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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 -
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 -
World Journal of Surgical Oncology Jan 2017The incidence of extrahepatic bile duct malignancies is about 2-3.6% of all gastrointestinal malignancies. Primary carcinoma of cystic duct is a rare condition... (Review)
Review
BACKGROUND
The incidence of extrahepatic bile duct malignancies is about 2-3.6% of all gastrointestinal malignancies. Primary carcinoma of cystic duct is a rare condition comprising a fraction of all extrahepatic bile duct malignancies with less than 70 cases reported worldwide. Majority of these cases were reported from East Asia. There is paucity in such case being reported from Indian subcontinent. We present a case of primary carcinoma of the cystic duct encountered during laparoscopic cholecystectomy.
CASE PRESENTATION
A 65-year-old lady presented to us with symptomatic gall stone disease. Investigations revealed a distended gall bladder with multiple stones. Patient was taken up for laparoscopic cholecystectomy, during surgery a stony hard structure was found at cystic duct-common bile duct junction which was not amenable for clear dissection. Procedure was converted to open, and the patient underwent cholecystectomy with resection of common bile duct with Roux-en-Y hepaticojejunostomy and regional lymphadenectomy. Histopathological findings revealed it to be moderately differentiated adenocarcinoma of the cystic duct.
CONCLUSION
Primary carcinoma of cystic duct is a rare condition where early diagnosis can be difficult and if accidentally detected may add to surgeon's dilemma. Proper surgery with en-bloc resection of gallbladder, cystic duct, common bile duct, and regional lymphadenectomy is the mainstay of treatment. The prognosis of carcinoma of cystic duct is better than extrahepatic bile duct malignancies. The old classification system has outlived its time and is more rigid in definition which is not practical in advanced cases; the new classification systems of this century offer better insight into understanding the tumor characteristics and prognosis.
Topics: Adenocarcinoma; Aged; Bile Duct Neoplasms; Cholecystectomy; Cystic Duct; Female; Humans; Prognosis
PubMed: 28103928
DOI: 10.1186/s12957-016-1073-4 -
British Medical Journal (Clinical... May 1987The factors influencing the migration of gall stones are ill understood. Altogether 331 patients undergoing cholecystectomy were studied prospectively. The diameters of...
The factors influencing the migration of gall stones are ill understood. Altogether 331 patients undergoing cholecystectomy were studied prospectively. The diameters of the cystic and common bile ducts and of stones in the gall bladder and bile ducts were measured. Increasing pressure was applied to the freshly excised gall bladder in an attempt to evacuate stones through the cystic duct. Stones passed in 33 (60.0%) of patients with choledocholithiasis, 45 (67.2%) of patients with pancreatitis, and 7 (3.2%) of patients without either pancreatitis or choledocholithiasis. Stones migrated in 6 (3.0%) who had a normal cystic duct diameter (less than or equal to 4 mm) and in 46 (32.5%) with a duct over 4 mm diameter. Common bile duct stones were often larger than the diameter of the cystic duct and when reintroduced into the gall bladder would not migrate. The passage of debris (less than or equal to 1 mm) through the cystic duct bore no relation to the presence or absence of choledocholithiasis or a dilated cystic duct. Small stones (1-4 mm diameter) must migrate to initiate and facilitate further migration; some must increase in size in the common bile duct. Increased biliary pressure consequently dilates the duct system retrogradely, allowing larger stones to follow. Patients at risk of stone migration and thereby pancreatitis and jaundice have large ducts that can be detected by ultrasound assessment.
Topics: Cholecystectomy; Cholelithiasis; Common Bile Duct; Cystic Duct; Gallstones; Humans; Pancreatitis; Pressure; Prospective Studies
PubMed: 3109635
DOI: 10.1136/bmj.294.6583.1320 -
Journal of Epidemiology 2014A report of multiple cases of bile duct cancer at a Japanese printing company raised concern about such cancers. We examined long-term trends in bile duct cancer in...
BACKGROUND
A report of multiple cases of bile duct cancer at a Japanese printing company raised concern about such cancers. We examined long-term trends in bile duct cancer in Japan.
METHODS
Data from 4 population-based cancer registries were used to calculate incidence between 1985 and 2007, and vital statistics were used to estimate mortality between 1985 and 2011. Age-standardized rates were calculated and analyzed using a joinpoint regression model.
