisfied two or three were defined as the high score group. Immunohistology and pathological search were performed on the gallbladders' sections in both groups to evaluate chronic inflammation.
The cases with dysplasia, positive Ki67 labeling index, and gallbladder cancer were more common in the high score group and tended to have more lymphocyte infiltration. These findings indicate that the degree of inflammation and cell proliferation might be more severe in the high score group than in the low score group.
There is a close relationship between the confluent form and the histopathological findings of the gallbladder in patients with PBM. The confluent forms observed in the high score group might have an additional correlation with increased proliferation activity and subsequent malignant transformation of the gallbladder epithelium.
胰胆管合流异常（PBM）是一种先天性异常，其中胰液持续反流至胆道会诱发胆道癌。先前已通过对PBM中每种汇合形式进行分类的参数检查致癌和非致癌病例所获得的结果，报告了胆囊癌变的预测标准。本研究旨在验证这些先前的研究结果，并为预防胆囊癌变提供新的建议。
24例PBM患者接受了肝空肠吻合术。胆囊癌变的预测标准由三个要素组成。满足这三个标准中无或仅有一个标准的汇合形式被定义为低分组合，满足两个或三个标准的汇合形式被定义为高分组合。对两组胆囊切片进行免疫组织学和病理检查，以评估慢性炎症。
发育异常、Ki67标记指数阳性及胆囊癌病例在高分组合中更为常见，且淋巴细胞浸润往往更多。这些发现表明，高分组合中的炎症程度和细胞增殖可能比低分组合更严重。
PBM患者胆囊的汇合形式与组织病理学结果之间存在密切关系。在高分组合中观察到的汇合形式可能与胆囊上皮细胞增殖活性增加及随后的恶性转化存在额外关联。
