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Cancer cells spread through lymph vessels in the submucosal layer of the common bile duct in gallbladder carcinoma
Author(s) -
Chikamoto Akira,
Tsuji Tatsuya,
Nakahara Osamu,
Sakamoto Yasuo,
Ikuta Yoshiaki,
Tanaka Hiroshi,
Takamori Hiroshi,
Hirota Masahiko,
Kanemitsu Keiichiro,
Baba Hideo
Publication year - 2009
Publication title -
journal of hepato‐biliary‐pancreatic surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.63
H-Index - 60
eISSN - 1868-6982
pISSN - 0944-1166
DOI - 10.1007/s00534-009-0101-y
Subject(s) - hepatoduodenal ligament , lymph , pathology , lymphatic system , gallbladder , bile duct , bile duct cancer , carcinoma , common bile duct , medicine , bile duct carcinoma , lymphovascular invasion , h&e stain , gallbladder cancer , lymph node , lymphatic vessel , immunohistochemistry , cancer , metastasis , gastroenterology , resection , surgery
In the present study, we performed immunohistochemical staining with a lymphatic epithelium‐specific marker, D2‐40, to analyze the status of lymphatic spreading in the hepatoduodenal ligament in T2 gallbladder carcinoma (GC). Methods One hundred and eighty‐six paraffin‐embedded specimens from 15 T2 GC patients were reviewed. Results Lymph vessels lined with D2‐40 were visualized in the submucosal layer of the common bile duct in all cases. In 3 of 15 patients, clusters of cancer cells were identified in the submucosal lymph vessels of the extrahepatic bile duct, and this lymphatic invasion of cancer cells failed to be detected with only conventional hematoxylin–eosin staining. The frequency of the invasion to the submucosal lymph vessels in T2 GC correlated with presence of microscopic invasion to hepatoduodenal ligament and perineural invasion. Conclusion There were lymph vessels in the submucosal layer of the common bile duct, and cancer cells can spread through these channels in addition to the large lymph vessels in subserosal layer around the extrahepatic bile duct in GC. The present results would support the concept of en bloc resection of the extrahepatic bile duct in curative resection for T2 GC.