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The T category of distal extrahepatic bile duct carcinoma (DBDC) is based on invasion depth from the basal lamina to the deepest infiltrating tumor cells. Recently, invasive tumor thickness (ITT) was proposed, defined as maximal vertical distance of invasive tumor components regardless of the basal lamina. We compared the predictive value of T category, and ITT grading in 424 surgically resected DBDCs. DBDCs were categorized as 6 Tis (1.4%), 134 T1 (5 mm; 31.6%), 204 T2 (5 to 12 mm; 48.1%), and 80 T3 (12 mm; 18.9%). With ITT, there were 6 G0 (no invasion; 1.4%), 3 G1 (1 mm; 0.7%), 90 G2 (≥1 and5 mm; 21.2%), 188 G3 (≥5 and10 mm; 44.4%), and 137 G4 (≥10 mm; 32.3%). The 5-year survival rates of T1, T2, and T3 were 58.9%, 44.2%, and 18.2%, and those of ITT G1, G2, G3, and G4 were 33.3%, 54.1%, 51.6%, and 26.7%, respectively. The T category discriminated patient survival by overall (P0.001) and pairwise (T1 vs. T2, P=0.007; T2 vs. T3, P0.001) comparisons. ITT grading distinguished survival by overall and between G3-G4 (both P0.001), with no survival differences observed between G1-G2 and G2-G3 comparisons. The T category more accurately discriminated patient survival than ITT grading. To determine the T category for DBDCs, (1) longitudinal sectioning on gross examination, especially for DBDCs with large papillary or nodular growth patterns; (2) evaluation of serial sections or alternative hematoxylin and eosin slides; (3) use of a straight or curved baseline depending on the shape of the peritumoral normal bile duct wall and/or the basal lamina of the peritumoral normal biliary epithelia/biliary intraepithelial neoplasias are recommended.

BACKGROUMD: Alteration in scapular medial border displacement often observed as scapular winging, can affect the force couples of the rotator cuff muscles and thereby shoulder function. The relationship between scapular medial border displacement and shoulder internal and external rotator muscle function in the baseball player-throwing arm has not been studied. OBJECTIVE: The purpose of the study was to determine if any relationship exists between the amounts of scapular medial border displacement measured at rest and during the sitting hand press up test position and shoulder internal and external rotator muscular strength in Division III baseball players throwing arm. METHODS: A total of 51 Division III baseball players volunteered for the study. Scapular medial border displacement was measured with a standardized posterior scapular displacement measurement tool in two positions, the resting and the sitting hand press-up position. Isokinetic strength of concentric internal rotation (IR) and external rotation (ER) peak torque and time to peak torque for each subject were measured using 3 maximal testing repetitions at 60 ◦ /s. RESULTS: The results of the study showed a linear relationship between the amount of scapular medial border displacement and concentric IR strength and also in time to peak torque. However, no linear relationships were observed between scapular medial border displacement and other isokinetic strength variables. CONCLUSIONS: Scapular medial border displacement produced during a loaded state influences shoulder internal rotatory strength. This may bear on rehabilitation and strengthening exercises in terms of focusing on proper scapular position and subsequent muscular balance to optimize shoulder function.