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Pancreaticobiliary maljunction: pathophysiological and clinical aspects and the impact on biliary carcinogenesis

Langenbeck's Archives of Surgery volume 388, pages 122–131 (2003)Cite this article

Abstract

Background

Pancreaticobiliary maljunction (PBM) is frequently associated with congenital choledochal cyst (CCBD), but differs in embryonic cause and clinical features. It is thought to develop as a misarrangement of the embryonic connections in the pancreaticobiliary ductal system, with the terminal bile duct joined to one of the ducts of the ventral pancreas. Clinical aspects are intermittent abdominal pain, relapsing acute pancreatitis, jaundice, cholangitis, and gallbladder cancer. In patients with PBM and CCBD, primary bile duct stones, acute cholangitis, and bile duct cancer are considered to result from cholestasis, regurgitation of pancreatic juice, and reciprocal reflux of bile and pancreatic juice. The mixture of bile and pancreatic juice due to recipocal reflex very likely plays an important role in biliary carcinogenesis.

Patients and methods

We reviewed the pathophysiological and clinical aspects and biliary carcinogenesis in 250 PBM patients (169 with benign hepatobiliary and pancreatic disease, 81 with malignancy).

Results

PBM patients show elevated cellular proliferation activity in the gallbladder epithelia. A number of oncogenes and tumor suppressor genes have been identified and implicated in carcinogenesis, particularly the K-ras oncogene and the p53 suppressor gene. Some K-ras mutations do not appear essential for hyperplasia but may be an early event in carcinogenesis. The p53 mutations are involved in carcinogenesis in the biliary epithelium in PBM patients.

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Acknowledgements

This work was supported by a Grants-in-Aid (no.11470257) for Scientific Research and Special Clinical Research from the Japanese Ministry of Education, Science, and Culture.

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Affiliations

  1. Department of Surgery, Faculty of Medicine, University of Yamanashi, Tamaho, 409-3898, Yamanashi, Japan

    Yoshiro Matsumoto, Hideki Fujii, Jun Itakura, Masanori Matsuda & Yang Yang

  2. Department of Pathology, Faculty of Medicine, Juntendo University, Tokyo, Japan

    Bunsei Nobukawa & Kohichi Suda

Authors
  1. Yoshiro Matsumoto
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  2. Hideki Fujii
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  3. Jun Itakura
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  4. Masanori Matsuda
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  5. Yang Yang
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  6. Bunsei Nobukawa
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  7. Kohichi Suda
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Correspondence to Yoshiro Matsumoto.

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Matsumoto, Y., Fujii, H., Itakura, J. et al. Pancreaticobiliary maljunction: pathophysiological and clinical aspects and the impact on biliary carcinogenesis. Langenbecks Arch Surg 388, 122–131 (2003). https://doi.org/10.1007/s00423-003-0370-x

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  • DOI: https://doi.org/10.1007/s00423-003-0370-x

Keywords

  • Misarrangement of the embryonic connections in pancreaticobiliary ductal system
  • Gallbladder cancer
  • Bile duct cancer
  • Relapsing acute pancreatitis
  • Obstructive jaundice