title: Severe dysplasia of the gallbladder associated with occult pancreatobiliary reflux.
abstract: Pancreatobiliary reflux usually occurs in patients with pancreaticobiliary maljunction and can be associated with the occurrence of gallbladder carcinoma. We present the case of a patient with pancreatobiliary reflux despite having a normal pancreatobiliary junction (occult pancreatobiliary reflux; OPBR), in whom the resected gallbladder presented severe dysplasia. The patient, a 61-year-old woman, showed thickness of the gallbladder wall, detected by ultrasonography and computed temography (CT). Her biliary amylase level in the common bile duct was 103,000 IU/l, and in the gallbladder it was 153,500 IU/l, although endoscopic retrograde cholangiopancreatography revealed a normal pancreaticobiliary junction. Immunohistochemical staining showed many p53-positive nuclei in the dysplastic lesion, and about 50% of the dysplastic cells exhibited diffuse nuclear staining for Ki-67. In the present patient, early diagnosis of occult pancreatobiliary reflux led to early detection of a precancerous lesion of the gallbladder mucosa.
authors.affiliation: Department of Gastroenterology, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
authors.forename: Jin Kan
authors.initials: JK
authors.lastname: Sai
authors.forename: Masafumi
authors.initials: M
authors.lastname: Suyama
authors.forename: Bunsei
authors.initials: B
authors.lastname: Nobukawa
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kubokawa
authors.forename: Nobuhiro
authors.initials: N
authors.lastname: Sato
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis / Q000209:etiology; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D002763:Cholecystectomy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005706:Gallbladder Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D010179:Pancreas / Q000002:abnormalities*; D010182:Pancreatic Diseases / Q000150:complications / Q000175:diagnosis*; D018570:Risk Assessment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler