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Surgical Case Reports Apr 2023Microhepatocellular carcinoma with a gross bile duct tumor thrombus is extremely rare, making the correct preoperative diagnosis difficult.
BACKGROUND
Microhepatocellular carcinoma with a gross bile duct tumor thrombus is extremely rare, making the correct preoperative diagnosis difficult.
CASE PRESENTATION
A 78-year-old man was referred to our department for close examination of a liver tumor that was incidentally detected using ultrasonography. Blood tests revealed normal levels of tumor markers. Abdominal ultrasonography showed a 2-cm-sized hyperechoic mass with indistinct borders and hypoechoic margins at the origin of the right hepatic duct. Dynamic computed tomography showed a tumor with arterial phase predominance, a heterogeneous contrast effect, and prolonged enhancement. Cystic structures were observed in the tumors. In addition, localized dilatation of the caudate lobe bile duct was observed near the tumor. Cholangiography showed that the common bile duct, right and left hepatic ducts, and secondary branches did not have dilatation or stenosis. Biopsies of the bile duct revealed no malignancy. Under suspicion of intrahepatic intraductal papillary neoplasm of the bile duct, right hemi-hepatectomy was performed. The extrahepatic bile duct was preserved, because no tumor was found at the margin of the right hepatic duct during intraoperative frozen diagnosis. Macroscopically, the lesion was an 18 × 15 mm tumor occupying a dilated intrahepatic bile duct near the right hepatic duct, with a soft, fine papillary tumor. Based on morphology and immunostaining, tumor matched with moderately differentiated hepatocellular carcinoma. In addition, a 2 mm-sized hepatocellular carcinoma was observed in the liver parenchyma near the bile duct, where the tumor was located.
CONCLUSIONS
Based on these findings, the patient was diagnosed with small hepatocellular carcinoma with a gross bile duct tumor thrombus. The cystic part seen on the preoperative images was considered as a gap between the bile duct and the tumor thrombus. The patient recovered well with no signs of recurrence 20 months after surgery.
PubMed: 37121923
DOI: 10.1186/s40792-023-01646-3 -
Liver Transplantation : Official... Sep 2010Duct-to-duct reconstruction (DDR) of the bile duct has recently become the preferred choice in living donor liver transplantation (LDLT), but biliary complications still... (Comparative Study)
Comparative Study
Duct-to-duct reconstruction (DDR) of the bile duct has recently become the preferred choice in living donor liver transplantation (LDLT), but biliary complications still remain the most common cause of morbidity. We introduce our new technique of tailored telescopic reconstruction (TTR) of the bile duct for reducing bile duct complications in LDLT: the hilar plate covering the right and left hepatic ducts is bisected lengthwise through the right or left hepatic duct opening to make a funnel-shaped top, into which the donor hepatic duct is telescoped to match the recipient bile duct in size, and DDR is performed in the inner tissue of good vascular integrity of the recipient bile duct without redundancy. Forty-five consecutive LDLT procedures from January to August 2008 were analyzed through a comparison of 23 conventional duct-to-duct reconstructions (cDDRs) and 22 TTRs in bile duct anastomoses. At a mean follow-up of 19.5 months, the rates of overall biliary complications, leakage, and strictures were 43.5%, 26.1%, and 34.8%, respectively, for cDDR and 9.1%, 0%, and 9.1%, respectively, for TTR (P < 0.05 for each). In conclusion, TTR of the bile duct results in excellent outcomes with respect to minimization of biliary complications; thus, TTR can be recommended as a preferred method for biliary reconstruction in LDLT.
Topics: Adult; Aged; Anastomosis, Surgical; Biliary Tract Surgical Procedures; Cholangiopancreatography, Magnetic Resonance; Disease-Free Survival; Feasibility Studies; Female; Hepatectomy; Hepatic Duct, Common; Humans; Kaplan-Meier Estimate; Liver Transplantation; Living Donors; Male; Middle Aged; Postoperative Complications; Proportional Hazards Models; Republic of Korea; Retrospective Studies; Risk Assessment; Risk Factors; Suture Techniques; Time Factors; Treatment Outcome
PubMed: 20818745
DOI: 10.1002/lt.22116 -
World Journal of Radiology Sep 2012To evaluate cystic malformations of the cystic duct.
