Abstract
Between 1978 and 1988, 15 patients with gallbladder cancer and 2 patients with bile duct cancer were seen among 49 patients with anomalous union of the pancreaticobiliary ductal system. Radiographic findings revealed two types of this anomalous condition: one in which the pancreatic duct entered the common bile duct(type 1) and one in which the common bile duct entered the pancreatic duct (type 2). In gallbladder cancer, the common bile duct presented no dilatation, or in some patients, mild dilatation, and type-1 anomalous union was frequently found among these patients. In contrast, the two patients with bile duct cancer had cystic dilatation of the common bile duct and type-2 anomalous union. The bile amylase level, which was determined in seven patients, was extremely high in all the patients. Histopathologically, the tumors in most patients showed papillary to papillo-tubular proliferation in the mucosal layer while atypical epithelial hyperplasia was noted in the vicinity of the tumor area. These findings suggest that this congenital anomaly in both ducts results in a loss of the normal sphincteric mechanism of the doudenal papilla, and that chronic relapsing cholecystitis or cholangitis, caused by the reflux of pancreatic juice into the biliary tract, can induced progressive changes to atypical epithelial hyperplasia which may develop into carcinoma.
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Komi N, Udaka H, Ikeda N, Kashiwagi Y. Congenital dilatation of the biliary tract; New classification and study with particular reference to anomalous arrangement of the pancreaticobiliary ducts. Gastroenterol Jpn 1977; 12: 293–304.
Mutoh K, Nagashima K, Ikeda S, Hyodoh H. Radiological daignosus on the abnormal pancreatico-cholangio connection. Tan to Sui (Biliary tract and Pancreas) 1982; 3: 477–485. (in Japanese)
Unozawa T, Kimura K, Ohto M, Saisho H, Morita M, Ebara M, Kasutani N, Tsuchiya K, Okuda K. Clinical study on relationship between anomalous pancreatico-biliary ductal union and carcinoma of the gallbladder. Nippon Shokakibyo Gakkai Zasshi (Jpn J Gastroenterol) 1985; 82: 473–482. (in Japanese with English Abst.)
Nagakawa T, Ohta T, Takeshita Y, Konishi K, Miyazaki I. Clinical study on anomalous union of pancreatico-biliary duct system with special reference to biliary disease. I to Cho (Stomach and Intestinal) 1985; 20: 361–368. (in Japanese with English Abst.).
Kinoshita H, Nagata E, Hirohashi K, Sakai K, Kobayashi Y. Carcinoma of the gallbladder with an anomalous connection between the choledochus and the pancreatic duct. Cancer 1984; 54: 762–769.
Kuroda A, Nagai N, Morioka Y. Anomalous union of the pancreaticobiliary duct system and biliary carcinoma. Tan to Sui (Biliary tract and Pancreas) 1988; 9: 1191–1203. (in Japanese)
Yamauchi S, Koga A, Matsumoto S, Tanaka M, Nakayama F. Anomalous junction of pancreaticobiliary duct without congenital choledochal cyst: A possible risk factor for gallbladder. Am J Gastroenterol 1987; 82: 20–24.
Kimura K, Ohto M, Saisho H, Unozawa T, Tsuchiya Y, Morita M, Ebara M, Matsutani S, Okuda K. Association of gallbladder carcinoma and anomalous pancreatico-biliary ductal union. Gastroenterol 1985; 89: 1258–1265.
Kimura K, Ohto M, Ono T, Tsuchiya Y, Saisyo H, Kawamura K, Yogi Y, Karasawa E, Okuda K. Congenital cystic dilatation of the common bile duct: Relationship to anomalous pancreaticobiliary ductal union. Am J Roentgenol 1977; 128: 571–577.
Matsuzaki Y, Tanaka N, Ohsuga T. Cholelithiasis and carcinoma of the gallbladder. Tan to Sui (Pancreas and Intestine) 1987; 8: 1525–1529. (in Japanese)
Funabiki T, Sugiue K, Ochiai M, Amano H, Fujita S, Futawatari H, Yamaguchi H, Matsubara T, Kamei K, Fukui H, Hasegawa S. Studies on the bile acid fractions in the bile obtained from the patients with anomalous arrangement of the pancreaticobiliary ductal system. Biliary Tract 1987; 1: 77–83. (in Japanese with English Abst.)
Kozuka S, Tsubone M, Yasui A, Hachisuka K. Relation of adenoma to carcinoma in the gallbladder. Cancer 1982; 50: 2226–2234.
Ohakawa H, Sawaguchi S, Yamazaki Y, Sakaniwa M, Ishikawa A. Research on animal models of the anomalous pancreatico-biliary ductal union. Nippon Shonigeka Gakkai Zasshi (Jpn J Pediatr Surg) 1982; 18: 185–191. (in Japanese with English Abst.)
Ogura Y. Exp1/4erimental studies on reflux of pancreatic juice into the biliary tract with special reference to the effects in the hepato-biliary system. Nippon Geka Gakkai Zasshi (J Jpn Surg Soc) 1983; 84: 141–150. (in Japanese with English Abst.)
Ming SC, Goldman H, Freiman DG. Intestinal metaplasia and histogenesis of carcinoma in human stomach. Cancer 1967; 20: 1418–1429.
Lauren P. The two histological main types of gastric carcinoma. Acta Pathol Microbiol Scand 1965; 65: 31–49.
Jarvi O, Lauren P. Intestinal metaplasia in the mucosa of the gallbladder and common bile duct. Ann Med Exp Fenn 1967; 45: 213–223.
Hirai S. Clinicopathological study on metaplasia in resected gallbladder: As a background of histogenesis of gallbladder cancer. Jpn J Gastroenterol Surg 1980; 13: 35–44.
Kozuka S, Kurashina M, Tsubone M, Hachisuka K, Yasui A. Significance of intestinal metaplasia for the evolution of cancer in the biliary tract. Cancer 1984; 54: 2277–2285.
Komi N, Tamura T, Miyoshi Y, Udaka H, Yada S, Kawahara H. Epithelial metaplasia and cancerous change of the biliary duct in anomalous arrangement of the pancreaticobiliary ductal system. Shokaki Geka (Gastroenterol Surg) 1985; 8: 1677–1682. (in Japanese)
Komi N, Tamura T, Miyoshi Y, Hino M, Tada S, Kawahara H, Udaka H, Takehara H. Histochemical and immunohistochemical studies on development of biliary carcinoma in forty-seven patients with choledochal cyst special reference to intestinal metaplasia in the biliary duct. Jpn J Surg 1985; 15: 273–278.
Ohashi M. A clinical study of correlation between anomalous pancreaticobiliary ductal union and carcinoma of the biliary system. Nippon Shokaki Geka Gakkai Zasshi (Jpn J Gastroenterol Surg) 1987; 20: 1914–1922. (in Japanese)
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Ohta, T., Nagakawa, T., Ueno, K. et al. Clinical experience of biliary tract carcinoma associated with anomalous union of the pancreaticobiliary ductal system. The Japanese Journal of Surgery 20, 36–43 (1990). https://doi.org/10.1007/BF02470711
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DOI: https://doi.org/10.1007/BF02470711