Incidence of Gallbladder Carcinoma in Our Cholecystectomy Patients

Öz

Objective: We aimed to find the frequency of gallbladder carcinoma and the relationship between dysplasia and metaplasia, which are among predisposing factors for carcinoma.

Material and Methods: In this study, the histopathological results of 815 patients who underwent cholecystectomy between 2016-2019 in Ahi Evran Training and Research Hospital, Department of General Surgery were retrospectively analyzed.

Results: Of the patients who underwent cholecystectomy, 591 (72.5%) were female and 224 (27.5%) were male. The average age was 50.5 years for women and 54.1 years for men. The general average age was 51.5 years. Cholecystectomy was performed laparoscopically in 698 (85.6%) patients while in 117 (14.4%) patients the operation was either started as open cholecystectomy or the decision to convert to open cholecystectomy was made later during the operation for different reasons. Gallbladder carcinoma was detected in two (0.24%) patients, one 62-year-old male and one 67-year-old female. The rate of gallbladder carcinoma was 0.4%for male patients and 0.1%for female patients. Metaplasia in the gallbladder was detected in 16 (1.96%) patients, 15 of which were female and one was male. The average age of these patients was 43.6 years. Dysplasia was detected in only a 48-year-old male patient (0.12%).

Conclusion: Chronic irritation caused by the presence of gallstones leads to metaplasia which is a precancerous lesion. Therefore, we think that patients with gallstones should be evaluated for surgery or close follow-up, even if they do not have symptoms.

Anahtar Kelimeler

• acute cholecystitis
• intestinal metaplasia
• Gall bladder
• gallbladder cancer

KOLESİSTEKTOMİ YAPILAN HASTALARIMIZDA SAFRA KESESİ KARSİNOMU İNSİDANSI

Öz

Amaç: Çalışmamızda kliniğimizde yapılan kolesistektomileri retrospektif olarak tarayarak safra kesesi karsinomu sıklığını ve karsinom predispozan faktörleri arasında yer alan displazi ve metaplazi arasındaki ilişkiyi bulmayı amaçladık.

Gereç ve Yöntemler: Bu çalışmada Ahi Evran Eğitim ve Araştırma Hastanesi Genel Cerrahi Anabilim Dalında 2016-2019 yılları arasında kolesistektomi ameliyatı yapılan 815 hastanın histopatolojik sonuçları retrospektif olarak incelenmiştir.

Bulgular: Kolesistektomi yapılan hastaların 591’i (%72.5) kadın 224’ü (%27.5) erkekti. Yaş ortalaması kadınlarda 50.5 yıl, erkeklerde 54.1 yıl olarak bulundu. Genel yaş ortalaması 51.5 yıl idi. Kolesistektomi ameliyatı 698 (%85.6) hastaya laparoskopik olarak yapılmış, 117 (%14.4) hastada ise ya açık olarak başlanmış ya da sonradan farklı sebeplerle açık kolesistektomiye geçilmişti. Biri 62 yaşında erkek, diğeri 67 yaşında kadın olmak üzere iki (%0.24) hastada safra kesesi karsinomu saptandı. Erkek ve kadın cinsiyete göre safra kesesi karsinomu oranı sırasıyla %0.4 ve %.0.1 idi. Safra kesesinde metaplazi 16 (%1.96) hastada saptandı. Hastaların 15 tanesi kadın, bir tanesi erkekti. Bu hastaların yaş ortalaması 43.6 yıl idi. Sadece 48 yaşında bir erkek hastada displazi saptandı (%0.12).

Sonuç: Safra taşı varlığının neden olduğu kronik irritasyon, prekanseröz bir lezyon olan metaplaziye yol açmaktadır. Bu nedenle safra taşı olan hastaların semptomları olmasa dahi ameliyat için değerlendirilmesinin ya da yakın takibinin uygun olacağını düşünmekteyiz.

