Cellular activity in the gallbladder of children with anomalous arrangement of the pancreaticobiliary duct

Background/Purpose: Anomalous arrangement of the pancreaticobiliary duct (A APBD) is closely related to congenital biliary dilatation and frequently as sociated with biliary tract malignancy. To examine the mechanism of biliary tract carcinogenesis in patients with AAPBD, we investigated histologicall y the early changes in cell proliferative kinetics of the gallbladder mucos a of children with AAPBD. Methods: Twenty-three specimens of gallbladder were obtained from 23 childr en with AAPBD, and six control specimens were obtained from pediatric patie nts. All specimens were fixed routinely and paraffin embedded and examined histologically with H&E staining and immunohistochemically with monoclonal antibody Ki-67(MIB-1), which reacts with a human nuclear antigen associated with cell proliferation. Ki-67 labeling index (Ki-67 LI) was obtained by c ounting the numbers of Ki-67-positive cells per 1,000 gallbladder epithelia l cells. Results: Significant differences in Ki-67 LI were noted between children wi th and without AAPBD, Furthermore, Ki-67 LI and the incidence of epithelial hyperplasia of gallbladder were significantly higher in children with AAPB D in whom the major pancreatic duct joined the common bile duct (P-C type) than in those in whom the common bile duct joined the major pancreatic duct (C-P type). Conclusions. Cellular proliferative activity was increased in children with AAPBD, especially those with the P-C-type anomaly. These results suggest t hat the early mucosal changes of the gallbladder occurred in early childhoo d of patients with AAPBD and might be associated with gallbladder cancer, E arly diagnosis and early surgical division of the biliary tract and pancrea tic duct is recommended for children with AAPBD. J Pediatr Surg 34:962-966. Copyright (C) 1999 by W.B. Saunders Company.