We herein report a case of gallbladder carcinoma associated with occult pancreatobiliary reflux (PR) in the absence of pancreatobiliary maljunction. A 67-year-old woman was referred to our hospital for the evaluation and treatment of a gallbladder tumor. Ultrasonography and computed tomography showed a nodular lesion in the fundus of the gallbladder, indicating the possibility of a gallbladder carcinoma. Endoscopic retrograde ultrasonography showed the tumor in the fundus of the gallbladder and thickness of the surrounding epithelium. Endoscopic retrograde cholangiopancreatography revealed a normal pancreaticobiliary junction without the common channel and a mild dilatation of the common bile duct (15 mm in the diameter). An open cholecystectomy and partial resection of the liver bed of the gallbladder with regional lymphadenectomy were performed. A C-tube was inserted from the cut end of the cystic duct into the common bile duct to prevent the bile stasis. Biliary amylase and lipase levels sampled in the gallbladder were 2,604 IU/l and 775 IU/l, respectively. Biliary amylase level in the bile collected from the C-tube in the common bile duct was 119,550 IU/l on postoperative day (POD) 6 and 22,265 IU/ on POD 12. These observations suggested that PR was present in this patient. The histopathological findings of the resected specimen showed a well differentiated adenocarcinoma of the gallbladder with invasion to the muscle layer and no metastasis of the resected lymph nodes. A high index of the nuclear staining for MIB-I in the cancer cells (about 10%) was exhibited, and a few cells of the normal epithelium also stained positive.
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