A small-cell carcinoma of the gallbladder is an uncommon cancer with high malignancy potential. It is usually found in elderly women and is associated with cholelithiasis. These tumors show an aggres sive clinical course and death usually occurs within a few months after diagnosis. The diagnosis of a small-cell carcinoma should be based on cell morphology, histologic pattern, and immunohistochemical study. Correct diagnosis is important not only because these tumors give rise to endocrine syndrome but also because the chemotherapeutic approach to a small-cell carcinoma differs from that for an adeno carcinoma. We experienced a case of a small-cell carcinoma of the gallbladder in a 73-year-old woman with acute cholecystitis syndrome. She was treatment with a palliative cholecystectomy and chemotherapy with short-term excellent response. The literature on the subject is reviewed.
Aged ; Carcinoma, Small Cell* ; Cholecystectomy ; Cholecystitis, Acute ; Cholelithiasis ; Diagnosis ; Drug Therapy ; Female ; Gallbladder* ; Humans

The bile was collected from fro patients with biliary infections, with the bacterium isolated to study the sensitivity of each kind of the bacterium to several antibiotics in common use. Except G- bacterium, we also found some kinds of G+ bacterium in infection bile. G- bacterium were not sensitive to Clindamycin, G+ bacterium were sensitive to Ciprofloxacin. Escherichia coli, Xanthomonas maltophilia, Enterobacter cloacae, Pseudomonas aeruginosa were sensitive to Ampicillin. G+ bacterium were not sensitive to Azactam. Enterococcus faecalis, Enterococcus faecium, Enterobacter cloacae were not sensitive to Ceftazidime. Enterococcus faecalis, Staphylococcus coagulase negative, Staphylococcus epidermidis, Pseudomonas aeruginosa were not sensitive to Ceftriaxone Sodium. We didn't found any bacterium resistance Imipenem. The possibility of the existence of G+ bacterium as well as drug resistance should be considered n patients with biliary infections. The value of susceptibility test should be respected to avoid drug abuse of antibiotics.
Anti-Bacterial Agents/*pharmacology ; Anti-Bacterial Agents/therapeutic use ; Cholecystitis/drug therapy ; Cholecystitis/*microbiology ; Drug Resistance, Bacterial ; Enterobacter aerogenes/drug effects ; Enterococcus faecalis/*drug effects ; Escherichia coli Infections/*drug therapy ; Gram-Positive Bacterial Infections/*drug therapy ; Klebsiella Infections/drug therapy ; Klebsiella pneumoniae/drug effects ; Microbial Sensitivity Tests

Actinomycosis is a chronic suppurative and granulomatous disease, characterized by the formation of abscess, draining sinuses, abundant granulation, and dense fibrous tissue. Actinomycosis of the gallbladder is extremely rare. We report a case of an 56-years old man who abruptly presented with right upper quadrant abdominal pain. Abdominal CT showed that the gallbladder had 2 cm sized stone and an edematous thick wall. Our preoperative diagnosis was acute calculous cholecystitis. After the management of acute cholecystitis, laparoscopic cholecystectomy was performed but converted to open surgery due to severe adhesion to liver and greater omentum. Partial cholecystectomy was performed. Histologic section of the gallbladder showed sulfur granule with gram-positive branching bacilli compatible with actinomyces. After cholecystectomy, the patient received intravenous penicillin G for 2 weeks, followed by oral penicillin for 3 months.
Actinomycosis/*diagnosis/drug therapy/pathology ; Cholecystectomy ; Cholecystitis, Acute/*diagnosis/surgery ; Gallbladder Diseases/*diagnosis/drug therapy/pathology ; Humans ; Male ; Middle Aged ; Penicillins/administration & dosage ; Tomography, X-Ray Computed

