Clinicopathology of pancreaticobiliary maljunction: relationship between alterations in background biliary epithelium and neoplastic development.
OBJECTIVE
Between 1988 and 2003, 38 patients underwent biliary resection for pancreaticobiliary maljunction (PBM). We reviewed the histopathologic findings for the surgically resected specimens to compare the clinical and pathologic features and assess the relationship between changes in the background biliary epithelium and the development of neoplasms.


METHODS
Papillary hyperplasia (PHP) seen in the biliary epithelium of patients with PBM, was classified into grades 0--III in the gallbladder and grades 0--II in the extrahepatic bile duct, according to the extent, and was assessed for links with tumors in the same specimens.


RESULTS
The incidence of gallbladder carcinoma was 13/21 in grades I--II, versus 0/16 in grade III, while the incidence of bile duct carcinoma was 4/20 in grade I versus 0/5 in grade II. Furthermore, these incidences for patients below age 50 years and age 50 or older were 1/18 versus 12/20, and 0/14 versus 6/17, respectively.


CONCLUSIONS
PHP of the biliary epithelium in PBM patients is an important precursor lesion, especially for gallbladder cancer, and the risk becomes greater with age, regardless of the type of pancreatobiliary junction (PBJ) and its location in the biliary tract.
Department of Surgery, Cancer Institute Hospital, 1-37-1 Kami-Ikebukuro, Toshima-ku, Tokyo, 170-8455, Japan.
Makoto
M
Seki
Akio
A
Yanagisawa
Eiji
E
Ninomiya
Yasuro
Y
Ninomiya
Hirotoshi
H
Ohta
Akio
A
Saiura
Junji
J
Yamamoto
Toshiharu
T
Yamaguchi
Akiko
A
Aruga
Keiko
K
Yamada
Koichi
K
Takano
Rikiya
R
Fujita
Masayuki
M
Ikeda
Keiko
K
Sasaki
Yo
Y
Kato
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000002:abnormalities* / Q000601:surgery; D001661:Biliary Tract Neoplasms / Q000209:etiology*; D004065:Digestive System Abnormalities / Q000150:complications / Q000601:surgery; D004848:Epithelium / Q000473:pathology*; D005260:Female; D006801:Humans; D006965:Hyperplasia; D008297:Male; D008875:Middle Aged; D010183:Pancreatic Ducts / Q000002:abnormalities* / Q000601:surgery