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Indian Journal of Gastroenterology :... Sep 2016Knowledge about anatomic variations in intrahepatic biliary ducts (IHBD) is relevant for performing biliary drainage and for avoiding bile duct injury during...
Intrahepatic biliary duct branching patterns, cystic duct anomalies, and pancreas divisum in a tertiary referral center: A magnetic resonance cholangiopancreaticographic study.
BACKGROUND
Knowledge about anatomic variations in intrahepatic biliary ducts (IHBD) is relevant for performing biliary drainage and for avoiding bile duct injury during cholecystectomy and liver resections. Low insertion of cystic duct (LICD) is a common anatomic variant. Pancreas divisum is the commonest congenital anomaly of pancreas; it has been causally linked with recurrent acute pancreatitis (RAP).
METHODS
Magnetic resonance cholangiopancreaticography (MRCP) images of 500 consecutive patients were reviewed for anatomic variants of IHBD, cystic duct, and pancreatic duct.
RESULTS
Anatomy of IHBD could be evaluated in 458 MRCP's, of these 301 (65.72 %) had 'typical' anatomy. The variant in 157 persons included 'triple confluence' in 56 (12.23 %), 'right posterior segmental duct (RPSD) draining to left hepatic duct (LHD)' in 64 (14 %), 'RPSD to common hepatic duct (CHD)' in 20 (4.4 %), 'RPSD to cystic duct' in 2 (0.4 %), 'accessory duct to CHD' in 3 (0.7 %), 'accessory duct to right hepatic duct (RHD)' in 1 (0.2 %), 'segment 2 and 3 separately to CHD' in 1 (0.2 %), and complex variants in 10 (2.2 %). Cystic duct could be evaluated in 338 patients; of these, 15 (4.4 %) had LICD. Patients with RAP had pancreas divisum more often than those without any pancreatic disease, (-/-,10 % and -/-, 0.8 %; p = 0.004).
CONCLUSIONS
Nearly one third of MRCPs showed atypical IHBD pattern with RPSD draining to LHD being the commonest. LICD was the most common cystic duct variant. Pancreas divisum was more frequent in patients with RAP than in persons without pancreatic disease.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anatomic Variation; Bile Ducts, Intrahepatic; Child; Child, Preschool; Cholangiopancreatography, Magnetic Resonance; Cystic Duct; Female; Humans; Infant; Male; Middle Aged; Pancreatic Ducts; Tertiary Care Centers; Young Adult
PubMed: 27660206
DOI: 10.1007/s12664-016-0693-5 -
BMC Surgery May 2017This retrospective study aimed to investigate the incidence of each type of accessory hepatic duct by drip infusion cholangiography with CT (DIC-CT).
BACKGROUND
This retrospective study aimed to investigate the incidence of each type of accessory hepatic duct by drip infusion cholangiography with CT (DIC-CT).
METHODS
Five hundred sixty nine patients who underwent preoperative DIC-CT and laparoscopic cholecystectomy were reviewed. Accessory hepatic ducts were classified as follows: type I (accessory hepatic ducts that merged with the common hepatic duct between the confluence of the right and left hepatic ducts and the cystic duct confluence), type II (those that merged with the common hepatic duct at the same site as the cystic duct), type III (those that merged with the common bile duct distal to the cystic duct confluence), type IV (the cystic duct merged with the accessory hepatic duct), and type V (accessory hepatic ducts that merged with the common hepatic or bile duct on the left side).
RESULTS
Accessory hepatic ducts were observed in 50 patients. Type I, II, III, IV, and V accessory hepatic ducts were detected in 32, 3, 1, 11, and 3 patients, respectively. Based on their drainage areas, the accessory hepatic ducts were also classified as follows: a posterior branch in 22 patients, an anterior branch in 9 patients, a combination of posterior and anterior branches in 16 patients, a left-sided branch in 2 patients, and a caudate branch in 1 patient. None of the patients with accessory hepatic ducts suffered bile duct injuries.
CONCLUSION
There are a number of variants of the accessory hepatic duct. DIC-CT is useful to detect the accessory hepatic duct.
Topics: Cholangiography; Cholecystectomy, Laparoscopic; Common Bile Duct; Hepatic Duct, Common; Humans; Infusions, Intravenous; Retrospective Studies; Tomography, X-Ray Computed
PubMed: 28482819
DOI: 10.1186/s12893-017-0251-9 -
Digestive Endoscopy : Official Journal... Jul 2021
Topics: Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Cholestasis; Humans; Palliative Care; Stents; Treatment Outcome
PubMed: 33527611
DOI: 10.1111/den.13922 -
Clinical Journal of Gastroenterology Jun 2022Recently, "polypoid invasive carcinoma (PICA)" showing grossly visible polypoid, invasive carcinoma with no adenoma component was proposed as a neoplastic polyp of the...