Signet ring cell carcinoma is a rare form of gallbladder cancer and has a worse prognosis. Since few cases have been reported, information regarding the behavior and prognosis of the gallbladder carcinoma is limited. About twenty four cases of gallbladder signet ring cell carcinoma have been reported so far. We present a rare case of primary signet ring cell carcinoma of the gallbladder. A 58-year-old male presented with epigastric pain. Abdominal computed tomography showed diffuse gallbladder wall thickening with enhancement, gallstones, and choledocholithiasis. After endoscopic treatment of choledocholithiasis, laparoscopic cholecystectomy was performed. Pathologic examination of the resected gallbladder revealed adenocarcinoma of signet ring cell type in the epithelium. Immunohistochemical stain for cytokeratin 7 was positive for tumor cells. The final pathologic diagnosis was primary signet ring cell carcinoma of the gallbladder. Lymph node metastasis was detected and he received chemotherapy and radiotherapy. After one year of follow-up, bone metastasis in the lumbar spine and malignant ascites were found. The patient is being provided with palliative care.
Adenocarcinoma ; Ascites ; Carcinoma, Signet Ring Cell* ; Cholangitis ; Cholecystectomy, Laparoscopic ; Cholecystitis* ; Cholecystitis, Acute ; Choledocholithiasis ; Diagnosis ; Drug Therapy ; Epithelium ; Follow-Up Studies ; Gallbladder Neoplasms ; Gallbladder* ; Gallstones ; Humans ; Keratin-7 ; Lymph Nodes ; Male ; Middle Aged ; Neoplasm Metastasis ; Palliative Care ; Prognosis ; Radiotherapy ; Spine

Adolescent ; Adult ; Cholecystitis ; complications ; drug therapy ; surgery ; Cholecystolithiasis ; complications ; drug therapy ; surgery ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Pancreatitis ; drug therapy ; etiology ; surgery ; Phytotherapy ; Postoperative Period ; Sphincterotomy, Endoscopic

Both systemic lupus erythematosus and Sjogren's syndrome are autoimmune diseases. Almost all organs can be involved but the gall bladder is an unusual site. We report a 39-year-old woman with systemic lupus erythematosus and Sjogren's syndrome presenting with acute acalculous cholecystitis. It is a very rare complication and, in the literature review, surgical interventions are mostly applied for treatment. In our case, high dose corticosteroid was tried and clinical manifestations and radiologic findings were improved.
Acute Disease ; Adult ; Case Report ; Cholecystitis/*complications/diagnosis/drug therapy ; Female ; Human ; Lupus Erythematosus, Systemic/*complications/diagnosis ; Methylprednisolone/therapeutic use ; Sjogren's Syndrome/*complications/diagnosis ; Tomography, X-Ray Computed

Primary gallbladder carcinoma is relatively uncommon, but not a very rare disease. It accounts for 3- 4% of all gastrointestinal tract tumors, and is the most common malignant disease of the biliary tract. It occurs more frequently in women than in men at a ratio of 3:1. The etiology of gallbladder carcinoma is unknown, but the association of gallstones with it is well known. The diagnosis often is not made before laparotomy because its symptoms and signs are very nonspecific and are similar to those of cholecystitis. Commonly, it is encountered in the later stages and has very unfavorable courses. Recently, the operative treatments of gallbladder carcinoma have advanced significantly, and many studies revealed that more aggressive surgery gives rise to better prognosis in comparison with previous surgical treatment modalities. We reviewed 60 cases of this disease experienced in our hospital from October, 1988 to February, 1998. We evaluated whether the aggressive surgical treatment and the adjuvant therpy of gallbladder cancer had influence on prognosis. And additionally, we examined the clinical situations of primary gallbladder carcinoma. Only 33 patients of 60 were followed up until a recent date, and so all survival data were calculated within 33 cases. The results are as follows : 1) The incidence of gallbladder carcinoma in females outnumbered in males at a ratio of 1.2:1, and sixty per cent of all patients were 7th and 8th decades of age. 2) Almost all patients had varying degrees of upper abdominal pain, and the duration of symptoms was less than 4 weeks in half of the patients. 3) Forty-five per cent of all patients had gallstones. 4) Preoperative diagnoses were made in 28 cases(46.7%). 5) At the time of diagnosis, many patients(about 70%) were on the TNM stage III and IV. 6) The curative resectability rate of the cancer was merely 53.3%(32/60), and in the remainder of patients(n=28), palliative surgery and only laparotomy were carried out. The operative methods performed on purpose of a curative resection of the cancer were simple cholecystectomy in 14 patients(23.3%), cholecystectomy plus liver wedge resection plus LN dissection(radical cholecystectomy) in 15 patients(25%), radical cholecystectomy plus Roux-en-Y hepaticojejunostomy in 1(1.7%), and radical cholecystectomy plus right hepatic lobectomy in 2(3.3%). 7) The cumulative 5-year-survival rates of gallbladder carcinoma were 80% in stage I, 75% in stage II, 33% in stage III, and 0% in stage IV(p=0.002). In advanced cases(that is, in stage III and IV), the survival data was analized according to the operation methods. The mean survival times were 25.9 months in curative operation group and 3.3 months in palliative operation or explo-laparotomy group(p=0.003). 8) In a small number of patients of stage III and IV, chemotherapy and radiation therapy were carried out. But we could not find the statistical significances on the differences of survival rates.
Abdominal Pain ; Biliary Tract ; Cholecystectomy ; Cholecystitis ; Diagnosis ; Drug Therapy ; Female ; Gallbladder Neoplasms* ; Gallbladder* ; Gallstones ; Gastrointestinal Tract ; Humans ; Incidence ; Laparotomy ; Liver ; Male ; Palliative Care ; Prognosis ; Rare Diseases ; Survival Rate