AIM
To evaluate cystic malformations of the cystic duct.
METHODS
Over a 2-year period, we came across 10 cases of cystic malformation of the cystic duct among patients who were investigated in our radiology department with ultrasonography, multidetector computed tomography, or magnetic resonance imaging for abdominal complaints. Radiological diagnosis of cystic malformation of the cystic duct was made on the basis of a dilated, nonvascular cystic structure near the porta hepatis, and visualization of a clear communication with either the gallbladder, normal caliber cystic duct and/or common bile duct (CBD) on at least one imaging modality.
RESULTS
Four of 10 patients had saccular dilatation of the cystic duct. Six patients had fusiform dilatation of the cystic duct, and two of these had only mild fusiform dilatation. Two patients had associated CBD dilatation and one had associated cystic duct calculi and malignancy.
CONCLUSION
Cystic malformations of the cystic duct should be recognized as a distinct type of choledochal cyst and should be added as type VI cyst in Todani's classification.
PubMed: 23024843
DOI: 10.4329/wjr.v4.i9.413 -
World Journal of Surgical Oncology Apr 2014Bile duct adenoma (BDA) is a comparatively rare disease clinically, therefore, there are relatively few reported cases about it both in China and abroad. (Review)
Review
BACKGROUND
Bile duct adenoma (BDA) is a comparatively rare disease clinically, therefore, there are relatively few reported cases about it both in China and abroad.
CASE PRESENTATION
Herein, we present a 51-year-old man, diagnosed preoperatively with enhanced-contrast abdominal computed tomography, as having a nodule in the left hepatic. The patient underwent a liver tumor resection, and the histological examination revealed bile duct adenoma (BDA).
CONCLUSIONS
BDA is an extremely rare benign tumor, which is difficult to distinguish BDA from hepatocellular carcinoma definitely preoperatively, surgical resection is needed as a way of treatment.
Topics: Adenoma, Bile Duct; Bile Duct Neoplasms; Diagnosis, Differential; Humans; Liver Neoplasms; Male; Middle Aged; Prognosis; Tomography, X-Ray Computed
PubMed: 24767257
DOI: 10.1186/1477-7819-12-125 -
Digestive Surgery 2014The German anatomist Hubert von Luschka gave name to several structures in the human body. One of great discussion is the duct of Luschka, part of the biliary system....
BACKGROUND
The German anatomist Hubert von Luschka gave name to several structures in the human body. One of great discussion is the duct of Luschka, part of the biliary system. There are different descriptions of the duct of Luschka. This might lead to confusion in the debate and as to what therapy should best be provided in case of an injured duct of Luschka.
METHODS
We reviewed the literature on descriptions of Luschka's duct and studied the original German descriptions by Hubert von Luschka.
RESULTS
While reading the original work by von Luschka on the hepatobiliary system, we were not able to find a description of either one of the two structures that are nowadays referred to as 'the duct of Luschka'.
CONCLUSIONS
von Luschka maybe never described the so-called duct of Luschka. He did, however, describe the peribiliary glands in the intra- and extrahepatic bile ducts and gallbladder wall. These might have been misinterpreted as a duct running along the gallbladder fossa. The lack of a clear definition is the reason for the development of rather confusing and sometimes misleading eponyms as the duct of Luschka. The eponym 'duct of Luschka' should, therefore, better not be used.
