7165 Less association of adenomyomatosis with cancer of the gallbladder even if the presence of pancreaticobiliary ductal maljunction.

Abstract

AIMS: Pancreaticobiliary ductal maljunction(PBM) is associated with several pancreatobiliary diseases including pancreatitis and carcinoma. Relation between adenomyomatosis (ADM) of the gallbladder and malignancy is not clear because of lacking of the data. However patients with ADM but free from abdominal symptoms are usually followed as benign proliferative disease although it is hard to differentiate from gallbladder cancer. To clarify the relation, histological studies were conducted for specimens obtained by surgical resection of the gall bladder from patients with ADM including those with both ADM and PBM. SUBJECTS AND METHODS: Four patients, 1 male and 3 females, with gallbladder ADM associated with PBM and 32 patients, 21 males and 11 females, with gallbladder ADM but free from PBM were enrolled in this study. In 13 patients without symptoms related to the pancreatobiliary area ADM was found by transabdominal ultrasonography performed for the other purposes. ADM were divided into 3 subtypes, segmental, fundal and diffused types. PBM and ADM were diagnosed by endoscopic retrograde cholangiopancreatography and histological study for the surgical specimen respectively. RESULTS: Among 32 patients with ADM free from PBM, totally 21 (65.6%), consisting of 14 (66.7%) segmental type, 2 (66.7%) fundal type and 5 (62.5%) diffused type had clinical symptoms. Of these 24 (75.0%) patients, consisting of 16 (76.2%) segmental type, 2 (66.7%) fundal type, 6 (75.0%) diffused type were complicated by gallbladder stones. However there was no significant clinical difference among the subtypes. Two out of 4 patients (50%) with ADM associating with PBM, belonging to segmental type, had symptoms. However none of the four patients were complicated with gallbladder stones. None of the thirty-six patients with ADM were complicated with gallbladder cancer at all. CONCLUSION: None of 36 patients with ADM including 4 patients associated with PBM are not complicated with gallbladder cancer.