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Histopathology Jan 2021Precursor lesions of small duct type intrahepatic cholangiocarcinoma (small duct iCCA) have not been clarified so far. We hypothesised that precursor lesions may be...
BACKGROUND/AIMS
Precursor lesions of small duct type intrahepatic cholangiocarcinoma (small duct iCCA) have not been clarified so far. We hypothesised that precursor lesions may be frequently distributed in the background liver of small duct iCCA.
METHODS AND RESULTS
We determined by histology the presence of bile duct adenomas and von Meyenburg complexes as candidate precursor lesions in the background liver of small duct iCCA, with other primary liver carcinomas as control. Subjects included 28 patients with small duct iCCA, 29 with large duct iCCAs, 60 with combined hepatocellular-cholangiocarcinoma (Comb) and 40 with hepatocellular carcinoma (HCC). The prevalence of bile duct adenomas in the background liver was significantly higher in small duct iCCA (35.7%) compared to other primary liver carcinomas (Comb, 4.9%; 10%, HCC) (P < 0.01). The prevalence of bile duct adenomas was significantly associated with the presence of von Meyenburg complexes and ductal plate malformation-like patterns in small duct iCCAs and Combs. Von Meyenburg complexes were detected in 11 small duct iCCA (39.3%), five large duct iCCAs (17.2%), 10 Comb (16.4%) and 13 HCC (33.3%), respectively (P > 0.05). Small duct iCCAs showed altered expression of ARID1A (46.4%), p53 (39.3%), PBRM1 (14.3%), IMP3 (85.7%) and EZH2 (82.1%), whereas these markers were negative in bile duct adenomas.
CONCLUSION
Bile duct adenomas may be precursor lesions of small duct iCCAs. Alteration of ARID1A, p53 or PBRM1 may be involved in the carcinogenesis of small duct iCCAs.
Topics: Adenoma, Bile Duct; Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Biomarkers, Tumor; Carcinoma, Hepatocellular; Cholangiocarcinoma; Diagnosis, Differential; Female; Humans; Liver; Liver Neoplasms; Male; Middle Aged
PubMed: 33405289
DOI: 10.1111/his.14222 -
Journal of Gastrointestinal Surgery :... Aug 2023
Topics: Female; Humans; Endometriosis; Common Bile Duct; Common Bile Duct Neoplasms
PubMed: 36973499
DOI: 10.1007/s11605-023-05658-0 -
Diagnostic and Interventional Radiology... Sep 2018We aimed to evaluate the imaging features of bile duct adenoma (BDA) on ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). (Comparative Study)
Comparative Study Review
PURPOSE
We aimed to evaluate the imaging features of bile duct adenoma (BDA) on ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI).
METHODS
Retrospective search in our institution database was performed for histologically confirmed BDA. Their imaging studies before histologic confirmation were reviewed. The search identified seven adults (mean age, 52.9 years) with histologically proven single BDA each. US (n=3), CT (n=5), and MRI (n=3) were performed before histologic confirmation. Additionally, a systematic English literature review for BDA and reported imaging findings since 2000 was also conducted using the following search criteria "bile duct adenoma, peribiliary hamartoma, biliary adenoma, CT, ultrasound, MRI" (date range: 01/01/2000 through 08/31/2016). The imaging findings of those cases reported were summarized and compared with our series.
RESULTS
All seven individual nodules were well circumscribed. Five lesions were located in the right hepatic lobe and two in the left hepatic lobe. On US, lesions appeared hypoechoic (n=2) and hyperechoic (n=1). BDA was hypodense on unenhanced CT images (n=1). On MRI, BDA were hypointense on T1 (n=3), hyperintense on T2 (n=3), and hyperintense on diffusion-weighted images (n=2). On contrast-enhanced CT and MRI, BDAs showed arterial phase hyperenhancement that persisted on portal venous/delayed phase images.
CONCLUSION
BDA demonstrates characteristic arterial phase hyperenhancement that persisted into the portal venous and delayed phases on CT and MRI, which may be useful in differentiating from other hepatic lesions.
Topics: Adenoma, Bile Duct; Adult; Aged; Bile Duct Neoplasms; Diffusion Magnetic Resonance Imaging; Female; Humans; Image-Guided Biopsy; Liver; Magnetic Resonance Imaging; Male; Middle Aged; Retrospective Studies; Tomography, X-Ray Computed; Ultrasonography
PubMed: 30211677
DOI: 10.5152/dir.2018.18036 -
Scandinavian Journal of Gastroenterology Aug 2017The aim of this study was to assess the significance and safety of endoscopic retrograde cholangiopancreatography (ERCP) in diagnosing and treating bile duct injuries in...
BACKGROUND AND STUDY AIMS
The aim of this study was to assess the significance and safety of endoscopic retrograde cholangiopancreatography (ERCP) in diagnosing and treating bile duct injuries in children.