RESULTS
Among men, the incidence rate of intrahepatic bile duct cancer increased throughout the observation period; among women, it increased until 1996-1998 and remained stable thereafter. The incidence rate of extrahepatic bile duct cancer was stable in men and decreased from 1993-1995 in women. In people aged 30 to 49 years, the incidence rates of intra- and extrahepatic bile duct cancer remained stable or decreased. The mortality rate of intrahepatic bile duct cancer increased in both sexes and in all age groups since 1996, while that of extrahepatic bile duct cancer decreased since 1992. In people aged 30 to 49 years, the mortality rates of intra- and extrahepatic bile duct cancer remained stable and decreased, respectively.
CONCLUSIONS
The incidence and mortality rates of intrahepatic bile duct cancer remained stable or increased throughout the observation period. The incidence rate of extrahepatic bile duct cancer remained stable or decreased, and the mortality rate decreased since 1992. In people aged 30 to 49 years, the incidence and mortality rates of intra- and extrahepatic bile cancer remained stable or decreased.
Topics: Adolescent; Adult; Age Distribution; Aged; Aged, 80 and over; Bile Duct Neoplasms; Bile Ducts, Extrahepatic; Bile Ducts, Intrahepatic; Child; Child, Preschool; Female; Humans; Incidence; Infant; Infant, Newborn; Japan; Longitudinal Studies; Male; Middle Aged; Mortality; Registries; Sex Distribution; Young Adult
PubMed: 24614916
DOI: 10.2188/jea.je20130122 -
Internal Medicine (Tokyo, Japan) Jan 2019
PubMed: 30146604
DOI: 10.2169/internalmedicine.1490-18 -
Endoscopic Ultrasound 2016Pancreas divisum (PD) is the most common developmental anatomic variant of pancreatic duct. Endoscopic ultrasound (EUS) is often performed to evaluate idiopathic...
Pancreas divisum (PD) is the most common developmental anatomic variant of pancreatic duct. Endoscopic ultrasound (EUS) is often performed to evaluate idiopathic pancreatitis and has been shown to have high accuracy in diagnosis of PD. The different techniques to identify PD by linear EUS have been described differently by different authors. If EUS is done with a proper technique it can be a valuable tool in the diagnosis of PD. The anatomical and technical background of different signs has not been described so far. This article summarizes the different techniques of imaging of pancreatic duct in a suspected case of PD and gives a technical explanation of various signs. The common signs seen during evaluation of pancreatic duct in PD are stack sign of linear EUS, crossed duct sign on linear EUS, the dominant duct and ventral dorsal duct (VD) transition. Few other signs are described which include duct above duct, short ventral duct /absent ventral duct, separate opening of ducts with no communication, separate opening of ducts with filamentous communication, stacking of duct of Santorini and indirect signs like santorinecele. The principles of the sign have been explained on an anatomical basis and the techniques and the principles described in the review will be helpful in technical evaluation of PD during EUS.
PubMed: 26879163
DOI: 10.4103/2303-9027.175878 -
International Journal of Medical... 2016To explore the prevalence of lacrimal duct obstruction in patients with infectious keratitis, and the necessity of lacrimal duct dredge in the treatment of human...
To explore the prevalence of lacrimal duct obstruction in patients with infectious keratitis, and the necessity of lacrimal duct dredge in the treatment of human infectious keratitis. The design is prospective, non-control case series. Thirty-one eyes from twenty-eight continuous patients with infectious keratitis were included in this study. The presence/absence of lacrimal duct obstruction was determined by the lacrimal duct irrigation test. The diagnosis of infectious keratitis was made based on clinical manifestations, cornea scraping microscopic examination and bacterial/fungus culture. Diagnosis of viral keratitis was set up based on the recurrent history, deep neovascularization and typical outlook of the cornea scar. The treatment of keratitis included drugs, eye drops or surgery, while treatment of chronic dacryocystitis was lacrimal duct dredging with supporting tube implantation surgery. In the thirty-one eyes with infectious keratitis, fifteen suffered from fungal keratitis (48%), two bacterial keratitis (6%), and fourteen viral keratitis (45%). Eleven eyes (35%) from ten patients with infectious keratitis also suffered from lacrimal duct obstruction. In those cases, six eyes also suffered from lower canalicular obstruction, three nasolacrimal duct obstruction and chronic dacryocystitis, one a combination of upper and lower canalicular obstruction, one upper canalicular obstruction. After local and systemic applications of anti-bacterial, anti-viral, anti-fungal and anti-inflammatory drugs, twenty-eight eyes (90%) recovered within three weeks, while the ulceration of three patients required the lacrimal duct dredging and supporting tube implantation surgery for the healing. Herein, we first report that the prevalence of infectious keratitis is closely correlated to the occurrence of lacrimal duct obstruction. When both confirmed, simultaneous treatment of keratitis and lacrimal duct obstruction promptly is required. Further evaluation of mechanism, prevention and control of the diseases are warranted.
