J.Jpn. Surg. Soc.. 60(11): 1804-1817, 1960
STUDIES ON THE PRIMARY CARCINOMA OF THE GALL-BLADDER
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Prof. M. Muto's Surgical Clinic, Tohoku University, Sendai Hiroshi OTSUKI |
1. Tumors of the gall-bladder were observed in 26 cases or 9.9 percent of the total 263 cases ; in 22 of these, the tumors were found macroscopically during operation or upon opening the ectomized specimens, but in the remaining 4 cases, the existence of cancer was ascertained only upon microscopic examination. The tumors in these 26 cases comprised 24 cancerous neoplasms (including 2 of aggravated papilloma), and one for each case of adenoma and myoma.
2. Besides the above, in 31 cases of the 237 surgical cholecystic diseases, abnormal proliferation of the cells was observed in the gall-bladder epithelium, and in 10 of the cancer cases, microscopic incipient cancer foci were found in the mucous membrane of the gall-bladder outside the site of the main tumor.
From closer examination of these 41 cases, the following facts were found :
a) Anomalous hypertrophy of the epithelium of the mucous membrane is observed in the gall-bladder afflicted by inflammation, whether mild or severe, old or new, and this seems to be closely correlated with the destruction and regereration of the mucous membrane.
b) As the process of cancerous development, the following two types could be observed : (1) First a papilloma or an obvious papillary · hypertrophy comes forth, a part of the epithelial cells therein become atypical, giving the appearance of cancer in situ, and then infiltrative growth of the tumor is initiated, or (2) the epithelium shows atypicality as soon as the papillary or adenomatous hypertophy begins, and this is followed very early by infiltrative development.
c) The discovery of incipient cancerous lesions outside the site of the main tumor in the wall in 9 cases of the confirmed carcinoma of the gall-bladder suggests a multiple development of macroscopic or microscopic cancer foci in such cases, leading to the conclusion of the multicentric origin of cancerous tumors in the gall-bladder.
3. The frequency of severe epithelial hypertrophy, ranging from papillary or adenomatous hypertrophy to macroscopically obvious cancer, was found to be more closely correlated with the severity of chronic inflammation rather than with the existence of calculi in the gall-bladder, as follows :
a) Among the 241 surgical cholecystic diseases, abnormal epithelial hypertrophy was observed in 16.9 percent of the cases with and in 8.7 percent of those without gall-stones, while precancerous or cancerous changes were found in 6.4 percent of the calculous but only in 1.4 percent the non-calculous cases. The frequency was slightly higher among the calculous cases.
b) On the other hand, upon dividing the same 241 cases into 5 groups by the grade of inflammation in their gallbladder, the frequency of observed anomalous epithelial hypertrophy stood at 4.6 percent among the 131 cases with mild chronic inflammation, but among the 97 cases with severe chronic inflammation or acute inflammation plus severe chronic inflammation, the percentage rose to a far higher level of 29.9 percent.
4. On 26 cases of gall-bladder tumor.
a) The 24 gall-bladder cancer cases comprised 6 of papillary hypertrophy type (including 3 of stemmed and 3 of broad-based types), 5 of localized and 13 of diffuse infiltrative types, as classified by macroscopic findings.
b) As classified histologically, the same 24 cases comprised 9 Carcinoma adenomatosum papilliferum, 9 of Ca. aden. simplex, 3 of Ca. solidum alveolare, 2 of Ca. solid. diffusum and one of squamous-cell carcinoma- adenomatous cancer cases totaling 18 or accounting for the great majority of 75 percent of the cases. In the squamous-cell carcinoma case, microscopic high-cylindrical adenomatous cancerous formations were observed in some parts of the mucous membrane at some distance from the main cancerous foci, suggesting the existence of the so-called "double cancer".
c) In the papillary and the nodular cases, the development of the cancerous tumors generally took the form of expansion, showing only rather mild infiltration into the surrounding organs, but obvious metastasis from the gallbladder to the liver and the lymph glands was rather frequent. The diffuse infiltrative cancer tumors on the other hand always showed extremely strong infiltrative development and in many cases caused prominent dissemination on the peritoneum.
d) Cholelithiasis was concurrently diagnosed in 17 cases or 65.8 percent of the total 26 cases of the gallbladder tumor and in 15 or 62.5 percent of the 24 cases of the gall-bladder cancer.
(Author's abstract)
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