Importance of Gross Type in Patients With T2 Gallbladder Cancer

The 8th edition of the American Joint Committee on Cancer (AJCC) guidelines categorize T2 gallbladder cancer (GBCA) according to pathologic tumor location; peritoneal- and hepatic-side tumors are categorized as T2a and T2b, respectively. We hypothesized that the gross type of GBCA is more important and aimed to investigate their importance in the T2 stage GBCA. Eighty-six patients with GBCA underwent operation from February 2008 to December 2017. We retrospectively reviewed the medical records of 30 patients with pathologically confirmed T2-stage GBCA. There were 8 peritoneal-side and 22 hepatic-side GBCAs. Regarding gross types, 21 and 9 patients had infiltrative- and exophytic-type tumors. Mean disease-free survival (DFS) of T2a and T2b was 38 vs 36 months (p=0.48), respectively, and overall survival (OS) was 50 vs 52 months (p=0.312), respectively. However, patients with infiltrative-type tumors showed significantly worse DFS of 24 months (vs 67 months; p=0.003) and relative different OS of 48 months (vs 67 months; p=0.092). The gross type and lymph node metastasis were the only significant prognostic factor for DFS and OS, respectively. The gross types of T2 gallbladder cancer may be more important prognostic factor than tumor location.

Hilar Cholangiocarcinoma

Sixty-seven patients had hilar cholangiocarcinomas which were divided into 3 types based on tumor morphology as observed on cholangiography and CT. The pathology, vascularity, and pattern of tumor spread of these types were compared. Most of the infiltrative tumors (n = 44) were scirrhous adenocarcinomas, which on CT showed poor or no contrast enhancement with frequent lymph node metastases and liver atrophy. At angiography, there was vascular encasement in 52%, in rare cases neovascularity, and tumor stain. The exophytic type (n = 19) was divided into 2 subgroups depending on the main location of the tumor. The nodular subtype (n = 16) was mainly inside the liver and somewhat hypervascular similar to peripheral cholangiocarcinoma, often with intrahepatic metastases. The periductal subtype (n = 3) was hypovascular, similar to the infiltrative cholangiocarcinoma, and had a tendency to spread along the portal vein. The intraductal type (n = 4) was observed as a filling defect on cholangiography. CT revealed an intraluminal low density mass. Histologically, they were papillary adenocarcinomas. The radiologic types of hilar cholangiocarcinoma showed different characteristics with regard to pathologic findings, vascularity, and pattern of spread.

Prognosis with X-Chromosomal Abnormalities: Neoplastic Disease

The report of Eller, et al. on the prognosis in newborn infants with X-chromosomal abnormalities prompts this note. Because of our interest in cytogenetic factors in carcinogenesis, a routine buccal smear for sex chromatin is performed on all our patients with amenorrhea or irregular vaginal bleeding. Recently a 26-year-old woman with dysmenorrhea and irregular periods was seen. She had a mass arising from the cervix which was subsequently diagnosed as an unusual exophytic type of squamous cell carcinoma.