Recently, "polypoid invasive carcinoma (PICA)" showing grossly visible polypoid, invasive carcinoma with no adenoma component was proposed as a neoplastic polyp of the gallbladder. Herein, we report four cases of PICA of the bile duct. PICA cases of bile duct showed single, sessile polypoid growth grossly, and polypoid components were composed of invasive carcinoma of papillary/tubular patterns with active desmoplasia, and invaded directly and continuously into the bile duct wall and periductal tissue. While PICA and other intraductal papillary neoplasm of bile duct (IPNB) shared several features, PICA showed an invasive carcinoma growing in the duct lumen and also invading into the bile duct wall, thus different from IPNB which is the intraluminal polypoid, preinvasive epithelial neoplasia with back-to-back epithelial units. Taken together, PICA and IPNB could be differentiated from each other.
Topics: Bile Duct Neoplasms; Bile Ducts; Carcinoma; Carcinoma, Papillary; Common Bile Duct; Humans
PubMed: 35334086
DOI: 10.1007/s12328-022-01626-4 -
Pancreas Aug 2015Double-duct sign (combined dilatation of the common bile duct and pancreatic duct) is an infrequently encountered finding in cross-sectional radiological imaging of the...
OBJECTIVES
Double-duct sign (combined dilatation of the common bile duct and pancreatic duct) is an infrequently encountered finding in cross-sectional radiological imaging of the pancreatobiliary system. This sign is commonly deemed to signify on ominous pathology and suggests the presence of pancreatic or biliary malignancy.
METHODS
We aim to correlate double-duct sign discovered on magnetic resonance cholangiopancreatogram (MRCP) in the clinical context. We retrospectively analyzed MRCP database over a period of 4 years, January 2010 to December 2013. Follow-up information was available for a median of 27 months (range, 12-42 months)
RESULTS
The commonest cause of double-duct sign was choledocholithiasis followed closely by pancreatobiliary malignancy. Patients with jaundice in the context of double-duct sign had a higher incidence of malignancy (48%). None of the anicteric patients were found to have malignancy (P = 0.002).
CONCLUSIONS
In patients with MRCP evidence of double-duct sign, the absence of jaundice makes a malignant etiology unlikely. Conversely, in jaundiced patients, a malignant cause is much more likely. Figures from larger series are needed to support this conclusion.
Topics: Aged; Aged, 80 and over; Bilirubin; Biomarkers; Cholangiopancreatography, Magnetic Resonance; Choledocholithiasis; Common Bile Duct; Common Bile Duct Neoplasms; Dilatation, Pathologic; England; Female; Humans; Incidence; Jaundice; Male; Middle Aged; Pancreatic Diseases; Pancreatic Ducts; Pancreatic Neoplasms; Predictive Value of Tests; Prognosis; Retrospective Studies; Risk Factors; Time Factors
PubMed: 26087354
DOI: 10.1097/MPA.0000000000000372 -
HPB : the Official Journal of the... Feb 2019Growing evidence has suggested that intrahepatic cholangiocarcinoma (iCCA) can be classified into small- and large-duct types. The present study aimed to elucidate how... (Comparative Study)
Comparative Study
BACKGROUND
Growing evidence has suggested that intrahepatic cholangiocarcinoma (iCCA) can be classified into small- and large-duct types. The present study aimed to elucidate how large-duct iCCA is similar and dissimilar to perihilar cholangiocarcinoma (pCCA).
METHODS
The study cohort consisted of iCCA (n = 58) and pCCA (n = 44). After iCCA tumors were separated into small- (n = 36) and large-duct (n = 22) types based on our histologic criteria, genetic statuses of the three types of neoplasms were compared. Locations of iCCA were plotted on a three-dimensional image and their distances from the portal bifurcation were measured.
RESULTS
Large-duct iCCA was distinct from small-duct iCCA in terms of frequency of bile duct reconstruction required, perineural infiltration, and survival, with these features more similar to pCCA. Large-duct iCCA and pCCA more frequently had the loss of SMAD4 expression and MDM2 amplifications than small-duct iCCA, whereas the loss of BAP1 expression and IDH1 mutations were mostly restricted to small-duct iCCA. From imaging analysis, most tumors of large-duct iCCA were present around the second branches of the portal vein.
CONCLUSION
Large-duct type iCCA shared the molecular features with pCCA, and it may be reasonable to expand the definition of pCCA to include cancers originating from the second bile duct branches.
