EARLY MUCOSAL CHANGES OF THE GALLBLADDER IN PATIENTS WITH ANOMALOUS ARRANGEMENT OF THE PANCREATICOBILIARY DUCT

Background & Aims: Anomalous arrangement of the pancreaticobiliary duc t (AAPBD) is frequently associated with gallbladder cancer. The aim of this study was to characterize the early epithelial changes of the ga llbladder that might be associated with carcinogenesis in patients wit h AAPBD. Methods: Routinely fixed tissue specimens obtained from pedia tric patients with AAPBD and control patients were examined histologic ally with H&E, periodic acid-Schiff, and argyrophilic nucleolar organi zer region (AgNOR) staining. Results: Epithelial hyperplasia was frequ ently observed in the gallbladder of patients with AAPBD but not in pa tients without this anomaly. The incidence of epithelial hyperplasia w as significantly higher in the gallbladder of patients in whom the maj or pancreatic duct joined the common bile duct (P-C type) than in pati ents in whom the common bile duct joined the pancreatic duct (C-P type ). The mean AgNOR number in the gallbladder mucosa was significantly h igher in patients with AAPBD than in patients without AAPBD. Patients with P-C type AAPBD had a significantly higher mean AgNOR number of th e gallbladder mucosa than patients with C-P type AAPBD. Conclusions: P atients with AAPBD, especially those with the P-C type anomaly, have i ncreased cellular proliferative activity of the gallbladder mucosa in early childhood.