Topics: Adult; Aged; Aged, 80 and over; Animals; China; Dacryocystitis; Endoscopy; Eye Infections, Fungal; Female; Humans; Keratoconjunctivitis, Infectious; Lacrimal Apparatus; Lacrimal Duct Obstruction; Male; Middle Aged; Prevalence; Prospective Studies; Young Adult
PubMed: 27766030
DOI: 10.7150/ijms.16515 -
Arquivos Brasileiros de Oftalmologia 2021Concomitant nasolacrimal duct obstruction can occur in cataract carriers, which increases the risk of postoperative endophthalmitis. The primary aim of this study is to...
PURPOSE
Concomitant nasolacrimal duct obstruction can occur in cataract carriers, which increases the risk of postoperative endophthalmitis. The primary aim of this study is to evaluate the knowledge of Brazilian cataract surgeons on the diagnosis and management of cataracts associated with nasolacrimal duct obstruction.
METHODS
This survey was based on a questionnaire involving Brazilian cataract surgeons that was conducted from March to April 2018. Data were collected on the participant's profile, time and experience in ophthalmic practice, previous training in diagnosis and management of nasolacrimal duct obstruction, and background with endophthalmitis after cataract surgery in patients with nasolacrimal duct obstruction. All data were entered into an Excel spreadsheet and analyzed according to the frequency of occurrence.
RESULTS
Ninety-one ophthalmologists answered the questionnaire. Most (63.7%) had been performing cataract surgery for >10 years, and most (84.6%) received training to diagnose and handle nasolacrimal duct obstruction during their medical residence training. Nasolacrimal duct obstruction was investigated in the preoperative period of the cataract by lacrimal sac expression test (53.8%) or by irrigation of the tear pathways (23.1%). Nasolacrimal duct obstruction was treated with antibiotic eye drops by 47.2% of respondents. Seventy-eight percent of surgeons indicate usually performing lacrimal surgery prior to the intraocular surgery, waiting for 4 to 6 weeks to proceed with the cataract surgery. The procedure of choice for treating nasolacrimal duct obstruction prior to cataract surgery was dacryocystorhinostomy (88.4%). Most participants recognized the need for a protocol to assist in the detection and management of nasolacrimal duct obstruction in cataract carriers.
CONCLUSION
Improvement in the diagnosis and management of nasolacrimal duct obstruction concomitant to cataract is needed, as this is a risk factor for endophthalmitis.
Topics: Cataract; Dacryocystorhinostomy; Humans; Lacrimal Duct Obstruction; Nasolacrimal Duct; Preoperative Period
PubMed: 33567033
DOI: 10.5935/0004-2749.20210044 -
BMC Gastroenterology Aug 2019Endoscopic transpapillary cannulation of the gallbladder is useful but challenging. This study aimed to investigate cystic duct anatomy patterns, which may guide cystic...
BACKGROUND
Endoscopic transpapillary cannulation of the gallbladder is useful but challenging. This study aimed to investigate cystic duct anatomy patterns, which may guide cystic duct cannulation.
METHODS
A total of 226 patients who underwent endoscopic transpapillary cannulation of the gallbladder were analyzed retrospectively.
RESULTS
According to the cystic duct take-off, 226 cystic duct patterns were divided into 3 patterns: Type I (193, 85.4%), located on the right and angled up; Type II (7, 3.1%), located on the right and angled down; and Type III (26, 11.5%), located on the left and angled up. Type I was further divided into three subtypes: Line type, S type (S1, not surrounding the common bile duct; S2, surrounding the common bile duct), and α type (α1, forward α; α2, reverse α). Types I and III cystic ducts were easier to be cannulated with a higher success rate (85.1 and 86.4%, respectively) compared with Type II cystic duct (75%) despite no statistically significant difference. The reasons for the failure of gallbladder cannulation included invisible cyst duct take-off, severe cyst duct stenosis, impacted stones in cyst duct or neck of the gallbladder, sharply angled cyst duct, and markedly dilated cyst duct with the tortuous valves of Heister.
CONCLUSION
Classification of cystic duct patterns was helpful in guiding endoscopic transpapillary gallbladder cannulation.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Catheterization; Child; Cholangiopancreatography, Endoscopic Retrograde; Cholecystitis; Cholelithiasis; Cystic Duct; Female; Gallbladder; Humans; Male; Middle Aged; Retrospective Studies; Sphincterotomy, Endoscopic; Young Adult
PubMed: 31382888
DOI: 10.1186/s12876-019-1053-6