Topics: Adult; Aged; Aged, 80 and over; Bile Duct Neoplasms; Biomarkers, Tumor; Female; Gene Amplification; Gene Deletion; Genetic Predisposition to Disease; Humans; Klatskin Tumor; Male; Middle Aged; Mutation; Phenotype; Prognosis
PubMed: 30170977
DOI: 10.1016/j.hpb.2018.07.021 -
Medicine Feb 2018Duplication of the extrahepatic bile duct is an extremely rare congenital anomaly of the biliary system. (Review)
Review
RATIONALE
Duplication of the extrahepatic bile duct is an extremely rare congenital anomaly of the biliary system.
PATIENT CONCERNS
A 44-year-old woman presented with a history of continuous upper abdominal pain and vomiting.
DIAGNOSES
Magnetic resonance cholangiopancreatography (MRCP) disclosed diffuse dilatation of the intrahepatic and extrahepatic bile ducts. Endoscopic retrograde cholangiopancreatography (ERCP) showed the presence of two extrahepatic bile ducts with calculus at the distal end of the CBD.
INTERVENTIONS
Laparoscopic cholecystectomy (LC) was performed after an ERCP. Choledochoscopy, performed during the operation, showed duplicated common bile duct and the cystic duct was seen opening at the right side of the extrahepatic duct.
OUTCOMES
The patient was doing well after 6 months of follow-up.
LESSONS
We reported a case of a double common duct with choledocholithiasis and gallstone. This rare anomaly may lead to cholangitis, common bile duct injury during surgery, malignancy occurrence, and should be treated with extreme care.
Topics: Adult; Bile Duct Diseases; Bile Ducts, Extrahepatic; Cholangiopancreatography, Endoscopic Retrograde; Cholangiopancreatography, Magnetic Resonance; Cholecystectomy, Laparoscopic; Choledocholithiasis; Common Bile Duct; Female; Gallstones; Humans
PubMed: 29465584
DOI: 10.1097/MD.0000000000009953 -
Pathology International Nov 2014Morphologic features and neoplastic potentials of bile duct adenoma (BDA) and von Meyenburg complex (VMC)-like duct arising in chronic liver disease were unknown....
Morphologic features and neoplastic potentials of bile duct adenoma (BDA) and von Meyenburg complex (VMC)-like duct arising in chronic liver disease were unknown. Thirty-five BDAs and 12 VMC-like duct lesions were observed in 39 cases with chronic liver disease. BDAs were divided into the EMA-cytoplasmic type (n = 14) and EMA-luminal type (n = 21). EMA-cytoplasmic BDA composed of a proliferation of cuboidal to low-columnar cells forming an open lumen with NCAM(+)/MUC6(-), resembling an interlobular bile duct. EMA-luminal BDA showed uniform cuboidal cells with narrow lumen, and NCAM(++)/MUC6(++), resembling a ductular reaction. VMC-like duct showed positive MUC1 expression and negative MUC6. The expression of S100P, glucose transporter-1 (GLUT-1) and insulin-like growth factor II mRNA-binding protein 3 (IMP-3) were not detected in three lesions. p16 expression was higher than those of the ductular reaction, and the Ki67 and p53 indexes were very low (<1.0%). Large-sized EMA-luminal BDA shows sclerotic stroma. We classified small nodular lesions of ductal or ductular cells in chronic hepatitis and cirrhosis into the following groups: BDA, interlobular bile duct type; BDA, ductular/peribiliary gland type; and VMC-like duct. They may be reactive proliferation rather than neoplastic lesions.
Topics: Adenoma, Bile Duct; Aged; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Female; Hamartoma; Hepatitis; Humans; Liver Cirrhosis; Male; Middle Aged
PubMed: 25329860
DOI: 10.1111/pin.12209 -
Orbit (Amsterdam, Netherlands) Dec 2022Angioleiomyomas are benign tumors composed of smooth muscle and vascular endothelium. While infrequent in overall prevalence, they are exceptionally rare in the head and... (Review)
Review
Angioleiomyomas are benign tumors composed of smooth muscle and vascular endothelium. While infrequent in overall prevalence, they are exceptionally rare in the head and neck. Herein, we describe the case of a 65-year-old female who was found to have an angioleiomyoma of the right nasolacrimal duct. Endoscopic excision of the lesion along with medial maxillectomy and dacryocystorhinostomy was performed without complication. The current report is one of the few reported cases of angioleiomyoma of the lacrimal drainage system.
Topics: Female; Humans; Aged; Nasolacrimal Duct; Angiomyoma; Dacryocystorhinostomy; Endoscopy; Lacrimal Duct Obstruction
PubMed: 34057005
DOI: 10.1080/01676830.2021.1933080 -
Journal of Pediatric Ophthalmology and... 2015
Topics: Humans; Lacrimal Duct Obstruction; Nasolacrimal Duct; Practice Patterns, Physicians'
PubMed: 25643367
DOI: 10.3928/01913913-20141230-04