PATIENTS AND METHODS
Fourteen pediatric patients, with traumatic or postoperative bile duct injury, in which ERCP was performed, were retrospectively evaluated.
RESULTS
We performed 46 ERCP and 12 endoscopic papillotomies in children with suspected bile duct injuries. A bile stent was primarily inserted in 13 patients and there were 20 replacements. Endoscopic treatment of bile leakage without need for bile duct sutures or reconstruction was successful in 85.7%. Post ERCP complications included cholangitis and recurrent bleeding, which occurred only in two patients each.
CONCLUSIONS
ERCP and endoscopic bile stent insertion is a highly effective, minimally-invasive treatment for bile duct injury and should be included as part of the therapeutic procedures in pediatric patients with suspected bile duct injury.
Topics: Adolescent; Bile Duct Diseases; Bile Ducts; Child; Child, Preschool; Cholangiopancreatography, Endoscopic Retrograde; Cholangitis; Czech Republic; Female; Humans; Infant; Male; Postoperative Complications; Postoperative Hemorrhage; Retrospective Studies; Sphincterotomy, Endoscopic; Stents; Treatment Outcome
PubMed: 28388849
DOI: 10.1080/00365521.2017.1309453 -
Surgical Case Reports Mar 2019Risk factors for bile duct injury in laparoscopic cholecystectomy include severe inflammation at Calot's triangle and aberrant bile duct variations. Knowledge of the...
BACKGROUND
Risk factors for bile duct injury in laparoscopic cholecystectomy include severe inflammation at Calot's triangle and aberrant bile duct variations. Knowledge of the various biliary anomalies and early identification may therefore assist in decreasing the rate of bile duct injury.
CASE PRESENTATION
A 65-year-old woman was admitted with right hypochondrial pain and high fever. A diagnosis of acute calculous cholecystitis was made by radiological imaging. Magnetic resonance cholangiopancreatography revealed that the confluence of the right and left hepatic duct was unclear. Intraoperatively, the procedure was converted from a laparoscopic cholecystectomy to laparotomy because of unclear anatomy of the cystic duct with severe inflammation at Calot's triangle. Furthermore, intraoperative cholangiography from Hartmann's pouch showed the main right hepatic duct entering the cystic duct. Subtotal cholecystectomy was performed to avoid injuring the right hepatic duct.
CONCLUSION
Although an aberrant hepatic duct entering the cystic duct is not uncommon, the main right hepatic duct infiltrating the cystic duct is extremely rare. Preoperative and intraoperative evaluation of the biliary duct and awareness of aberrant biliary duct variations is important in preventing bile duct injury.
PubMed: 30911867
DOI: 10.1186/s40792-019-0604-y -
The American Surgeon Apr 2021Differential diagnosis between pancreatic head cancer (PHC) and intrapancreatic bile duct cancer (BDC) is important, but no clinical standard has been established. Here...
BACKGROUNDS
Differential diagnosis between pancreatic head cancer (PHC) and intrapancreatic bile duct cancer (BDC) is important, but no clinical standard has been established. Here we examine the diagnostic utility of bile duct axis deviation and other clinical factors for this differential diagnosis.
METHODS
This study enrolled patients who underwent pancreaticoduodenectomy for PHC or BDC at our center between 2009 and 2016. PHCs in groove or uncinate portions were excluded from analysis. From contrast-enhanced computed tomography images, the bile duct angle (BDA) was measured using three points: the junction of intrahepatic bile ducts, upper pancreatic edge, and Vater papilla. Logistic regression was performed to evaluate the diagnostic performance of BDA and other clinical factors for differential diagnosis.
RESULTS
During the study period, 22 PHCs and 31 BDCs were resected. The combination of BDA ≤ 130°, main pancreatic duct diameter ≥ 4.3 mm, and absence of jaundice predicted PHC rather than BDC with an area under the curve of the receiver-operator characteristics curve of .856 (95% confidence interval, .766-.947).
CONCLUSION
Clinical findings of larger bile duct axis deviation, main pancreatic duct dilation, and the absence of jaundice may be useful for distinguishing PHC from BDC.
Topics: Aged; Bile Duct Neoplasms; Bile Ducts; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Pancreatic Neoplasms; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 33153309
DOI: 10.1177/0003134820954851 -
Medical Hypotheses Mar 2019Surfactants are complex mixtures of phospholipids and proteins produced by type II alveolar cells of the lungs and play a crucial role in pulmonary physiology. Six types...