Topics: Anatomy; Bile Ducts; Eponyms; Germany; History, 19th Century
PubMed: 24776787
DOI: 10.1159/000362095 -
Modern Pathology : An Official Journal... Aug 2014On the basis of morphological features, we subclassified 189 intrahepatic cholangiocarcinomas into two subtypes: bile duct and cholangiolar. The cholangiolar type is... (Comparative Study)
Comparative Study
On the basis of morphological features, we subclassified 189 intrahepatic cholangiocarcinomas into two subtypes: bile duct and cholangiolar. The cholangiolar type is composed of cuboidal to low columnar tumor cells that contain scanty cytoplasm. The bile duct type is composed of tall columnar tumor cells arranged in a large glandular pattern. In this study, 77 (41%) tumors were classified as the cholangiolar type and 112 (59%) tumors were classified as the bile duct type. The cholangiolar-type intrahepatic cholangiocarcinoma was more frequently associated with viral hepatitis, whereas all but one intrahepatic cholangiocarcinoma associated with intrahepatic lithiasis were classified as the bile duct type. Biliary intraepithelial neoplasm or intraductal papillary neoplasm of the bile duct could be identified in 50 bile duct-type intrahepatic cholangiocarcinomas (45%), but in only 3 cholangiolar-type intrahepatic cholangiocarcinomas (4%). Cholangiolar-type intrahepatic cholangiocarcinomas frequently expressed N-cadherin, whereas bile duct intrahepatic cholangiocarcinomas were more likely to express S100P, Trefoil factor 1, and anterior gradient 2. KRAS is mutated in 23 of 98 (23%) bile duct-type intrahepatic cholangiocarcinomas and in only 1 of 76 (1%) cholangiolar-type intrahepatic cholangiocarcinomas. Cholangiolar-type intrahepatic cholangiocarcinomas had a higher frequency of IDH1 or 2 mutations than did the bile duct-type intrahepatic cholangiocarcinomas. The molecular features of the bile duct-type intrahepatic cholangiocarcinoma were similar to those of hilar cholangiocarcinoma. Patients with the cholangiolar-type intrahepatic cholangiocarcinoma had higher 5-year survival rates than those of patients with the bile duct-type intrahepatic cholangiocarcinoma. Our results indicated that intrahepatic cholangiocarcinoma was a heterogeneous tumor. Subclassification of intrahepatic cholangiocarcinomas based on cholangiocytic differentiation divides them into two groups with different etiologies, clinical manifestations, and molecular pathogeneses.
Topics: Aged; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Biomarkers, Tumor; Cholangiocarcinoma; Cholelithiasis; Female; Genetic Predisposition to Disease; Hepatitis, Viral, Human; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Mutation; Phenotype; Proportional Hazards Models; Risk Factors; Terminology as Topic; Time Factors; Treatment Outcome
PubMed: 24406866
DOI: 10.1038/modpathol.2013.241 -
Annals of Surgery Jul 1986A consecutive series of 614 operative cholangiograms was studied prospectively to determine the relationship of pancreatic-duct reflux to a previous history of acute...
A consecutive series of 614 operative cholangiograms was studied prospectively to determine the relationship of pancreatic-duct reflux to a previous history of acute gallstone pancreatitis. Of 53 patients who had previously had pancreatitis, 33 had pancreatic-duct reflux on their cholangiogram (62.3%), whereas, of 561 patients with no history of pancreatic disease, pancreatic-duct reflux was seen in only 82 (14.6%). In patients with a history of pancreatitis, reflux occurred into a wider pancreatic duct, at a greater angle between the bile and pancreatic ducts, and was associated with a longer functioning common channel. The wider cystic duct, wider common bile duct, and multiple small stones seen in patients with previous pancreatitis and pancreatic-duct reflux were suggestive of gallstone migration being associated with reflux. There was no correlation between pancreatic-duct reflux and the presence of choledochal calculi. Two patients developed recurrent severe pancreatitis after pancreatic-duct reflux of infected bile. Patients with gallstone pancreatitis appear to have an increased tendency for pancreatic-duct reflux that is mechanically facilitated by differences in the choledocho-pancreatic duct anatomy.
Topics: Acute Disease; Bile Duct Diseases; Cholangiography; Cholelithiasis; Female; Humans; Male; Middle Aged; Pancreatic Diseases; Pancreatic Ducts; Pancreatitis
PubMed: 3729584
DOI: 10.1097/00000658-198607000-00008 -
Caspian Journal of Internal Medicine 2020Persistent thyroglossal duct leads to a fibrous cyst formation named thyroglossal cyst which is the most common form of congenital cyst and usually located in the...
