담낭선종 혹은 선종연관 병변의 조직 병리학적 분석 = Histopathologic Analysis of Adenoma and Adenoma-related Lesions of the Gallbladder

다국어 초록 (Multilingual Abstract)

Background/Aims: In order to determine the malignant potential of gallbladder adenoma for progression to carcinoma, we evaluated the histopathologic features of adenoma and adenoma-related lesions on cholecystectomized specimens. Methods: Among 1,847 cholecystectomized specimens, 63 specimens from 26 benign adenomas, 9 carcinomas in situ (CIS), and 28 invasive carcinomas were selected. A pathologist reviewed all specimens and selected benign adenomas, CIS in the adenoma, and adenoma residue in invasive carcinomas. Adenomas and adenoma- related lesions were classified according to morphology (tubular, tubulopapillary, and papillary) and the consisting epithelium (biliary, pyloric metaplasia, and intestinal metaplasia). The age and the size of the benign adenomas and carcinomas in the adenoma were also compared. Results: Adenoma and adenoma-related lesions were found in 34 out (1.8%) of all resected gallbladder. Among 9 CIS and 28 invasive carcinomas, adenoma-related lesions were detected in 7 and 1 case, respectively. All eight carcinomas arising in the adenoma were well-differentiated solitary tumors. The diameters of the carcinomas in the adenoma were, on average, larger than that of the benign adenomas (1.8 cm vs. 0.9 cm, p=0.01). The patients with carcinomas in the adenoma were, on average, older than those with benign adenomas, although the difference was insignificant (57 years vs. 47 years, p=0.09). The morphology and consisting epithelium did not differ between the benign adenomas and carcinomas in the adenoma. The malignant transformation occurred in 23.5% of adenomas. Conclusions: Gallbladder adenoma is a rare disease, although malignant transformation occurs frequently. Adenoma is a precancerous lesion and the adenoma-carcinoma sequence is one of the gallbladder cancer carcinogenesis. (Korean J Gastroenterol 2010;55: 119-126)

참고문헌 (Reference)

1 문정호, "담낭 선종과 암종에서 β-catenin의 발현 양상" 대한외과학회 63 (63): 138-145, 2002

2 이재승, "담낭 결석이 동반되지 않은 담낭 용종의 악성화 관련 인자" 대한소화기학회 52 (52): 97-105, 2008

3 Albores-Saavedra J, "The precursor lesions of invasive gallbladder carcinoma. Hyperplasia, atypical hyperplasia and carcinoma in situ" 45 : 919-927, 1980

4 Albores-Saavedra J, "The WHO histological classification of tumors of the gallbladder and extrahepatic bile ducts. A commentary on the second edition" 70 : 410-414, 1992

5 Kozuka S, "Relation of adenoma to carcinoma in the gallbladder" 50 : 2226-2234, 1982

6 Roa I, "Preneoplastic lesions in gallbladder" 93 : 615-623, 2006

7 Sasatomi E, "Precancerous conditions of gallbladder carcinoma: overview of histopathologic characteristics and molecular generic findings" 7 : 556-567, 2000

8 Terzi C, "Polypoid lesions of the gallbladder: report of 100 cases with special reference to operative indications" 127 : 622-627, 2000

9 Chang HJ, "Phenotypic alterations of mucins and cytokeratins during gallbladder carcinogenesis" 54 : 576-584, 2004

10 Tabah EJ, "Papilloma of the gallbladder with in situ carcinoma" 34 : 57-71, 1953

11 Albores-Saavedra J, "Non-neoplastic polypoid lesions and adenomas of the gallbladder" 28 (28): 145-177, 1993

12 Chang HJ, "Mutation and altered expression of beta-catenin during gallbladder carcinogenesis" 26 : 758-766, 2002

13 Nakajo S, "Morphometrical analysis of gall-bladder adenoma and adenocarcinoma with reference to histogenesis and adenoma-carcinoma sequence" 417 : 49-56, 1990

14 Yu ES, "Metaplastic variant of the gallbladder adenoma: a report of a case" 19 : 350-354, 1985

15 Yamamoto M, "Histological classification of epithelial polypoid lesions of the gallbladder" 38 : 181-192, 1988

16 Watanabe H, "Histological and genetic changes in malignant transformation of gallbladder adenoma" 10 (10): S136-S139, 1999

17 Mindell HJ, "Gallbladder wall thickening: ultrasonic finding" 133 : 699-701, 1979

18 Boulton RA, "Gallbladder polyps: when to wait and when to act" 349 : 817-, 1997

19 Wistuba II, "Gallbladder cancer: lessons from a rare tumour" 4 : 695-706, 2004

20 Randi G, "Gallbladder cancer worldwide: geographical distribution and risk factors" 118 : 1591-1602, 2006

21 Wistuba II, "Gallbladder adenomas have molecular abnomalities different from those present in gallbladder carcinomas" 30 : 21-25, 1999

22 Lazcano-Ponce EC, "Epidemiology and molecular pathology of gallbladder cancer" 51 : 349-364, 2001

23 Seki S, "Cyclooxygenase-2 expression in the adenoma-carcinoma sequence of human gallbladder" 97 : 2146-2147, 2002

24 Chang JW, "Clinicopathological significance for polypoid lesions of the gallbladder: the adenoma- carcinoma sequence" 53 : 432-438, 1997

25 Shim SG, "Clinical features of gallbladder polyps diagnosed by histology" 34 : 100-107, 1999

26 Misra S, "Carcinoma of the gallbladder" 4 : 167-176, 2003

27 Christensen AH, "Benign tumors and pseudotumors of the gallbladder. Report of 180 cases" 90 : 423-432, 1970

28 Kimura K, "Association of gallbladder carcinoma and anomalous pancreaticobiliary ductal union" 89 : 1258-1265, 1985

29 "Annual Report of the Korea Central Cancer Registry (2002. 1-2002. 12)" Korea Central Cancer Registry Ministry of Health and Welfare 2003

30 Xuan YH, "An immunohistochemical study of the expression of cell-cycle-regulated proteins p53, cyclin D1, RB, p27, Ki67 and MSH2 in gallbladder carcinoma and its precursor lesions" 20 : 59-66, 2005

31 Farinon AM, "Adenomatous polyps of the gallbladder” adenomas of the gallbladder" 3 : 251-258, 1991

32 Itoi T, "APC, K-ras codon 12 mutations and p53 gene expression in carcinoma and adenoma of the gall-bladder suggest two genetic pathways in gall-bladder carcinogenesis" 46 : 333-340, 1996