Anahtar Kelimeler

• safra kesesi
• akut kolesistit
• intestinal metaplazi
• safra kesesi kanseri

Kaynakça

1. 1. Hundal R, Shaffer EA. Gallbladder cancer: epidemiology and outcome. Clin Epidemiol. 2014;7(6):99-109.
2. 2. Mukhopadhyay S, Landas SK. Putative precursors of gallbladder dysplasia: a review of 400 routinely resected specimens. Arch Pathol Lab Med. 2005;129(3):386-90.
3. 3. Duarte I, Llanos O, Domke H, Harz C, Valdivieso V. Metaplasia and precursor lesions of gallbladder carcinoma. Frequency, distribution, and probability of detection in routine histologic samples. Cancer. 1993;72(6):1878-84.
4. 4. Zimmermann A. Adenocarcinoma of the gallbladder (classical gallbladder cancer). Tumors and tumor-like lesions of the hepatobiliary tract. Germany. Springer, 2016:1-21.
5. 5. Seçinti İE, Akıncıoğlu E. İnsidental safra kesesi karsinomlarında metaplazi araştırılması: tek merkez deneyimi. Mustafa Kemal Üniversitesi Tıp Dergisi. 2016;7(26):9-18.
6. 6. Genç V, Kırımker EO, Akyol C, Kocaay AF, Karabörk A, Tüzüner A et al. Incidental gallbladder cancer diagnosed during or after laparoscopic cholecystectomy in members of the Turkish population with gallstone disease. Turk J Gastroenterol. 2011;22(5):513-6.
7. 7. Waghmare RS, Kamat RN. Incidental gall bladder carcinoma in patients undergoing cholecystectomy. A Report of 7 Case. J Assoc Physicians India. 2014;62(9):793-6.
8. 8. Kanthan R, Senger JL, Ahmed S, Kanthan SC. Gallbladder cancer in the 21st Century (Review Article). J Oncol. 2015;2015:967472.

9. 9. Randi G, Franceschi S, La Vecchia C. Gallbladder cancer world wide: geographical distribution and risk factors. Int J Cancer. 2006;118(7):1591-602.
10. 10. Bahadır B, Gün BD, Çolak S, Kertiş G, Cömert M, Özdamar ŞO. Safra kesesinde metaplazi, displazi ve karsinom dizgesi. Akademik Gastroenteroloji Dergisi. 2007;6(1):25-9.
11. 11. Mazlum M, Dilek FH, Yener AN, Tokyol Ç, Aktepe F, Dilek ON. Profile of gallbladder diseases diagnosed at Afyon Kocatepe University: a retrospective study. Turk Patoloji Derg. 2011;27(1):23-30.
12. 12. Seretis C, Lagoudianakis E, Gemenetzis G, Seretis F, Pappas A, Gourgiotis S. Metaplastic changes in chronic cholecystitis: implications for early diagnosis and surgical intervention to prevent the gallbladder metaplasia-dysplasia-carcinoma sequence. J Clin Med Res. 2014;6(1):26-9.
13. 13. Kawachi T, Kogure K, Tanaka N, Tokunaga A, Sugimura T. Studies of intestinal metaplasia in the gastric mucosa by detection of disaccharidases with "Tes-Tape". J Natl Cancer Inst. 1974;53(1):19-30.
14. 14. Tsutsumi Y, Nagura H, Watanabe K. Immune aspects of intestinal metaplasia of the stomach: an immunohistochemical study. Virchows Arch A Pathol Anat Histopathol. 1984;403(4):345-59.
15. 15. Yamagiva H, Tomiyama H. Intestinal metaplasia-dysplasiacarcinoma sequence of the gallbladder. Acta Pathol Jpn. 1986;36(7):989-97.
16. 16. Adsay NV. Gallbladder. Extrahepatic biliary tree and ampulla. In: Mills SE, ed. Sternberg’s Diagnostic Surgical Pathology. 6th ed. Philadelphia. Wolters Kluwer, 2015:1770-846.
17. 17. Maesawa C, Ogasawara S, Yashima-Abo A, Kimura T, Kotani K, Masuda S et al. Aberrant maspin expression in gallbladder epithelium is associated with intestinal metaplasia in patients with cholelithiasis. J Clin Pathol. 2006;59(3):328-30.
18. 18. Sasatomi E, Tokunaga O, Miyazaki K. Precancerous conditions of gallbladder carcinoma: overview of histopathologic characteristics and molecular genetic findings. J Hepatobiliary Pancreat Surg. 2000;7(6):556-67.
19. 19. Roa I, de Aretxabala X, Araya JC, Roa J. Preneoplastic lesions in gallbladder cancer. J Surg Oncol. 2006;93(8):615-23.
20. 20. Albores-Saavedra J, Alcántra-Vazquez A, Cruz-Ortiz H, Herrera-Goepfert R. The precursor lesions of invasive gallbladder carcinoma. Hyperplasia, atypical hyperplasia and carcinoma in situ. Cancer. 1980;45(5):919-27.
21. 21. Bolat F, Kayaselçuk F, Nursal TZ, Bal N, Tuncer İ. Kolesistektomilerde örnek sayısının artırılması ile histopatolojik bulguların korelasyonu. Turk Patoloji Derg. 2007;23(3):137-42.
22. 22. Amiraslanov A, Zade KY, Musayev J. Laparoskopik kolesistektomi uygulanan olgularda safra kesesinin histopatolojik profili. Marmara Medical Journal. 2015;28(1):32-37.
23. 23. Akay E, Çoban G, Deniz K, Patıroğlu TE, Akay A, Elmalı F. Safra kesesinin metaplazi-displazi-karsinom sekansında p16 ve p21 İmmün reaktivitesi. Turkiye Klinikleri J Gastroenterohepatol. 2014;21(1):1-8