title: Report of a case with gallbladder carcinoma: P53 expression of the peritumor epithelium might predict biliary tract recurrence.
abstract: BACKGROUND
  The over-expression of P53 protein in gallbladder carcinoma is a biomarker correlating with a poor survival. However, the significance of P53 expression in peritumor tissues is unknown. We experienced a case of gallbladder carcinoma where the operative specimen showed over-expression of P53 on the peritumor epithelium, and early recurrence developed at the biliary tract.
  
  
  METHODS
  A 74-year-old female patient was referred to our hospital due to wall thickening of the gallbladder on ultrasonography. Radiographic examinations revealed wall thickening at the fundus of gallbladder and no abnormalities of the biliary tract or surrounding lymph nodes. We performed open cholecystectomy and lymph node dissection without extrahepatic bile duct resection, as a frozen section of the surgical stump of the cystic duct was cancer-free. However, a pathological examination revealed over-expression of P53 protein in the epithelium of the peritumor to the cystic duct, which were diagnosed as normal on hematoxylin eosin staining. The patient developed bile duct metastases, two and half years after the operation. She underwent endoscopic stenting for the obstruction of bile duct with no additional therapy, and died 6 months later.
  
  
  CONCLUSIONS
  The immunohistochemical staining of the GB wall or surgical stump for a surgical specimen of GBC may be crucial to predict the bile duct recurrence.
authors: Department of Surgery, Japan. Electronic address: a-takano0902@ych.pref.yamanashi.jp.
authors: Atsushi
authors: A
authors: Takano
authors: Department of Surgery, Japan.
authors: Hiroshi
authors: H
authors: Nakagomi
authors: Department of Surgery, Japan.
authors: Kou
authors: K
authors: Ikegame
authors: Department of Surgery, Japan.
authors: Atsushi
authors: A
authors: Yamamoto
authors: Department of Surgery, Japan.
authors: Hideki
authors: H
authors: Watanabe
authors: Department of Surgery, Japan.
authors: Haruka
authors: H
authors: Nakada
authors: Department of Surgery, Japan.
authors: Masayuki
authors: M
authors: Inoue
authors: Department of Surgery, Japan.
authors: Hidemitsu
authors: H
authors: Sugai
authors: Department of Surgery, Japan.
authors: Michiya
authors: M
authors: Yasutome
authors: Department of Surgery, Japan.
authors: Kazushige
authors: K
authors: Furuya
authors: Department of Surgery, Japan.
authors: Masao
authors: M
authors: Hada
authors: Department of Surgery, Japan.
authors: Yoshiaki
authors: Y
authors: Miyasaka
authors: Department of Pathology, Japan.
authors: Toshio
authors: T
authors: Oyama
authors: Department of Digestive Medicine, Japan; Yamanashi Prefectural Central Hospital, University of Tokyo, Japan.
authors: Masao
authors: M
authors: Omata
keywords: Case report; Gallbladder carcinoma; P53 protein expression; Peritumor findings