BACKGROUND
Persistent thyroglossal duct leads to a fibrous cyst formation named thyroglossal cyst which is the most common form of congenital cyst and usually located in the midline neck below the hyoid bone. Rarely the thyroglossal cyst is associated with thyroid cancer. Although the Sistrunk procedure is often considered adequate, currently there is no clear consensus on the optimal management of thyroglossal duct cyst especially duct cyst carcinoma. In addition, there is no consensus about concurrent thyroidectomy in patients with thyroglossal cyst duct carcinoma.
CASE PRESENTATION
In this article, we present four patients with thyroglossal duct cyst and papillary thyroid cancer. Papillary thyroid cancer was located into the thyroglossal duct cyst (thyroglossal duct carcinoma) in two patients and two patients had thyroglossal duct cyst with thyroid carcinoma in thyroid tissue. Cervical lymph nodes were involved in one of the three patients. Sistrunk procedure and total thyroidectomy were performed for all. The thyroid lobes were not involved in patients with thyroid duct cyst carcinoma. Tumor or thyroglossal duct cyst recurrence did not occur in any of the patients in follow-up.
CONCLUSION
The correlation between thyroglossal cyst and papillary thyroid carcinoma is high. In subjects with thyroglossal duct cyst, in addition to cyst assessment, thyroid gland and neck lymph nodes should be evaluated for malignancy.
PubMed: 32042395
DOI: 10.22088/cjim.11.1.110 -
The Tokai Journal of Experimental and... Sep 2016The case of a patient with asymptomatic double common bile duct that was identified by chance is presented. A 41-year-old man underwent esophagogastroduodenoscopy(EGD)... (Review)
Review
The case of a patient with asymptomatic double common bile duct that was identified by chance is presented. A 41-year-old man underwent esophagogastroduodenoscopy(EGD) as part of a regular health checkup, during which he was found to have an elevated lesion in the lesser curvature of the upper gastric corpus with bile draining from its tip. Further examination led to a diagnosis of double common bile duct from the left intrahepatic bile duct to the opening into the stomach. Morphological abnormalities of the biliary tree are commonly encountered in everyday gastroenterological practice, but a double common bile duct with an ectopic opening into the stomach is comparatively rare. It is also associated with an increased risk of developing cancer of the stomach or bile duct, and as such is a biliary abnormality that must be treated with caution. This case is reported together with a discussion of the literature.
Topics: Adult; Bile Duct Neoplasms; Bile Ducts, Intrahepatic; Cholangiopancreatography, Magnetic Resonance; Common Bile Duct; Drainage; Endoscopy, Digestive System; Humans; Incidental Findings; Male; Risk; Stomach; Stomach Neoplasms; Tomography, X-Ray Computed
PubMed: 27628600
DOI: No ID Found -
BMC Pediatrics Nov 2022Duplication of the common bile duct (CBD) is extremely rare among the anatomical variations in the biliary tract system, which presents a septum within the CBD or an...
BACKGROUND
Duplication of the common bile duct (CBD) is extremely rare among the anatomical variations in the biliary tract system, which presents a septum within the CBD or an accessory CBD. In our study, we report a rare case of duplication of the common bile duct combined congenital biliary dilatation.we present a rare case of a septum in the dilated biliary tract.
CASE PRESENTATION
We reported a 5-year-old Asian girl who had history of repeated abdominal pain for 4 days and aggravated for 1 day. Magnetic resonance cholangiopancreatography (MRCP) examination revealed duplicated common bile duct (DCBD) malformation with congenital biliary dilatation and distal cholelithiasis. The patient underwent choledochal cyst resection and biliary tract reconstruction and abdominal cavity irrigation and drainage under general anesthesia. A septum was found within the common bile duct during the operation. The septum divided the extrahepatic bile duct into two parts connected to the left and right hepatic ducts respectively and the gallbladder is attached to the repeated right bile duct which was not previously reported in the literature.
CONCLUSIONS
We complement and adjust the classification of common bile duct duplication by reviewing the literature.
Topics: Female; Humans; Child, Preschool; Choledochal Cyst; Common Bile Duct; Biliary Tract; Biliary Tract Surgical Procedures; Bile Ducts, Extrahepatic
PubMed: 36348383
DOI: 10.1186/s12887-022-03708-1