Adenocarcinoma of the gallbladder associated with anomalous pancreaticobiliary ductal junction.

We have previously shown that an anomalous pancreaticobiliary ductal junction (APBDJ) is a risk factor for developing carcinoma of the gallbladder. However, the incidence of APBDJ in patients with primary carcinoma of the gallbladder has been little examined. Of 53 consecutive patients with gallbladder carcinoma, 37 patients had a direct cholangiography to allow satisfactory evaluation of the pancreaticobiliary ductal junction. Eleven per cent of these 37 patients had an associated APBDJ, which was significantly higher than the reported incidence of APBDJ in human (2%). Two of these four patients were associated with choledochal cyst and the other two were not. The main clinical differences in patients with gallbladder carcinoma associated with APBDJ and those without APBDJ were that the mean age of the former group was lower by about 10 years than the latter, and none had gallstones in the former while 54 per cent had gallstones in the latter group. The results show that APBDJ is a risk factor for developing carcinoma of the gallbladder earlier, and factors other than gallstone are more causative in patients with APBDJ. The frequent association with APBDJ should be kept in mind at the time of surgical treatment of the primary gallbladder carcinoma.