Surfactants are complex mixtures of phospholipids and proteins produced by type II alveolar cells of the lungs and play a crucial role in pulmonary physiology. Six types of surfactant proteins (SP) are known; SP-A, SP-B, SP-C, SP-D, SP-G and SP-H. The major role of SP is in reducing surface tension and various immunological functions. SP-A, SP-B, SP-C and SP-D have been demonstrated in the tear film and the epithelium of the lacrimal sac (LS) and nasolacrimal ducts (NLD). All surfactant proteins except SP-G were also isolated from the canalicular tissues. The authors hypothesize that surfactant proteins play a significant role in the pathogenesis of lacrimal drainage disorders; functional nasolacrimal duct obstruction (FNLDO) and infective dacryocystitis.
Topics: Animals; Body Fluids; Dacryocystitis; Humans; Lacrimal Apparatus; Lacrimal Duct Obstruction; Nasolacrimal Duct; Stents; Surface-Active Agents; Tears
PubMed: 30798912
DOI: 10.1016/j.mehy.2019.01.020 -
Langenbeck's Archives of Surgery Aug 2022T-tube drainage, primary closure, and biliary stenting are the common bile duct closure methods. There is great debate on the optimal duct closure technique after common... (Comparative Study)
Comparative Study
PURPOSE
T-tube drainage, primary closure, and biliary stenting are the common bile duct closure methods. There is great debate on the optimal duct closure technique after common bile duct exploration. This study aimed to assess the safety and efficacy of the three commonest common bile duct closure methods after common bile duct exploration for common bile duct stone for future generalization.
METHODS
In this analysis, 211 patients with common bile duct stone underwent common bile duct exploration from January 2016 to December 2020. The patients were divided according to common bile duct closure techniques into three groups, including the T-tube drainage group (63 patients), primary duct closure group (61 patients), and antegrade biliary stenting group (87 patients).
RESULTS
The incidence of overall biliary complications and bile leak were statistically significantly lower in the biliary stenting group than in the other two groups. Also, hospital stays, drain carried time, return to normal activity, re-intervention, and re-admission rates were statistically significantly lower in the biliary stenting group than in the other two groups. There were no statistically significant differences regarding operative and choledochotomy time, retained and recurrent stone, stricture, biliary peritonitis, cholangitis, and the cost among the three groups.
CONCLUSIONS
We state that the biliary stenting procedure should be the preferred first option for common bile duct closure after common bile duct exploration when compared with T-tube drainage and primary duct closure.
TRIAL REGISTRATION
ClinicalTrials.gov PRS (Approval No. NCT04264299).
Topics: Choledocholithiasis; Choledochostomy; Common Bile Duct; Drainage; Gallstones; Humans; Laparoscopy; Length of Stay; Postoperative Complications
PubMed: 35786738
DOI: 10.1007/s00423-022-02597-3 -
Zentralblatt Fur Chirurgie Apr 2016
Topics: Cholecystectomy, Laparoscopic; Cholecystitis, Acute; Common Bile Duct; Expert Testimony; Gallstones; Germany; Hepatectomy; Hepatic Duct, Common; Humans; Jejunostomy; Malpractice; Medical Errors; Reoperation
PubMed: 27088270
DOI: 10.1055/s-0036-1583227 -
Surgical and Radiologic Anatomy : SRA Feb 2024Evaluation of the cystic duct anatomy prior to bile duct or gallbladder surgery is important, to decrease the risk of bile duct injury. This study aimed to clarify the...
BACKGROUND
Evaluation of the cystic duct anatomy prior to bile duct or gallbladder surgery is important, to decrease the risk of bile duct injury. This study aimed to clarify the frequency of cystic duct variations and the relationship between them.
METHODS
Data of 205 patients who underwent cholecystectomy after imaging at Sada Hospital, Japan, were analyzed. The Chi-square test was used to analyze the relationships among variations.
RESULTS
The lateral and posterior sides of the bile duct were the two most common insertion points (92 patients, 44.9%), and the middle height was the most common insertion height (135 patients, 65.9%). Clinically important variations (spiral courses, parallel courses, low insertions, and right hepatic duct draining) relating to the risk of bile duct injury were observed in 24 patients (11.7%). Regarding the relationship between the insertion sides and heights, we noticed that the posterior insertion frequently existed in low insertions (75.0%, P < 0.001) and did not exist in high insertions. In contrast, the anterior insertion coexisted with high and never low insertions. Spiral courses have two courses: anterior and posterior, and anterior ones were only found in high insertion cases.
CONCLUSIONS
The insertion point of the cystic duct and the spiral courses tended to be anterior or lateral superiorly and posterior inferiorly. Clinically significant variations in cystic duct insertions are common and surgeons should be cautious about these variations to avoid complications.
Topics: Humans; Cystic Duct; Cholecystectomy, Laparoscopic; Bile Ducts; Cholecystectomy; Liver
PubMed: 38197959
DOI: 10.1007/s00276-023-03275-9