Is Gallbladder Adenomyomatosis a Precancerous Lesion? Comparison of Ki-67 and P53 Positive Expression with Normal Gallbladder Tissue

Öz

Aim: The exact pathogenesis of gallbladder adenomyomatosis (GBA) is still not fully elucidated, and there is some controversy regarding its diagnosis and treatment. Adenomyomatosis, which was initially considered a precancerous lesion, has been recognized in recent studies as a benign alteration of the gallbladder often associated with cholecystitis and cholecystolithiasis. In this study, to investigate the pathogenesis of GBA; It was aimed to compare the levels of biomarkers showing the proliferative activity of tumor cells in normal and adenomyomatosis tissue of the gallbladder and the levels of biomarkers showing the positivity pattern of neoplastic tissue in the same patient.

Method: The pathology reports of a total of 750 patients who underwent laparoscopic cholecystectomy between 2019-2020 were reviewed, and 20 cases diagnosed with adenomyomatosis were evaluated retrospectively. Ki-67 as a proliferation marker and P53 as a neoplastic activity marker were evaluated separately in the normal tissue of the gallbladder and adenomyomatosis tissue.

Results: When the mean values of the Ki-67 index in the normal gallbladder and adenomyomatosis tissue were compared, a statistically significant difference was found (p<0,000). However, when these two groups were compared in terms of the mean values of the P53 index, no statistical difference was found (p=0,062).

Conclusion: Although this study found significantly higher Ki-67 proliferation marker levels in adenomyomatosis tissues, the fact that the common P53-positivity pattern of gallbladder cancer did not show significant differences in these tissues compared to normal tissues appears to support that GBA is not a cancer-precursor lesion but a benign proliferative lesion.

Anahtar Kelimeler

• Gallbladder adenomyomatosis
• gallbladder cancer; P53
• proliferative marker
• neoplastic marker
• Safra kesesi adenomyomatozisi
• safra kesesi kanseri
• P53
• Ki-67
• proliferatif belirteç
• neoplastik belirteç

Safra Kesesi Adenomyomatozisi Prekanseröz Lezyon mudur? Ki-67 ve P53 Pozitif Ekspresyonunun Normal Safra Kesesi Dokusu ile Karşılaştırılması

Öz

Amaç: Safra kesesi adenomyomatozisinin (SKA) kesin patogenezi hala tam olarak açıklanamamıştır, tanı ve tedavisine ilişkin bazı tartışmalar mevcut. Başlangıçta kanser öncesi bir lezyon olarak kabul edilen adenomyomatozis, son zamanlarda yapılan çalışmalarda safra kesesinin sıklıkla kolesistit ve kolelitiazis ile ilişkili iyi huylu bir değişikliği olarak kabul edilmektedir. Bu çalışmada, SKA patogenezini araştırmak için; aynı hastada safra kesesi normal ve adenomyomatozis dokusunda, tümör hücrelerinin proliferatif aktivitesini gösteren biyobelirteç düzeyleri ve neoplastik doku pozitiflik paternini gösteren biyobelirteç düzeylerinin karşılaştırılması amaçlanmıştır.
Yöntem: 2019-2020 yılları arasında toplam 750 laparoskopik kolesistektomi uygulanan hastanın patoloji raporları incelenmiş, adenomyomatozis tanısı alan 20 vaka retrospektif olarak değerlendirilmiştir. Proliferasyon belirteci olarak Ki-67 ve neoplastik aktivite belirteci olarak P53, safra kesesi normal dokusu ile adenomyomatozis dokusunda ayrı ayrı değerlendirilmiştir.
Bulgular: Safra kesesi normal ve adenomyomatozis dokusundaki Ki-67 indeksi ortalama değerleri karşılaştırıldığında, istatistiksel olarak anlamlı fark bulundu (p<0,000). Ancak bu iki grup P53 indeksi ortalama değerleri açısından karşılaştırıldığında istatistiksel fark bulunamadı (p=0,062).
Sonuç: Çalışmada adenomyomatozis dokularında anlamlı derecede yüksek Ki-67 proliferasyon belirteci düzeyleri tespit edilmesine karşın, safra kesesi kanserinin yaygın P53-pozitiflik paterninin bu dokularda normal dokularla karşılaştırıldığında anlamlı farklar saptanmaması, SKA’nin kanser öncüsü bir lezyon olmayıp, iyi huylu proliferatif bir değişiklik olduğunu destekler görünmektedir.

Anahtar Kelimeler

• Safra kesesi adenomyomatozisi
• safra kesesi kanseri
• P53
• Ki-67
• proliferatif belirteç
• neoplastik belirteç

Kaynakça

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