Diffuse large B-cell lymphoma that arises from the gallbladder is extremely rare, and the associated studies are not well described in the literature. We report our experience that diffuse large B-cell lymphoma of the gallbladder was diagnosed by histological findings after laparoscopic cholecystectomy in a 75-year-old man. The patient was diagnosed with stage IV lymphoma, and chemotherapy was performed following surgery. The abdominal, chest, neck computed tomography (CT) and positron emission tomography (PET)-CT were performed after chemotherapy, and the results showed that there were no multiple lymphadenopathies. The patient was considered to have achieved complete remission. Diffuse large B-cell lymphoma of the gallbladder is extremely rare and never been diagnosis preoperatively. Pathological examination of the cholecystectomy specimen is important. This will be very helpful for identifying patients who need additional treatment.
Aged ; B-Lymphocytes ; Cholecystectomy ; Cholecystectomy, Laparoscopic ; Cholecystitis ; Diagnosis ; Drug Therapy ; Gallbladder ; Humans ; Lymphoma ; Lymphoma, B-Cell ; Neck ; Positron-Emission Tomography ; Thorax

The bile was collected from fro patients with biliary infections, with the bacterium isolated to study the sensitivity of each kind of the bacterium to several antibiotics in common use. Except G- bacterium, we also found some kinds of G+ bacterium in infection bile. G- bacterium were not sensitive to Clindamycin, G+ bacterium were sensitive to Ciprofloxacin. Escherichia coli, Xanthomonas maltophilia, Enterobacter cloacae, Pseudomonas aeruginosa were sensitive to Ampicillin. G+ bacterium were not sensitive to Azactam. Enterococcus faecalis, Enterococcus faecium, Enterobacter cloacae were not sensitive to Ceftazidime. Enterococcus faecalis, Staphylococcus coagulase negative, Staphylococcus epidermidis, Pseudomonas aeruginosa were not sensitive to Ceftriaxone Sodium. We didn't found any bacterium resistance Imipenem. The possibility of the existence of G+ bacterium as well as drug resistance should be considered n patients with biliary infections. The value of susceptibility test should be respected to avoid drug abuse of antibiotics.
Adult ; Aged ; Anti-Bacterial Agents ; pharmacology ; therapeutic use ; Cholecystitis ; drug therapy ; microbiology ; Drug Resistance, Bacterial ; Enterobacter aerogenes ; drug effects ; Enterococcus faecalis ; drug effects ; Escherichia coli Infections ; drug therapy ; Female ; Gram-Positive Bacterial Infections ; drug therapy ; Humans ; Klebsiella Infections ; drug therapy ; Klebsiella pneumoniae ; drug effects ; Male ; Microbial Sensitivity Tests ; Middle Aged

Adult ; Aged ; Cholangitis ; complications ; Cholecystitis, Acute ; complications ; Drugs, Chinese Herbal ; therapeutic use ; Female ; Humans ; Interleukin-2 ; blood ; Interleukin-6 ; blood ; Male ; Middle Aged ; Phytotherapy ; Systemic Inflammatory Response Syndrome ; drug therapy ; etiology ; Tumor Necrosis Factor-alpha ; metabolism