1/7. family consent, communication, and advance directives for cancer disclosure: a Japanese case and discussion.The dilemma of whether and how to disclose a diagnosis of cancer or of any other terminal illness continues to be a subject of worldwide interest. We present the case of a 62-year-old Japanese woman afflicted with advanced gall bladder cancer who had previously expressed a preference not to be told a diagnosis of cancer. The treating physician revealed the diagnosis to the family first, and then told the patient: "You don't have any cancer yet, but if we don't treat you, it will progress to a cancer". In our analysis, we examine the role of family consent, communication patterns (including ambiguous disclosure), and advance directives for cancer disclosure in japan. Finally, we explore the implications for Edmund Pellegrino's proposal of "something close to autonomy" as a universal good.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/7. A case of triple synchronous cancers occurring in the gallbladder, common bile duct, and pancreas.We report a 74-year-old man with triple synchronous cancers occurring in the gallbladder, common bile duct, and pancreas. The patient had consulted a nearby physician because of epigastralgia and icterus. On September 30, 1997, the patient was admitted to our department for further evaluation and treatment. Abdominal computed tomography (CT) showed dilatation of the common bile duct, cystic duct, and intrahepatic bile duct, and swelling of the gallbladder. On CT, the wall of the distal common bile duct was thick and a low-density mass was detected on the left side. cholangiography, performed via percutaneous transhepatic cholangiodrainage (PTCD), revealed stenosis of the distal common bile duct. Endoscopic retrograde pancreatography (ERP) showed marked dilatation of the main pancreatic duct. On October 17, 1997, pancreatoduodenectomy was performed under the diagnosis of carcinoma of common bile duct and pancreas. Histopathological examination revealed poorly differentiated tubular adenocarcinoma of the common bile duct, well-differentiated tubular adenocarcinoma of the gallbladder, and mucinous cystadenocarcinoma of the pancreas. These three tumors were histopathologically different. Moreover, p53-positive nuclei were recognized only in the pancreas tumor. These findings suggested that the oncogenic mechanisms of multiple synchronous cancers were not the result of only abnormal dna reparative mechanisms.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/7. Hepatocellular progenitor cell tumor of the gallbladder: a case report and review of the literature.A 75-year-old man presented to his physician with weakness, anorexia, and constant right upper quadrant pain. He underwent a laparoscopic cholecystectomy, which was converted to an open cholecystectomy due to presumed adhesions. Direct examination of the liver was negative for masses or lesions. A CT scan was negative for masses or nodules. The gallbladder was 8.5 x 2.5 cm(2), with a diffusely thick wall measuring 2.5 cm. Microscopic examination showed a monomorphic tumor consisting of cells with increased nuclear:cytoplasmic ratio and occasional nucleoli, infiltrating the entire gallbladder uniformly. The tumor cells that reacted to antibodies directed against HepPar1, CAM 5.2, CK19 and scattered cells were immunoreactive for CD117, CD34, and CD56. This immunohistochemical profile suggested a 'hepatocellular progenitor cell tumor of the gall bladder'. This report is, to our knowledge, the first such case of a tumor of this cell type reported in the gallbladder. In addition, we present a review of the literature.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/7. Metastatic melanoma of the gallbladder.Metastatic involvement of the gallbladder in melanoma is rare, but constitutes the most common metastatic lesion involving this organ. Two cases of metastatic melanoma to the gallbladder with radiographic evidence of gallbladder abnormality prior to surgery are presented. These cases are compared to the nine previously reported cases of metastatic melanoma to the gallbladder with abnormal cholecystograms. All eleven cases presented with signs and symptoms compatible with cholecystitis. Nine of the eleven patients had a previous melanoma primary and most had other extrabiliary metastases. Associated cholelithiasis appeared to be only incidental. In addition, nine reported cases of "primary" biliary melanoma were reviewed. Clinical and pathologic presentations in the latter cases were similar to the former cases with metastases. Seventy-eight percent had extrabiliary sites of metastasis at some time in the course of their disease, tending to refute the impression of "primary" biliary melanoma. melanoma in the gallbladder is much more likely to have metastasized from a regressed skin primary than to have arisen de novo. The two reported cases and the 18 cases from the literature indicate that the physician must consider gallbladder metastasis in melanoma patients presenting with symptoms compatible with cholecystitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/7. Xanthogranulomatous cholecystitis masquerading as gallbladder carcinoma.We herein present a case of xanthogranulomatous cholecystitis which involved both the liver and transverse colon, clinically mimicking gallbladder carcinoma. Such cases may sometimes be judged inoperable due to extensive extra-gallbladder invasion, and thus it is necessary for physicians to take this lesion into consideration when making a diagnosis. An intraoperative biopsy is necessary, therefore, even when the features seem to clearly indicate inoperable carcinoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/7. Primary adenocarcinoma of the gallbladder presenting as primary gynecologic malignancy: a report of two cases.BACKGROUND: Carcinoma metastatic to the uterus from extragenital sites is rare. Such metastatic disease is typically diagnosed at autopsy or in patients with known primary malignancies. This report discusses two cases of primary carcinoma of the gallbladder presenting as abnormalities in gynecologic screening procedures. CASES: A 71-year-old woman presented with postmenopausal bleeding. Uterine curettage revealed poorly differentiated adenocarcinoma of presumed endometrial origin. Intraoperative frozen-section analysis of the uterus showed carcinoma involving the lymphatics, but no primary tumor. Further exploration revealed primary adenocarcinoma of the gallbladder, with widespread metastases. The second case was a 67-year-old asymptomatic woman. Routine cervical cytology showed adenocarcinoma, but tissue studies were negative. She developed jaundice 1 month later. Computed tomography of the upper abdomen revealed a mass in the gallbladder fossa, and needle biopsy of the lesion showed adenocarcinoma. CONCLUSIONS: Metastatic carcinoma of non-genital tract origin may present as primary gynecologic malignancy. The physician should be aware of the implications of both the common and unusual interpretations of screening and diagnostic procedures. When the clinicopathologic presentation is atypical, a thorough knowledge of the differential diagnoses of abnormal test results allows appropriate and expeditious patient management.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/7. Portsite and intraabdominal metastases of unsuspected gallbladder carcinoma after laparoscopic cholecystectomy: report of a case.We herein report a rare case of portsite metastasis of gallbladder carcinoma which occurred after laparoscopic cholecystectomy. A 64-year-old man underwent laparoscopic cholecystectomy at another hospital for symptomatic cholecystolithiasis. The histological examination revealed an adenocarcinoma of the gallbladder infiltrating the entire wall. Despite the physician's advice the patient refused any additional treatment. Thirteen months after surgery he visited our hospital because of a palpable mass at the scar of the right trocar incision. The nodule was removed and histological examination confirmed metastasis from the gallbladder carcinoma.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |