Gallbladder carcinoma in a pregnant patient with Crohn's disease complicated with gallbladder involvement.
Gallbladder carcinoma in a pregnant patient with Crohn's disease complicated with gallbladder involvement.
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患有克罗恩病并发胆囊受累的妊娠患者的胆囊癌。
DOI：
10.4251/wjgo.v5.i2.29
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发表时间：
2013
影响因子：
3
通讯作者：
R. Abraham
中科院分区：
文献类型：
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作者：
Shada Attraplsi;Rima M Shobar;I. Lamzabi;R. Abraham
原发性胆囊 (GB) 癌和 GB 克罗恩病 (CD) 都很罕见。我们介绍一例患有 CD 的孕妇，发现有 GB 受累和原发性 GB 癌。一名 34 岁女性，妊娠 6 周，有 21 年 CD 病史，程度不明，出现 3 个月腹泻、尿急和腹痛。在检查过程中，她被发现转氨酶升高和碱性磷酸酶异常。影像显示有两个胆囊息肉，大小均大于 1 厘米。切除和组织学评估符合克罗恩病累及 GB、GB 低分化腺癌，侵入固有肌层和肝门淋巴结，转移性癌阳性（pT2N1 期）。已发表 6 例 CD 累及 GB、2 例 CD 中原发性 GB 癌以及 10 例妊娠期胆管癌。这是描述所有三个因素的唯一案例。 GB 型 CD 的常见特征包括急性胆囊炎、回肠受累以及独立于活动性肠道疾病的存在。患有 GB 恶性肿瘤的 CD 患者的共同特征包括检测年龄较轻、CD 病史较长、疾病广泛累及结肠和回肠、不存在胆石症和既往存在胆囊疾病（原发性硬化性胆管炎和胆囊息肉）。怀孕是这种情况特有的。 CD 在 GB 恶性肿瘤发展中的作用尚不清楚，妊娠对疾病传播的贡献也尚不清楚。荷尔蒙影响加剧了慢性炎症和免疫抑制。
Primary gallbladder (GB) carcinoma and Crohn's disease (CD) of the GB are individually rare. We present a case of a pregnant woman with CD found to have GB involvement and primary GB carcinoma. A 34-year-old female at 6 wk gestation with a 21 year history of CD of uncertain extent presented with 3 mo of diarrhea, urgency and abdominal pain. During work-up, she was found to have elevated transaminases and an abnormal alkaline phosphatase. Imaging revealed two gallbladder polyps both greater than 1 cm in size. Resection and histological evaluation was consistent with Crohn's involvement of the GB, poorly differentiated adenocarcinoma of the GB with invasion through the muscularis propria and matted lymph nodes in the porta hepatis positive for metastatic carcinoma (stage pT2N1). Six cases of CD involving the GB, two cases of primary GB carcinoma in CD, and ten cases of cholangiocarcinoma in pregnancy have been published. This is the only case that describes all three factors. Common features in CD of the GB include acute cholecystitis, ileal involvement, and presence independent of active intestinal disease. Common features in CD patients with GB malignancy include younger age of detection, a long history of CD, extensive colonic and ileal involvement of disease, the absence of cholelithiasis, and pre-existing gallbladder disease (primary sclerosing cholangitis and gallbladder polyps). Pregnancy is specific to this case. The role of CD in the development of GB malignancy is not well understood nor is the contribution of pregnancy to the spread of disease. Chronic inflammation and immunosuppression compounded by hormonal influence is implicated.
影响因子：
7.7
作者：
通讯作者：
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